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Hematoma
Last reviewed: 23.04.2024
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Otematoma is a limited accumulation of blood in the region of the auricle that occurs spontaneously (rarely) or as a result of a local contusion of the auricle.
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What causes the hematoma?
Spontaneous hematoma may arise from insignificant pressure on the auricle in leukemia, hemophilia, beriberi, trophic disorders, alimentary dystrophy, some infectious diseases accompanied by disorders of the blood coagulation system, and also as a result of degenerative cartilage changes under the influence of cold. The hematoma of traumatic genesis most often occurs with tangential impacts, or sharp pressure on the auricle, or with its fractures (deliberate blow, in sport - boxing, various types of martial arts, especially the so-called fight without rules).
Symptoms of hematoma
Localized hematoma more often in the upper part of the outer surface of the auricle. Externally is a fluctuating swelling of reddish-blue color, covered with normal skin. Symptoms of hematoma are usually absent, with palpation painless. The hematoma contains a fluid consisting of blood and lymph with a predominance of the latter, so the color of the contents of the hematoma is light yellow and the liquid itself does not coagulate. As a result of damage to the lymphatic and blood vessels, fluid accumulates between the skin and the perichondrium or between the latter and the cartilage. Capsules around the hematoma are not formed. There may be damage to the cartilage.
The cause of vascular damage is the mechanical separation of the skin from the subcutaneous tissue. Since on the medial surface of the auricle the connection of the skin with the perichondrium is more elastic than on the lateral surface, then the hematoma does not arise on it. Minor hematomas can resolve, but large, if untreated, within 3-5 weeks are organized into a dense scar tissue, as a result of which the auricle loses its relief and takes the form of a formless "cake". A feature of hematoma is its frequent recurrence, but the cause of damage to the lymphatic vessels and the predominant contents in the lymph fluid and the weakness of the muscular system of the vascular wall in this region (vasoconstrictors) and local disruption of blood coagulation.
The danger of hematoma is the possibility of its secondary infection. In this case, inflammation of the skin of the inflammatory nature occurs over the hematoma, spreading beyond its limits, pains in the region of the auricle, irradiating to neighboring areas, an increase in body temperature. Untimely opening of the abscess leads to perichondritis and necrosis of the cartilage, which results in deformation of the auricle.
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Treatment of hematoma
A small hematoma can be spontaneously resorbed by applying a pressure bandage, with the skin above the hematoma and around it lubricated with an alcohol solution of iodine. To increase the effectiveness of pressure, 2-3 gauze balls should be fixed with a sticky plaster over the swelling, and only then should a pressure bandage be applied. Apply also cold and after 2-3 days - massage. The use of heat is contraindicated.
With a large decoction with a prescription period of no more than 2-3 days, its contents can be removed under strictly sterile conditions by suction with a syringe and a thick needle, followed by the introduction of a few drops of alcoholic iodine solution into the cavity to accelerate the cohesion (scarring) of the cavity walls. After this, immediately apply a pressure bandage for 3 days or more. If it is necessary to change the bandage, the time interval between removal and application should be minimal.
When applying a pressure bandage under the auricle, a thick gauze roll of the appropriate size is put, and on the lateral surface on the area of the cavity - 2-3 gauze balls to increase pressure and impose a general bandage on the ear.
Large non-resorbed hematomas should be removed by dissection. To do this, make an arcuate incision at the edge of the swelling above or below it, remove the contents by dabbing and rubbing the cavity with sterile turundas, scrape the cavity of the pathological contents, wash with a sterile antiseptic solution. After this, either sutures are placed along the edges of the incision, leaving an unsealed part of the wound for subsequent drainage with rubber strips, or the wound is not sewn at all.
After this, apply a pressure bandage, which is changed every day. With a favorable course, the depth of drainage is reduced with each bandage, trying not to destroy the area of the current adhesive process. Healing occurs in 1-2 weeks. To remove the hematoma, a cut through the posterior surface of the urinary tract is also used: the part of the cartilage is removed, forming a small window (5x5 mm), emptying the hematoma, draining the cavity, and applying a pressure bandage. In all cases, local treatment of hematoma is supplemented by general treatment with antibiotics and sulfonamides.
How is hepatoma prevented?
The hematoma is prevented if the ear traumatism is prevented. Contusions and wounds of the auricle refer to infected injuries, and before providing the appropriate specialized care, they are carefully treated with antiseptic and hemostasis.
What is the prognosis of a hematoma?
A hematoma with respect to recovery has a favorable prognosis, but in the cosmetic plan it is cautious, especially with complication in the form of perichondritis; at chondritis - doubtful and even unfavorable.