Pseudocyst of the auricle

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| synonym = Auricular pseudocyst, endochondral pseudocyst, cystic chondromalacia, intracartilaginous auricular seroma cyst, and benign idiopathic cystic chondromalacia.

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Pseudocyst of the auricle, also known as auricular pseudocyst, endochondral pseudocyst, cystic chondromalacia, intracartilaginous auricular seroma cyst, and benign idiopathic cystic chondromalacia, is a cutaneous condition characterized by a fluctuant, tense, noninflammatory swelling on the upper half of the ear, known as the auricle or pinna.{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: Clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|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.

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.{{cite journal | last1=Beutler | first1=Bryce D. | last2=Cohen | first2=Philip R. | title=Pseudocyst of the auricle in patients with movement disorders: report of two patients with ataxia-associated auricular pseudocysts | journal=Dermatology Practical & Conceptual | publisher=Mattioli1885 | date=2015-10-31 | volume=5 | issue=4 | issn=2160-9381 | doi=10.5826/dpc.0504a15 | pages=59–64| pmid=26693094 }} Serous and serosanguinous fluid, however, might be present.{{cite journal | last1=Khan | first1=NazirA | last2=ul Islam | first2=Mudasir | last3=ur Rehman | first3=Ayaz | last4=Ahmad | first4=Shakeel | title=Pseudocyst of pinna and its treatment with surgical Deroofing: An experience at tertiary hospitals | journal=Journal of Surgical Technique and Case Report | publisher=CLOCKSS Archive | volume=5 | issue=2 | year=2013 | issn=2006-8808 | doi=10.4103/2006-8808.128728 | doi-access=free | page=72| pmid=24741423 | pmc=3977328 }} 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.{{cite journal | last1=Cohen | first1=P. R. | last2=Grossman | first2=M. E. | title=Pseudocyst of the Auricle: Case Report and World Literature Review | journal=Archives of Otolaryngology–Head & Neck Surgery | publisher=American Medical Association (AMA) | volume=116 | issue=10 | date=1990-10-01 | issn=0886-4470 | doi=10.1001/archotol.1990.01870100096021 | pages=1202–1204| pmid=2206508 }}{{cite journal | last1=Santos | first1=Vladimir B. | last2=Polisar | first2=Ira A. | last3=Ruffy | first3=Mauro L. | title=Bilateral Pseudocysts of the Auricle in a Female | journal=Annals of Otology, Rhinology & Laryngology | publisher=SAGE Publications | volume=83 | issue=1 | year=1974 | issn=0003-4894 | doi=10.1177/000348947408300103 | pages=9–11| pmid=4811583 }}

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.{{cite journal | last1=Abdel Tawab | first1=Hazem | last2=Tabook | first2=Salim | title=Incision and Drainage with Daily Irrigation for the Treatment of Auricular Pseudocyst | journal=International Archives of Otorhinolaryngology | publisher=Georg Thieme Verlag KG | volume=23 | issue=2 | date=2019-02-06 | issn=1809-9777 | doi=10.1055/s-0038-1676124 | pages=178–183| pmid=30956702 | pmc=6449161 }}

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.{{cite journal | last1=Ballan | first1=Anthony | last2=Zogheib | first2=Serge | last3=Hanna | first3=Cyril | last4=Daou | first4=Bechara | last5=Nasr | first5=Marwan | last6=Jabbour | first6=Samer | title=Auricular pseudocysts: a systematic review of the literature | journal=International Journal of Dermatology | publisher=Wiley | volume=61 | issue=1 | date=2021-08-04 | issn=0011-9059 | doi=10.1111/ijd.15816 | pages=109–117| pmid=34348416 }}

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.{{cite journal | last1=Ming | first1=Lim Chwee | last2=Hong | first2=Goh Yau | last3=Shuen | first3=Chao Siew | last4=Lim | first4=Lynne | title=Pseudocyst of the Auricle: A Histologic Perspective | journal=The Laryngoscope | publisher=Wiley | volume=114 | issue=7 | year=2004 | issn=0023-852X | doi=10.1097/00005537-200407000-00026 | pages=1281–1284}}{{cite journal | last1=Zhu | first1=L. | last2=Wang | first2=X. | title=Histological examination of the auricular cartilage and pseudocyst of the auricle | journal=The Journal of Laryngology and Otology | volume=106 | issue=2 | date=1992 | issn=0022-2151 | pmid=1556479 | pages=103–104| doi=10.1017/S002221510011881X }}

The differential diagnosis consists of subperichondrial hematoma owing to trauma, chondrodermatitis helicis, relapsing polychondritis, and cellulitis.{{cite journal | last1=Patel | first1=KrinaB | last2=Agrawal | first2=PriyaU | last3=Chauhan | first3=VasimF | last4=Nagani | first4=SavfeenaM | title=Pseudocyst of auricle—An uncommon condition and novel approach for management | journal=Indian Dermatology Online Journal | publisher=Medknow | volume=11 | issue=5 | year=2020 | pages=789–791 | issn=2229-5178 | doi=10.4103/idoj.idoj_532_19 | doi-access=free | pmid=33235847 | pmc=7678522 }}

Treatment

The literature reports a variety of therapies, such as simple aspiration, intralesional corticosteroid injection,{{cite journal | last=Juan | first=Kai-Hui | title=Pseudocyst of the Auricle: Steroid Therapy | journal=Auris Nasus Larynx | publisher=Elsevier BV | volume=21 | issue=1 | year=1994 | issn=0385-8146 | doi=10.1016/s0385-8146(12)80003-4 | pages=8–12}} and aspiration combined with reinforced pressure sutures{{cite journal | last1=Ophir | first1=Dov | last2=Marshak | first2=Gabriel | last3=a | first3=Kfar-Sab | title=Needle Aspiration and Pressure Sutures for Auricular Pseudocyst | journal=Plastic and Reconstructive Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=87 | issue=4 | year=1991 | issn=0032-1052 | doi=10.1097/00006534-199104000-00030 | pages=783–784| pmid=2008480 }} or a plaster of paris cast.{{cite journal | last1=Hegde | first1=Ramesh | last2=Bhargava | first2=Samir | last3=Bhargava | first3=K. B. | title=Pseudocyst of the auricle: a new method of treatment | journal=The Journal of Laryngology & Otology | volume=110 | issue=8 | date=1996 | issn=0022-2151 | doi=10.1017/S0022215100134917 | pages=767–769| pmid=8869613 }}

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.{{cite journal | last1=Harder | first1=Mary K. | last2=Zachary | first2=C. B. | title=Pseudocyst of the Ear: Surgical Treatment | journal=The Journal of Dermatologic Surgery and Oncology | volume=19 | issue=6 | date=1993 | issn=0148-0812 | doi=10.1111/j.1524-4725.1993.tb00394.x | pages=585–588| pmid=8509521 }} 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.{{cite journal | last1=Schulte | first1=Klaus W. | last2=Neumann | first2=Norbert J. | last3=Ruzicka | first3=Thomas | title=Surgical pearl: The close-fitting ear cover cast? a noninvasive treatment for pseudocyst of the ear | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=44 | issue=2 | year=2001 | issn=0190-9622 | doi=10.1067/mjd.2001.111616 | pages=285–287| pmid=11174388 }}

References

External links

[https://dermnetnz.org/topics/auricle-pseudocyst-pathology DermNet]
[https://www.visualdx.com/visualdx/diagnosis/pseudocyst+of+auricle?diagnosisId=52218&moduleId=101 VisualDx]

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Category:Epidermal nevi, neoplasms, and cysts