Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

A pseudocyst of pinna is benign, painless, rare and asymptomatic swelling on the lateral or anterior surface of the pinna resulting from intracartilaginous accumulation of fluid. The condition auricular pseudocyst was first described by Engel (Arch Otolaryngol 83:197-202, 1966). Pseudocyst of in majority of cases presents as unilateral lesions, predominantly in 35-40 years mean age group and affecting predominantly males (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). Commonly these cysts shows no symptoms but occasionally, there may be presence of minor discomfort and mild inflammatory signs. The pseudocyst of pinna typically involves in its descending order of involvement as scaphoid fossa, triangular fossa of the antihelix, and the Cymba concha (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). Diagnosis of psuedocyst is based mainly on the clinical characteristics without evidence of infection (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). There are wide range of treatment modalities described in the literature for this condition ranging from medical line of management including minimally invasive Intralesional steroid therapy, intralesional sclerosant therapy, systemic steroid therapy to surgical line of management including aspiration and pressure dressing, quilting suture with corrugated rubber drain, incision and drainage with mastoid dressing, cartilage curettage with drainage tube, surgical de-roofing and cartilage window procedure. Although multiple treatment options are available for this condition,there is no gold standard option is found In literature as more invasiveness of procedure associated with more complications and less invasiveness is associated with more recurrence (Bhat et al. in J Clin Diagn Res 8:KC05-KC07, 2014). The main aim of treatment is preservation or restoration of normal Anatomy or architecture of the auricle without recurrence or complications in postoperative duration (Schulte et al. in J Am Acad Dermatol 44:285-286, 2001). In our study we are going to compare the surgical deroofing with buttoning technique with Posterior Cartilage window with Pressure Gauze dressing technique in patients with pseudocyst on the basis of recurrence and complications. To compare effectiveness in terms of recurrence and complications between surgical deroofing with buttoning technique and posterior cartilage window with Pressure Gauze dressing technique in patients with pseudocyst of pinna. Prospective observational study done for duration of one year from June 2021 till June 2022 at Ashwini Rural medical college and Hospital, Solapur. Study was done on 30 patients aged between 20 and 70 years with pseudocyst of who are diagnosed on the basis of clinical presentation and characteristics of the aspirated fluids with no signs of infection or inflammation. Among 30 patients with pseudocyst 15 patients were undergone surgical deroofing with buttoning technique and remaining 15 patients were undergone posterior cartilage window with Pressure Gauze dressing technique. The age distribution of patients with psuedocyst of pinna in our study ranged from 20 to 70 years with maximum number of cases (i.e. 16) in the age group of 30-40 years which comprised of about 53% of study population. Among 30 cases in our study 26 were males (86.7%). All cases were of unilateral pseudocyst with left ear involvement more than right ear i.e. 20 and 10 cases respectively which indicates predominantly affecting left ear (66.6%). In our study we observed the site of involvement of pinna by pseudocyst showing maximum number of cases involving combined scaphoid fossa and triangular fossa i.e. 15 cases (50%) and minimum number of cases involving Concha i.e. 2 cases (6.6%). In our study we found that the aspirated fluid from pseudocyst of pinna was sterile in all cases i.e. 30 cases (100%). In our study we observed that the aspirated fluid was serous in majority of cases i.e. 21 cases (70%) and serosanguinous in few of them i.e. 3 cases (10%). Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence of pseudocyst of pinna, 2 groups were not statistically significant. Success rate in our study for posterior cartilage window with Pressure Gauze dressing technique was 100% with no recurrence. Among patients who have undergone surgical deroofing with buttoning technique 2 cases have minor complications like pressure discoloration of skin i.e. 1 case and thickening of skin of pinna i.e. 1 case. All these complications are temporary one and show recovery in follow up duration. Among patients who have undergone Posterior cartilage window with Pressure Gauze dressing technique 1 case had perichondritis at 1 week follow up which was resolved spontaneously at the end of 2 weeks and 2 cases had painless thicknening of pinna which also resolved spontaneously at the end of 2 weeks. Pseudocyst of pinna occurs commonly in middle aged males as unilateral lesions with left ear involvement in majority of cases. The most common involvement of pinna by pseudocyst is combined scaphoid fossa and triangular fossa, the least common site is concha. Most of the pseudocyst of pinna contain sterile serous fluid. Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence 2 groups were not statistically significant. Both surgical treatment groups have few and temporary complications but in terms of complications 2 groups were not statistically significant.