Auricular Pseudocyst: Treating with buttons

Auricular pseudocysts are uncommon, noninflammatory, fluctuant swellings of the ear which are believed to be caused by accumulation of glycosaminoglycans and subsequent ischemic necrosis of the cartilage, or from repeated minor trauma to the ear.  They are often a therapeutic challenge.  Many treatment options are available, including simple aspiration, plaster of paris casts, injectable agents (steroids, trichloroacetic acid and minocycline), and lastly, surgical intervention incorporating incision, drainage and curettage.  Some clinicians apply sclerosing agents, such as fibrin glue, as part of their surgical intervention to eliminate the space.  The patient shown above was treated with aspiration of the fluid three times and the psuedocyst recurred within a few weeks each time.

In considering my treatment options I thought an alternative to surgery or sclerosing agents might be use of buttons sutured into place for 7 days to provide even compression against the pseudocyst, as shown on the drawing above.

I chose buttons with smooth edges and also utilized a button that fit nicely into her scaphoid fossa, as shown above.

After 7 days the buttons were removed and the pseudocyst responded nicely.  There was no recurrence.  I have performed this procedure in 2 other patients with auricular pseudocysts with similar results.  This has been report in Dermatology News, to view this article please click HERE.