Clinical Analysis of 34 Patients with Relapsing Pseudocyst of Auricle Treating with Long Incision Cu.doc

1、1Clinical Analysis of 34 Patients with Relapsing Pseudocyst of Auricle Treating with Long Incision Cu（Linfen Vocational and Technical College Affiliated HospitaL, Shanxi, Linfen, 041000） Abstract. Objectives: make explorations on the treatment for the relapsing pseudocyst of auricle with Long incisi

2、on Curettage and observe the curative effect. Method: make a long incision along the ear marginal tissue and divide the skin and the subcutaneous tissue till the inner edge of cyst. Cut the cartilage-perichondrium and enter the cyst. Abstract the ovarian cyst fluid or the old blood clot. Shave the p

3、athological tissue and wash the cyst. Get hemostasis completely and get the incision stitched. Put the drainage strip to make wound compression. Make intravenous injection of antibiotics. 5 days after the operation, change the medicine and remove the suture in 7 to 10 days. The results: among 34 pat

4、ients, there are 31 patients who get cured and 3 cases are effective. Conclusion: the relapsing pseudocyst of auricle treating with Long incision curettage is a kind of effective 2treatment, which is safe and reliable. The treatment result is good and it would not recur and there is no sequel. Pseud

5、ocyst of the auricle is a cutaneous condition characterized by a fluctuant, tense, no inflammatory swelling on the upper half of the ear. The pseudocyst of the auricle is a rare and benign condition of the ear that is caused by intracartilaginous collection of serous fluid in the anterior aspect of

6、the article. The auricular pseudocyst of the auricle has a cavity that is not lined by epithelium. Pseudocyst of the auricle is a rare, asymptomatic intracartilaginous swelling of the auricle resulting from accumulation of yellow viscous fluid with unknown cause. Various methods of treatment such as

7、 aspiration, corticosteroid injections and surgical intervention have been advocated for this condition. We report two cases treated successfully with a combination of aspiration, pressure dressing and oral corticosteroid therapy. From September, 1995 to September, 2011, we have made the Relapsing P

8、seudocyst of Auricle Treating with Long Incision Curettage. 34 patients are observed and the treatment results are satisfied. The current report is shown as the followings: 1 Materials and Method 1.1 Ordinary materials 334 cases are all the patients in the hospital. Among them, there are 31 patients

9、 who are men and there are 3 cases who are women. Their ages rise from 21 to 69. The average ages are 38.3. There are 19 cases of the left ears and there are 15 cases that are of the right ears. The goals of treatment of pseudocyst of the auricle are preservation of anatomical architecture and preve

10、ntion of recurrence. Without treatment, permanent deformity of the auricle may occur. Treatment options include needle aspiration with pressure dressings, medication (either systemic or oral), and surgical care. Consensus on the best management for pseudocyst of the auricle is lacking, and a combina

11、tion of treatment modalities may be necessary to achieve optimal resolution. No medical treatment is uniformly effective for pseudocyst of the auricle. High-dose oral corticosteroids and intralesional corticosteroids therapies have been reported, with variable results. 1.2 Treatment method 34 cases

12、are all under the anesthesia. The aim of the study is to describe the histologic spectrum in the pseudocyst of the auricle and to identify any consistent histologic features of this condition. A prospective study was performed in which the tissue specimen from patients with pseudocyst of the auricle

13、 treated at the Department of Otolaryngology, Singapore General 4Hospital during a 1-year period was sent for histology. Consecutive patients with pseudocyst of the auricle who were treated had their tissue specimen sent for histology. These specimens were independently reviewed by one consultant pa

14、thologist. All specimens revealed an intracartilaginous cyst devoid of epithelial lining. Interestingly, there were consistent perivascular mononuclear infiltrates of lymphocytes evident in the connective tissue layer just superficial to the anterior segment of the cartilage. Pseudocyst of the auric

15、le is a benign condition predominantly affecting young Asian males. Histology characteristically reveals an intracartilaginous cyst devoid of epithelial lining, and there are no pathognomonic features. We postulate that an inflammatory response is crucial to the development of this condition on the

16、basis of a consistent perivascular inflammatory response seen in all our specimens. 5 days after the operation, change the medicine and remove the suture in 7 to 10 days. The results: among 34 patients, there are 31 patients who get cured and 3 cases are effective. 1.3 Treatment standards Pseudocyst

17、 of the Auricle is a tender red nodule that develops on the upper portion of the ear that I encounter in my 5The Woodlands dermatology and Conroe dermatology offices. It typically arises after trauma to the ear that may be as subtle as repeated rubbing or scratching of the ear. Inflammatory fluid de

18、velops between the cartilages separating it into two distinct layers, which create a cyst like cavity. Unlike “true“ cysts, pseudocyst of the Auricle does not have a sac lining that confines the cystic contents, thus the name “pseudocyst.“ The majority of all patients with pseudocyst of the Auricle

19、are young males between the ages of 20 and 40. Treatment involves aspirating the cystic fluid and applying a bolster to the ear for several weeks to close the cystic cavity. Simply aspirating the cyst fluid without applying long term pressure to the ear will result in recurrence of the pseudocyst. 2

20、 Results Among 34 patients with the relapsing pseudocyst of the auricle, there are 31 patients who have been cured after the operations (91.3%). Under this circumstance, 3 cases are effective（8.82%）. All of the patients are completely cured without recurrence. 3 Discussion 3.1 Causes Pseudocyst of t

21、he auricle was first reported by Hartmann in 1846 and first described in the English literature in 1966 by 6Engel. Historically, pseudocyst of the auricle has been termed endochondral pseudocyst, intracartilaginous cyst, cystic chondromalacia, and benign idiopathic cystic chondromalacia. Because the

22、 condition is uncommon, it may be misdiagnosed or underreported by clinicians. There are mainly the following conclusions in these years: 1) Partly mechanical stimulations Hyperalgesia to mechanical stimulation and heat is commonly observed in inflamed conditions. Although sensitization to heat is w

23、ell documented and its mechanism has also been well studied, it remains unclear whether and how nociceptors are sensitized to mechanical stimulation. 2) Autoimmune disease Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the

24、body. In other words, the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it. This may be restricted to certain organs or involve a particular tissue in different places. The treatment of autoimmune diseases is typically with immunosupp

25、ressantmedication which decreases the immune response. 73) Embryo development Embryogenesis is the process by which the embryo is formed and develops, until it develops into a fetus. Embryogenesis starts with the fertilization of the ovum (or egg) by sperm. The fertilized ovum is referred to as a zy

26、gote. The zygote undergoes rapid mitotic divisions with no significant growth (a process known as cleavage) and cellular differentiation, leading to development of an embryo. Although embryogenesis occurs in animal and plant development, this article addresses the common features among different ani

27、mals, with some emphasis on the embryonic development of vertebrates and mammals. 3.2 Pathology ZHANG Xiao-tong makes the pathology observation and the clinic period. The egg cell is always asymmetric, having an “animal pole“ and a “vegetal pole“. It is also covered with different protective envelop

28、es, with different layers. The first envelope - the one in contact with the membrane of the egg - is made of glycoproteins and is known as the vitelline membrane. Different taxa show different cellular and acellular envelopes englobing the vitelline membrane. Fertilization is the fusion of gametes t

29、o produce a new organism. In animals, the process involves a sperm fusing with an ovum, which 8eventually leads to the development of an embryo. Depending on the animal species, the process can occur within the body of the female in internal fertilization, or outside in the case of external fertiliz

30、ation. The fertilized egg cell is known as the zygote. 3.3 Diagnosis Pseudocyst of the auricle is a rare, asymptomatic intracartilaginous swelling of the auricle resulting from accumulation of yellow viscous fluid with unknown cause. Various methods of treatment such as aspiration, corticosteroid in

31、jections and surgical intervention have been advocated for this condition. We report two cases treated successfully with a combination of aspiration, pressure dressing and oral corticosteroid therapy. In holoblastic eggs the first cleavage always occurs along the vegetal-animal axis of the egg, and

32、the second cleavage is perpendicular to the first. From here the spatial arrangement of blastomeres can follow various patterns, due to different planes of cleavage, in various organisms. 3.4 Treatment Pseudocyst of the auricle is a rare condition and is hardly encountered in routine ENT practice. T

33、here have been only about 200 of these cases reported in world literature. The etiology remains obscure and the treatment modalities uncertain. The 9authors present their series of 15 cases and review the available literature on this condition. A new and completely successful method of treatment is

34、also presented. An auricular pseudocyst is a fluid filled cavity unlined by epithelium in the intracartilaginous space of the ear. Clinically, it presents as a painless outpouching on the upper anterior surface of the auricle with sterile straw coloured fluid found upon aspiration. If left untreated

35、, permanent deformity of the pinna may result. Treatment of the pseudocysts has varied in the literature with techniques involving aspiration alone or incision and drainage; however, due to the high recurrence rates with these methods more aggressive therapies have been instituted. Although these te

36、chniques have achieved reasonable results with few recurrences, their invasive nature and chemotherapeutic and toxic agents used have caused significant morbidity. We present treatment of an auricular pseudocyst by simple aspiration and local pressure application using an auricular prosthesis formul

37、ated with the creation of a moulage fitted to the ear by our prosthetics. This minimally invasive and simplistic approach can avoid some of the complications related to other therapies, such as cartilage deformity, depigmentation of skin, and scarring and yields optimal 10cosmetic results. The term

38、pseudocyst of the pinna was originally used by Hartmann in 1846 and later reported by Engel in the more modern literature and an auricular pseudocyst is a fluid filled cavity that is not lined by epithelium in the intracartilaginous space of the ear. Clinically, auricular pseudocysts present as a pa

39、inless outpouching on the upper anterior surface of the auricle with sterile straw colored fluid found upon aspiration.3 Although the aetiology is not clear, these lesions have been associated with minor trauma from a variety of sources including hard pillows, stereo headphones, and motorcycle helme

40、ts and these cysts, if left untreated, may result in permanent deformity of the pinna. Treatment of pseudocysts has varied in the literature. Incision and drainage or aspiration alone has resulted in multiple recurrences and ear deformities. Other treatments have included incision and drainage with

41、cyst curettage and pressure application, and aspiration followed by intraregional and oral steroid administration, and and incision and drainage with intracavitary injection of iodine or trichloracetic acid with and without bolstering. These and other methods have achieved reasonable results with few recurrences, but complications