Pseudocyst of the auricle: steroid therapy

Auricular pseudocysts: a systematic review of the literature

BACKGROUND

Auricular pseudocysts are benign fluid accumulations of the ear of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing auricular pseudocysts have been published to date.

OBJECTIVES

The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of auricular pseudocysts.

METHODS

On May 28, 2020, a systematic search of Medline, Embase, and Cochrane databases was conducted. All the studies describing treatment of auricular pseudocysts, procedure description, outcome, and follow-up period were included in this review.

RESULTS

After full-text article review, 74 articles were included, representing a total of 1,011 lesions. The commonly used treatments for auricular pseudocysts were deroofing (493 lesions), aspiration (284 lesions), incision and drainage (171 lesions), intralesional steroids (53 lesions), and observation (10 lesions). The highest cure rate was found with the deroofing procedure (97.2%) followed by incision and drainage (95.9%). The mean follow-up period was 6.7 months.

CONCLUSION

Surgical procedures (anterior deroofing or incision and drainage) showed the highest cure rates and should be considered as first-line treatment for auricular pseudocysts. Future adequately designed randomized controlled trials are warranted to compare the efficacy of the techniques described.

Case Series and Systematic Review of Treatment Outcomes for Auricular Pseudocysts

OBJECTIVE

Auricular pseudocyst (AP: intracartilaginous cyst, endochondral AP, cystic chondromalacia, and benign idiopathic cystic chondromalacia) is a benign condition of unknown etiology. This report systematically reviews the published demographics, treatment protocols, and outcomes of AP between the various medical disciplines, and compares the findings to a theretofore-unreported 12-patient cohort. Primary outcome measure was AP complete resolution without recurrence.

DATA SOURCE

A systematic literature search of "MEDLINE" via "PubMed" and "Google Scholar" was performed in June, 2020. The 12 new patients were enrolled between January 2016 and December 2020.

STUDY SELECTION

Seventy-four papers met the study inclusion criteria and provided data on sex distribution, surgical approach and outcome, performance of approaches according to medical specialty, and recurrence rates of the reported AP populations.

DATA EXTRACTION

The appropriateness and study design quality were independently assessed by two reviewers.

DATA SYNTHESIS

The primary outcome was therapeutic success. A comparative analysis was also performed on the same extracted information that was retrieved from the medical files of the 12 new patients (10 men, 2 women, average age 24 yrs, range, 17-38).

CONCLUSIONS

AP is not uncommon. In line with the published literature, incision and curettage with excision of the anterior pseudocystic wall (deroofing) resulted in a recurrence rate of less than 17% with good cosmetic outcome among all 12 patients. Aspiration alone was associated with increased recurrence rates. Deroofing emerged as the preferred modality, with good cosmetic outcome and reduced recurrence rate. It was usually performed by otolaryngologists, while dermatologists used more conservative approach more frequently. Incision and drainage combined with compression reduces risk of recurrence.

Treatment of Auricular Pseudocyst with Intralesional Steroid: A Study with Short-Term Follow-Up

Introduction

A pseudocyst is an uncommon, painless, benign cystic swelling on the lateral surface of the auricle with an unknown etiology. Various treatment modalities have been used with varying rates of success as this condition has high propensity for recurrence. We have used a minimally invasive treatment method for this condition to evaluate its efficacy in our setup.

Patients and Methods

This is a prospective study carried out in the department of ENT of Chitwan Medical College from May 2018 to April 2020. Complete aspiration of the pseudocyst with intralesional steroid (40 mg, triamcinolone acetonide) injection was done in 30 patients. They were followed up weekly for 4 weeks. Additional doses were injected in cases with persistence or recurrenqce before 3 weeks. Disappearance of the swelling, considered treatment success, was the main outcome. The total number of doses required for the complete resolution of the swelling along with the number of recurrences or complications, if any, were noted at the final follow-up at 4 weeks.

Results

All of our patients responded completely with intralesional triamcinolone. However, the total dose requirement for different patients varied. Out of the 30 patients, 21 (70%) responded to the single dose of the drug. Six (20%) required a second dose, while the remaining 3 (10%) patients required a third dose for complete resolution of the swelling. All three (10%) patients who received a third dose of triamcinolone complained of skin thickening, but there was no obvious cosmetic deformity.

Conclusion

Aspiration with intralesional steroid injection shows an immediate positive response in patients with auricular pseudocyst. It can achieve complete resolution of the swelling without any serious complications. Thus, it appears to be a simple and effective management of the condition in the short term.

Incision and Drainage with Daily Irrigation for the Treatment of Auricular Pseudocyst

Introduction  Pseudocyst of the pinna is a rare condition that occurs when fluid accumulates in the intercartilagenous space of the auricle. The main goal when treating this condition is to keep acceptable cosmetic results with no recurrence rate.

Objective  To demonstrate the superior impact of incision and drainage of auricular pseudocysts with the insertion of a catheter drain and daily irrigation as the treatment of this condition.

Methods  A total of 42 patients with auricular pseudocysts were enrolled in the present study in the period between May 2011 and May 2017. All of the patients were treated with incision and drainage with compression. The average follow-up time reached ∼ 6 months in all of the cases.

Results  All of the patients had satisfactory cosmetic results with no recurrence and no complications.

Conclusion  Among the different methods of surgical treatment of pseudocyst of the pinna, incision and drainage with daily irrigation is a significantly efficient method both for the eradication of auricular pseudocysts and for good cosmetic results.

Transwindow Suture Technique for Pseudocyst of Pinna

Pseudocyst or seroma of the pinna is the accumulation of serous fluid between the perichondrium and cartilage of pinna. Though there are several surgical techniques in the treatment of seroma, recurrence is common. The aim and objective of this preliminary study is to present and discuss a novel technique of treating pseudocyst of pinna which is practiced at Karwar Institute of Medical sciences. A prospective study was done with a novel procedure "Transwindow suture technique" for the treatment of pseudocyst of pinna in four patients. Three of the four patients had a very good results without any recurrence. One patient had a small quantity of recollection due to premature closure of the skin window which was successfully corrected. In this preliminary study we had encouraging results in the treatment of pseudocyst of pinna. A large scale prospective study would demonstrate the effectiveness of this procedure.

Cruciate incision for treatment of primary/recurrent cases of seroma/hematoma of pinna : a novel approach

INTRODUCTION

Seroma of pinna have a high predisposition for recurrence. Its surgical management requires excision of cartilage and perichondrium which can cause scarring, deformity of pinna, perichondritis and abscess formation, postoperatively.The aim of the current study is to the access the outcome of a novel approach using cruciate incision for surgical treatment of seroma/ hematoma of pinna.

MATERIALS AND METHODS

Study was conducted at Father Muller Medical College in the Department of Otorhinolaryngology for a period of three months between January 2014 to March 2014 during which period 30 patients with seroma of the pinna were taken up for the study. Procedure was done under local anaesthesia with all aseptic precautions. A cruciate incision was given over the most dependent part of the swelling and flaps were raised. The collection was drained and the under surface of the flap was scraped using Rosen's knife followed by pressure dressing for three days. Patients were followed up for three months.

RESULTS

A total of 30 patients with seroma were studied. Out of the 30 cases 24 were primary cases and 6 were recurrent cases. Majority of the patients were in the age group 41-50 y. Out of 30 patients 18 were males and 12 were females. Out of 30 patients studied, none of them had recurrence. Four patients however developed perichondrial reaction with pain and inflammation which required analgesics and antibiotics. In 6 cases a thickening of the auricle at the site of incision was noticed which resolved over a period of 4 to 5 months. Overall cosmetic deformity was negligible with most of the patients showing a negligible scar after 6 months of follow up.

CONCLUSION

Cruciate incision is a good technique for treatment of seroma and hematoma of pinna as the outcome is good with no recurrence.

Treatment of recurrent auricle pseudocyst with intralesional injection of minocycline: a report of two cases

Pseudocyst of the auricle (PCA) is characterized by asymptomatic and fluctuant swelling of the external ear and frequent relapses despite various therapeutic approaches. We describe two patients with recurrent PCA who were successfully treated with intralesional injection of 1 mg/mL of minocycline hydrochloride (minocycline), 2 or 3 times at 2-week intervals. Intralesional injection of minocycline may be a new therapeutic choice for conservative management of PCA, especially in recurrent cases. The mechanisms of minocycline action that may have led to reduction of the cystic lesions are discussed.

Auricular pseudocysts: a treatment with the Chulalongkorn University vacuum device

Auricular pseudocysts are rare lesions that present as an asymptomatic cystic swelling of the anterior surface of the auricle, particularly the antihelix. Typically, the pseudocysts contain viscous straw-yellow fluid similar in appearance to olive oil; however, a clear pale yellow serous transudate may also be encountered. Various therapeutic approaches have been used with variable success. We describe a simple small vacuum device called the Chulalongkorn University vacuum device, which was developed in our center. The device can be easily made anywhere by any surgeon. We report the outcome in 17 patients treated by means of needle aspiration plus application of the Chulalongkorn University vacuum device for 5 days. A complete resolution of the lesion was obtained in 15 (88.2%) patients. Because the procedure is safe and effective and does not require an operating room setting, it may be accepted as an option in the treatment of auricular pseudocysts.

Pseudocyst of the auricle-a new method of treatment

Pseudocyst of the auricle is a rare condition and is hardly encountered in routine ENT practice. There have been only about 200 of these cases reported in world literature. The etiology remains obscure and the treatment modalities uncertain. The authors present their series of 15 cases and review the available literature on this condition. A new and completely successful method of treatment is also presented.