The Head and Neck 67 



the perichondrium of the conchal cartilage. It may occur on both 

 sides but it is more often confined to the internal one. Ordinarily 

 the fluid remains unchanged other than to clot but it may suppurate. 

 If it undergoes resorption, which it is very slow to do, the re- 

 sultant cicatrization usually causes considerable shriveling and de- 

 formity. A spontaneous cure is rare. 



Its origin is always traumatic, in most cases resulting from 

 the shaking and scratching provoked by otitis or conchal ulceration, 

 but it may also be caused by bites, or bruises. 



Symptoms and Diagnosis. The affected ear-flap exhibits a 

 characteristic bulging generally confined to the inner side but some- 

 times involving both. When of recent origin, the swelling is hot, 

 tense, and sensitive, and the head is depressed towards the affected 

 side. When of long-standing, it is insensitive, devoid of inflamma- 

 tory phenomena, somewhat indurated at its borders, and fluctuates. 



Treatment. The indications are to evacuate the fluid and as 

 speedily as possible promote reunion between the separated peri- 

 chondrium and its subjacent cartilage. The latter step is accom- 

 plished by mechanical or chemical means. Simple lancing and with- 

 drawal of the fluid is ineffectual, for the sac continues to refill 

 for a lengthened period as often as it is emptied, and the longer 

 the healing process is protracted the greater is the resultant deform- 

 ity of the parts. 



The most satisfactory results are obtained by the following 

 procedure: Evacuate the fluid by incision at the most dependent 

 portion of the flap. Then, after the manner first suggested by Mc- 

 Queen, pass interrupted radiat- 

 ing sutures through all the tis- 

 sues of the flap at intervals of 

 about one-third of an inch, 

 throughout the cystic area, tying 

 the knots on the surface where 

 the flap is free from hair. On 

 each succeeding day examine the 

 flap and squeeze out any little 

 fluid which may have accumu- 

 lated, through the original in- ^ 

 cision. Remove the sutures in 5?^ .^ ^ . , ,^ 



the course of a week. In some no. le. operation for Hematoma of the Bar-aap. 



