Yamasoba T, Tayama N, Kitamura K
Department of Otolaryngology, University of Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 1990 Dec;93(12):2028-37. doi: 10.3950/jibiinkoka.93.2028.
Auricular hematoma is not rare condition and its prognosis has been considered to be good in Japanese textbooks. Recurrence of the hematoma, however, frequently occurs by use of simple aspiration or incision, and a pressure dressing. In this paper, we report a case of ruptured othematoma and review the biliographies concerning the pathology and treatment of othematomas. A 37-year-old man sustained a fist blow to his left ear at the beginning of May, 1989. He was first seen with auricular hematoma on July 4, but refused a surgical treatment. The laceration of the skin overlying the hematoma occurred by once more fist blow on July 26, with the upper auricle divided into anterior and posterior parts. The auricular cartilage was broken into several pieces, some of which attached to the anterior side and the others to the posteriors side. Under general anesthesia, fibrin glue was applied to the dead space after irrigation, minimal debridement, and removal of the clots. Four horizontal mattress sutures were put through the entire pinna after the anterior skin was protected by fluffed gauze with antibiotic ointment and the posterior skin by buttons. The dressing was allowed to remain in place ten days and was then removed. Nine months after the operation the pinna appeared almost normal. In recent reports, the othematoma is considered to occur between the perichondrium and the cartilage, or within the cartilage. Various techniques have been applied to treat the othematoma, which are classified into three types: incision and drainage, pressure dressing with splinting mold, or with mattress suture. Treatment of choice is discussed, with reviewing the advantages and disadvantages of each method.
耳廓血肿并非罕见病症，在日本的教科书中其预后被认为良好。然而，通过单纯抽吸、切开及加压包扎，血肿复发的情况却屡见不鲜。在本文中，我们报告一例破裂性耳血肿病例，并回顾有关耳血肿病理及治疗的文献。一名37岁男性于1989年5月初左耳遭拳击。他于7月4日首次因耳廓血肿就诊，但拒绝手术治疗。7月26日，血肿上方皮肤因再次遭拳击而撕裂，耳廓上部被分为前后两部分。耳廓软骨破碎成数块，部分附着于前侧，部分附着于后侧。在全身麻醉下，冲洗、进行最小限度清创并清除血凝块后，在死腔内涂抹纤维蛋白胶。在前侧皮肤用涂有抗生素软膏的蓬松纱布保护、后侧皮肤用纽扣保护后，穿过整个耳廓放置了4根水平褥式缝线。敷料留置10天后拆除。术后9个月，耳廓外观几乎正常。在最近的报告中，耳血肿被认为发生在软骨膜与软骨之间，或软骨内。已应用多种技术治疗耳血肿，这些技术分为三类：切开引流、用夹板模具加压包扎或用褥式缝线。在回顾每种方法的优缺点时，对治疗方法的选择进行了讨论。
