Auricular hematoma: Let’s break down the words. Auricular is an adjective referring to the ear. “Hema” is a prefix referring to blood. “Toma” means swelling, and is the root for our word tumor.
Junior's auricular hematoma before surgery
Auricular hematoma occurs when blood collects between the skin layers and cartilage of the flap of the ear, known as the pinna. Blood can be released when the ear is traumatized, such as an ear that’s itchy from infection, parasites or allergy. The patient scratches at the ears, or shakes his head in an effort to relieve the itchiness and the resulting pounding breaks a blood vessel inside the pinna.
Sometimes dogs and cats in automobile accidents suffer blows to the head, leading to hematoma of the ear.
There are a number of ways to repair auricular hematomas, mostly surgical. A non-surgical treatment has been described that involves high doses of corticosteroids, some administered into the hematoma and some oral. I have tried it a few times in cases where budgetary limitations excluded surgery, but have had little success.
A decade or so I published a variation of the traditional surgical repair that has given me impressive results while also reducing anesthesia and surgery time for most patients.
My modification of traditional technique is to first “support” the area that has not yet begun to swell by using surgical staples to stapling the “inside” (least-haired) layer of skin to the cartilage underneath. The amount of surgical time saved is dramatic, because the next step in closure of the hematoma is extremely tedious and time-consuming.
Side view of Junior's hematoma showing how thick the swelling is
Now we drain the blood from the hematoma. Pet owners frequently ask why this step alone is not sufficient. The reason goes back to why the hematoma first developed. With the skin separated from the cartilage by the pressure of the bleeding, a space was created. When the body has space in it, the body is going to fill that space with something. If we simply drain the hematoma with a needle and syringe, bleeding may continue, and/or fluid will collect in the space unless the space is surgically obliterated. Therefore, even if the blood is removed, more must be done.
Removing the blood requires an incision the length of the swelling, which allows clots and fibrin threads to be removed effectively. A thorough cleaning reduces post-operative scarring of the pinna.
Surgical closure can now begin. Slowly and methodically sutures are placed from the least-haired side of the ear, through the skin and cartilage and through the skin on the other side. Then the same suture is passed back through the pinna, about ½ inch from the initial placement, and a knot is tied. The procedure is repeated again and again until the entire hematoma space is closed.
Cartilage is a relatively inactive tissue, healing slowly, so sutures and staples are left in for three to four weeks to allow complete attachment.
Ears are a very sensitive part of the body, so we prefer to remove the sutures and staples under general anesthesia so as to minimize discomfort.
Outside of Junior's ear after auricular hematoma surgery
It is imperative that the underlying cause of the incident be discovered and appropriately treated. We have covered the principles and importance of proper ear cleaning and proper ear treatment .
Your pet’s doctor would prefer to prevent ear problems rather than treat them. Your dog and cat’s comfort and health are his primary concerns. Clean your pet’s ears weekly and after every bath. When medication is dispensed for an ear problem follow the veterinarian’s instructions exactly to prevent pain and complications, including prevention of auricular hematoma.
Junior's ear immediately after Dr. Randolph's technique of staples and sutures for Auricular Hematoma surgical repair
{ 4 comments… read them below or add one }
What is your post-operative care regimen for this type of surgery?
Care for an ear after aurcular hematoma surgery is pretty straightforward. If an infection has been diagnosed as the cause of the hematoma, treat the infection as directed. Most of these patients are also on systemic antibiotics, either orally or by use of Convenia long-acting antibiotic injection. Serum often “weeps” from the suture sites and can actually coat the pinna with a crust. Serum must not be allowed to accumulate, and hydrogen peroxide is usually adequate to remove it IF you keep up with daily cleaning. As stated in the Article, we prefer to remove sutures and staples under general anesthesia 3-4 weeks after surgery.
I have a 15 year old Corgi who had an auricular hematoma approximatly 3 months ago. Due to his age and congestive heart failure he was not a candidate for surgery. The ear was drained with a syringe sucessfully - until last week. The hematoma returned and was again drained (and injected with corticosteroids) only to return the next day, again drained, and now, 4 days later, the ear is larger than ever. Is there any other non-surgical route that could be an option for treatment of this? He will be returning to the veterinarian again tomorrow and is becomming increasingly uncomfortable.
As I mentioned in the Auricular Hematoma article, in my hands, the success rate of corticosteroid treatment for auricular hematoma is very low. However, there is a technique of applying continuous suction, similar to a chest tube, that can continuously drain the space between skin and cartilage. It is a slow process, but requires only light to moderate sedation to install and some maintenance on your part to keep it clean. The device can even be “homemade” with syringes and tubing if your pet’s doctor is clever. Keep us posted, Dr. Randolph.