Auricular pseudocyst, also known as benign idiopathic cystic chondromalacia, is a rare disorder that typically affects young men without associated comorbidities. It very often recurs within a few days after drainage of the fluid.1,2 We report a case of this disease in which compression treatment with thermoplastic splinting (Aquaplast) was performed in our department after drainage to prevent recurrence. This technique is simple and achieves a good cosmetic result.

A 27-year-old man without associated comorbidities, who regularly practiced boxing with headgear, presented with a soft, painless nodular lesion on the right ear that had appeared several months earlier (Fig. 1). The patient reported previous needle aspiration that had resulted in complete remission but the lesion had recurred after a few weeks. A diagnosis of auricular pseudocyst was made and partial drainage with biopsy was performed. Histology revealed an intracartilaginous space with eosinophilic degeneration of the cartilage and perichondrial fibrosis, confirming the diagnosis of auricular pseudocyst.

Figure 1.

Nodular lesion on the upper edge of the ear which is soft to palpation.

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It was decided to perform surgical treatment by draining the fluid content with a punch followed by compression on both sides of the ear with a thermoplastic splint (Aquaplast) using a button suture. The thermoplastic splint (Fig. 2A) must be heated to make it moldable. After heating for a few seconds it is put into place, molded to the shape of the ear on both sides (Figs. 2B and C), and then fixed with a button suture through the entire thickness of the ear (Fig. 2D). After a few minutes, the splint will have hardened in the shape of the ear and will apply constant pressure on both sides (Fig. 3).

Figure 2.

A, Thermoplastic splint of 1.6mm thickness before placing in hot water. B, Splint trimmed to size. C, The splint is placed on either side of the ear and manual compression is applied for a few seconds until it hardens. D, Button suture on both sides of the ear.

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Figure 3.

Final result after placement of the splint on both sides of the ear.

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The splint and sutures were removed 10 days after surgery without patient discomfort or signs of inflammation. Today, after 1 year of follow-up, the patient has had no recurrence.

A review of the literature indicates that auricular pseudocyst recurs within 4 to 5 days in practically 100% of cases if only fluid drainage is performed.3 Subsequent intralesional injection of corticosteroids lowers the recurrence rate to 50% but involves the risk of causing irreversible deformity to the ear.4,5 Many authors have reported the use of subsequent compression using a variety of materials, ranging from pressure dressings to clothing button bolstering.6 Thermoplastic splints provide good compression adjustment and patient comfort. They are made of gypsum and are widely used in nasal and facial plastic surgery. They have also been used in dermatologic surgery to provide stability and compression after skin graft placement.7 Salgado et al.8 described their use in the surgical treatment of auricular pseudocyst. They are easy to use: after heating for a few seconds they become elastic and pliable, enabling them to be shaped and sutured. After a few minutes they cool and solidify, allowing a firm compression to be applied with a perfect fit to the area treated.

In conclusion, the use of thermoplastic splints for treating auricular pseudocyst is a simple procedure that employs a readily available material. It could reduce the frequent recurrence of this disease and avoid the use of more complex compression methods or more aggressive techniques.