Pseudocyst of the auricle

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Pseudocyst of the auricle
Other namesAuricular pseudocyst, endochondral pseudocyst, cystic chondromalacia, intracartilaginous auricular seroma cyst, and benign idiopathic cystic chondromalacia. [1]
Specialty Dermatology

Pseudocyst of the auricle, also known as auricular pseudocyst, endochondral pseudocyst, cystic chondromalacia, intracartilaginous auricular seroma cyst, and benign idiopathic cystic chondromalacia, [1] is a cutaneous condition characterized by a fluctuant, tense, noninflammatory swelling on the upper half of the ear, known as the auricle or pinna. [2] [3] : 681  Pseudocysts of the auricle are nontender, noninflammatory cystic lesions that progress over a 4- to 12-week period, ranging from 1 to 5 cm in diameter. They are usually unilateral, often on the right ear, but can also present bilaterally.

Contents

The auricle pseudodocyst can occur independently, but prior trauma is a significant factor in initiating tissue plane separation within cartilage, leading to fluid buildup in the affected area.

Diagnosis is often based on a patient's history, physical examination, and histopathologic analysis. Differential diagnoses include subperichondrial hematoma due to trauma, chondrodermatitis helicis, relapsing polychondritis, and cellulitis. Various therapies, including simple aspiration, corticosteroid injection, and reinforced pressure sutures, are available.

Signs and symptoms

A single lesion on the front part of the ear is usually the initial sign of pseudocyst of the auricle. Pseudocysts of the auricle appear as flesh-colored, nontender, noninflammatory cystic lesions and progress gradually over a 4- to 12-week period. Their diameters range from 1 to 5 cm. Usually, the lesions start off soft and get firmer with time. They are filled with a viscous substance that resembles olive oil and is often straw-yellow in hue. [4] Serous and serosanguinous fluid, however, might be present. [5] The most common appearance of pseudocyst of the auricle is unilateral, usually on the right ear, while reports of bilateral presentations have also been made. [6] [7]

Causes

Pseudocyst of the auricle can happen on its own, but the majority of authors concur that prior trauma is a key initiating factor for the separation of tissue planes inside the cartilage, which is followed by fluid buildup in that area. [8]

Diagnosis

A patient's history and physical examination are frequently used to make a diagnosis. Histopathologic analysis may occasionally be necessary for the confirmation of a diagnosis. [9]

Cyst-like lesions with a fibrous, cartilaginous, and granulation tissue lining devoid of epithelium, coupled with ahyalinizing degeneration of the surrounding cartilage, are typical histopathologic features. [10] [11]

The differential diagnosis consists of subperichondrial hematoma owing to trauma, chondrodermatitis helicis, relapsing polychondritis, and cellulitis. [1]

Treatment

The literature reports a variety of therapies, such as simple aspiration, intralesional corticosteroid injection, [12] and aspiration combined with reinforced pressure sutures [13] or a plaster of paris cast. [14]

More invasive methods such as opening the cavity, draining it, and then obliterating it with curettage, sclerosing agent, and pressure dressing; open deroofing, which entails removing the anterior cartilaginous leaflet of the pseudocyst and realigning the skin flap overlying it, have also been suggested. [15] On the other hand, the risk of perichondritis aggravated by the development of a cauliflower deformity or floppy ear is associated with invasive treatment techniques, and recurrences may occur afterward. [16]

See also

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References

  1. 1 2 3 Patel, KrinaB; Agrawal, PriyaU; Chauhan, VasimF; Nagani, SavfeenaM (2020). "Pseudocyst of auricle—An uncommon condition and novel approach for management". Indian Dermatology Online Journal. 11 (5). Medknow: 789–791. doi: 10.4103/idoj.idoj_532_19 . ISSN   2229-5178. PMC   7678522 . PMID   33235847.
  2. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  3. ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN   978-0-7216-2921-6.
  4. ↑ Beutler, Bryce D.; Cohen, Philip R. (2015-10-31). "Pseudocyst of the auricle in patients with movement disorders: report of two patients with ataxia-associated auricular pseudocysts". Dermatology Practical & Conceptual. 5 (4). Mattioli1885: 59–64. doi:10.5826/dpc.0504a15. ISSN   2160-9381. PMID   26693094.
  5. ↑ Khan, NazirA; ul Islam, Mudasir; ur Rehman, Ayaz; Ahmad, Shakeel (2013). "Pseudocyst of pinna and its treatment with surgical Deroofing: An experience at tertiary hospitals". Journal of Surgical Technique and Case Report. 5 (2). CLOCKSS Archive: 72. doi: 10.4103/2006-8808.128728 . ISSN   2006-8808. PMID   24741423.
  6. ↑ Cohen, P. R.; Grossman, M. E. (1990-10-01). "Pseudocyst of the Auricle: Case Report and World Literature Review". Archives of Otolaryngology — Head and Neck Surgery. 116 (10). American Medical Association (AMA): 1202–1204. doi:10.1001/archotol.1990.01870100096021. ISSN   0886-4470. PMID   2206508.
  7. ↑ Santos, Vladimir B.; Polisar, Ira A.; Ruffy, Mauro L. (1974). "Bilateral Pseudocysts of the Auricle in a Female". Annals of Otology, Rhinology & Laryngology. 83 (1). SAGE Publications: 9–11. doi:10.1177/000348947408300103. ISSN   0003-4894. PMID   4811583.
  8. ↑ Abdel Tawab, Hazem; Tabook, Salim (2019-02-06). "Incision and Drainage with Daily Irrigation for the Treatment of Auricular Pseudocyst". International Archives of Otorhinolaryngology. 23 (2). Georg Thieme Verlag KG: 178–183. doi:10.1055/s-0038-1676124. ISSN   1809-9777. PMID   30956702.
  9. ↑ Ballan, Anthony; Zogheib, Serge; Hanna, Cyril; Daou, Bechara; Nasr, Marwan; Jabbour, Samer (2021-08-04). "Auricular pseudocysts: a systematic review of the literature". International Journal of Dermatology. 61 (1). Wiley: 109–117. doi:10.1111/ijd.15816. ISSN   0011-9059. PMID   34348416.
  10. ↑ Ming, Lim Chwee; Hong, Goh Yau; Shuen, Chao Siew; Lim, Lynne (2004). "Pseudocyst of the Auricle: A Histologic Perspective". The Laryngoscope. 114 (7). Wiley: 1281–1284. doi:10.1097/00005537-200407000-00026. ISSN   0023-852X.
  11. ↑ Zhu, L.; Wang, X. (1992). "Histological examination of the auricular cartilage and pseudocyst of the auricle". The Journal of Laryngology and Otology. 106 (2): 103–104. doi:10.1017/S002221510011881X. ISSN   0022-2151. PMID   1556479.
  12. ↑ Juan, Kai-Hui (1994). "Pseudocyst of the Auricle: Steroid Therapy". Auris Nasus Larynx. 21 (1). Elsevier BV: 8–12. doi:10.1016/s0385-8146(12)80003-4. ISSN   0385-8146.
  13. ↑ Ophir, Dov; Marshak, Gabriel; a, Kfar-Sab (1991). "Needle Aspiration and Pressure Sutures for Auricular Pseudocyst". Plastic and Reconstructive Surgery. 87 (4). Ovid Technologies (Wolters Kluwer Health): 783–784. doi:10.1097/00006534-199104000-00030. ISSN   0032-1052. PMID   2008480.
  14. ↑ Hegde, Ramesh; Bhargava, Samir; Bhargava, K. B. (1996). "Pseudocyst of the auricle: a new method of treatment". The Journal of Laryngology & Otology. 110 (8): 767–769. doi:10.1017/S0022215100134917. ISSN   0022-2151. PMID   8869613.
  15. ↑ Harder, Mary K.; Zachary, C. B. (1993). "Pseudocyst of the Ear: Surgical Treatment". The Journal of Dermatologic Surgery and Oncology. 19 (6): 585–588. doi:10.1111/j.1524-4725.1993.tb00394.x. ISSN   0148-0812. PMID   8509521.
  16. ↑ Schulte, Klaus W.; Neumann, Norbert J.; Ruzicka, Thomas (2001). "Surgical pearl: The close-fitting ear cover cast? a noninvasive treatment for pseudocyst of the ear". Journal of the American Academy of Dermatology. 44 (2). Elsevier BV: 285–287. doi:10.1067/mjd.2001.111616. ISSN   0190-9622. PMID   11174388.

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