Hyaluronidase injection for the treatment of facial and neck hematomas.

INTRODUCTION Facial and neck hematomas are a significant complication of surgical procedures and direct trauma. Effective treatment of these hematomas is crucial for the prevention of cosmetic deformity, functional disturbance, infection, and tissue necrosis. Current treatment options include aspiration, incision and drainage, steroid injection, and drainage tube placement. However, these methods have potential limitations. Aspiration can be difficult due to the viscosity of hematoma fluid, whereas incision and drainage may leave a cosmetically displeasing scar. Steroid injections may cause local immune suppression leading to abscess formation. Drainage tube placement is inconvenient for the patient and likely unnecessary for smallto medium-sized hematomas. In an attempt to avoid these potential complications, we have injected hematomas with a solution of recombinant hyaluronidase prior to needle aspiration. Hyaluronidase is an enzyme that degrades hyaluronic acid, a prominent component of the extracellular matrix in the subcutaneous fat. To date, hyaluronidase has been used successfully to treat dextrose, intravenous drug, and contrast material extravasations and has been used as an adjunct to enhance anesthetic absorption. In these scenarios, hyaluronidase breaks down hyaluronic acid in nearby tissues, facilitating the diffusion and reabsorption of localized fluid collections into nearby lymphatic channels and capillaries. Hyaluronidase has also proven effective in the treatment of hematomas formed at femoral angiographic puncture sites. A recent study investigated the efficacy of hyaluronidase as an adjunct to steroid injection for subacromial bursitis. However, the authors concluded that simultaneous hyaluronidase injection had little additive effect for reducing the effective steroid dosage. Hylenex is an U.S. Food and Drug Administrationapproved human recombinant hyaluronidase. For this study, we hypothesized that injection of facial and neck hematomas with this recombinant hyaluronidase prior to needle aspiration would allow for early evacuation of the hematoma while achieving a favorable cosmetic result. Although this is an off-label application, we felt that the ability of hyaluronidase to enhance tissue permeability would be efficacious in this clinical scenario.