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

Objectives Traumatic hematomas of the cartilaginous pinna in adults are generally regarded as a surgical emergency because persistent subperichondrial hematoma may compromise cartilage perfusion and result in permanent auricular deformity. In children, however, evidence supporting routine urgent evacuation is scarce, and current management is largely extrapolated from adult practice. This study aimed to characterize the presentation, management, and outcomes of traumatic hematomas of the cartilaginous pinna in children, with particular emphasis on clinically diagnosed subperichondrial hematomas. Methods This retrospective single-center cohort study included all children aged ≤ 16 years presenting to the emergency department of a tertiary children's hospital between January 2014 and June 2025 with traumatic hematoma of the cartilaginous pinna. Lesions were classified as subperichondrial or superficial hematomas based on predefined clinical criteria. The primary outcome was the initial management strategy for subperichondrial hematomas. The secondary outcomes included documented complications, recurrence, treatment modification during follow-up, and clinical outcomes. Results A total of 104 children were included (median age 4 years [IQR 2–6]; 70.2% male). Twenty-eight lesions (26.9%) fulfilled the clinical criteria for subperichondrial hematoma, whereas 76 (73.1%) were classified as superficial hematomas. Overall, 97 children (93.3%) were managed conservatively, including 21 of 28 (75.0%) with subperichondrial hematoma. Two children subsequently underwent delayed surgical evacuation. Mild residual pinna deformity was documented in two patients, one following delayed surgical evacuation performed 22 days after injury and one in a child managed conservatively after unsuccessful needle aspiration under local anesthesia. Conclusion Most traumatic hematomas of the cartilaginous pinna in this cohort were managed without immediate invasive treatment, including the majority of clinically diagnosed subperichondrial hematomas. Prospective studies with standardized long-term follow-up are required before treatment recommendations can be made.