Most Pediatric Pinna Hematomas Were Managed Conservatively Without Immediate Surgery

A retrospective cohort study evaluating pediatric emergency admissions found that the vast majority of traumatic hematomas of the cartilaginous pinna were managed conservatively without immediate surgical evacuation. Across an eleven-year observation period at a tertiary children’s hospital, medical teams treated 93.3 percent of presenting pediatric patients without immediate operative intervention. This non-invasive initial management strategy was applied not only to superficial collections but also to the majority of patients who met clinical criteria for subperichondrial hematomas.

In adult emergency and surgical care, traumatic hematomas affecting the cartilaginous external ear are routinely treated as urgent surgical emergencies. Persistent subperichondrial hematoma may compromise cartilage perfusion and result in permanent auricular deformity. However, the study authors observed that empirical evidence supporting immediate, routine surgical evacuation in children is scarce, meaning contemporary pediatric treatment protocols have historically been extrapolated from adult clinical observations rather than pediatric trials.

To characterize the clinical presentation, management choices, and outcomes associated with these injuries in younger patients, researchers reviewed records for all children aged 16 years and younger who presented to the emergency department of a tertiary children's hospital between January 2014 and June 2025. The final study cohort comprised 104 pediatric patients with a median age of 4 years and an interquartile range spanning 2 to 6 years. Male patients represented the majority of the study population, accounting for 70.2 percent of all evaluated cases.

Presenting ear lesions were categorized clinically using predefined diagnostic criteria to distinguish between subperichondrial collections and superficial hematomas. Among the 104 children included in the investigation, 28 patients—constituting 26.9 percent of the cohort—fulfilled the clinical diagnostic criteria for subperichondrial hematoma. The remaining 76 children, representing 73.1 percent of the total patient group, were classified as having superficial hematomas.

Analysis of initial treatment strategies revealed that conservative observation was the primary approach adopted by clinicians across both diagnostic categories. Overall, 97 of the 104 children were managed conservatively. Even among the 28 patients presenting with clinically diagnosed subperichondrial hematomas, 21 children, or 75.0 percent, were treated conservatively from the outset rather than undergoing immediate surgical intervention.

The study tracked secondary outcomes including clinical complications, lesion recurrence, treatment alterations during outpatient follow-up, and structural cosmetic sequelae. Following initial observation, two children subsequently required delayed surgical evacuation. Overall, documented adverse outcomes were rare across the cohort, with mild residual pinna deformity recorded in only two patients: one child who underwent delayed surgical evacuation 22 days after the initial traumatic injury, and another child who received conservative care following an unsuccessful needle aspiration performed under local anesthesia.

The authors concluded that most traumatic hematomas of the cartilaginous pinna in this cohort were managed without immediate invasive treatment, including the majority of clinically diagnosed subperichondrial hematomas. Nevertheless, the research team highlighted that the single-center retrospective design limits definitive clinical recommendations, concluding that prospective investigations with standardized long-term follow-up protocols are required before establishing revised clinical treatment guidelines for pediatric ear hematomas.

Subject of Research: Conservative versus invasive management of traumatic pinna hematomas in children

Article Title: Management of traumatic hematoma of the cartilaginous pinna in children: a retrospective cohort study

Article References: Galli, J., Odermatt, M., Gysin, C., Neugebauer, M., & Seiler, M. (2026). Management of traumatic hematoma of the cartilaginous pinna in children: a retrospective cohort study. Frontiers in Pediatrics, 14, Article 1987879. https://doi.org/10.3389/fped.2026.1987879

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DOI: 10.3389/fped.2026.1987879

Keywords: traumatic pinna hematoma, subperichondrial hematoma, superficial hematoma, pediatric emergency care, cartilaginous pinna, auricular trauma, conservative management, delayed surgical evacuation, permanent auricular deformity, cartilage perfusion, needle aspiration, retrospective cohort study, pediatric otolaryngology, University Children's Hospital Zurich, auricular hematoma, clinical outcomes, pediatric trauma