Assessment and management of auricular hematoma and cauliflower ear
- Kelly Michele Malloy, MD
Kelly Michele Malloy, MD
- Associate Professor
- Department of Otolaryngology - Head and Neck Surgery
- University of Michigan Medical School
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic reviews the assessment and management of auricular hematoma focusing on an approach that best avoids the long-term complication of cauliflower ear. The assessment and management of auricle (ear) lacerations is discussed separately. (See "Assessment and management of auricle (ear) lacerations".)
Auricular hematoma describes a collection of blood within the cartilaginous auricle (outer ear) which typically results from blunt trauma during sports (eg, amateur wrestling, rugby, boxing, or mixed martial arts). This injury warrants prompt drainage and measures to prevent reaccumulation of blood.
Cauliflower ear is the permanent deformity caused by fibrocartilage overgrowth that occurs when an auricular hematoma is not fully drained, recurs, or is left untreated (picture 1).
ANATOMY AND PATHOPHYSIOLOGY
The uniquely protuberant nature of the external ear makes it particularly susceptible to trauma. The cartilaginous subunits of the pinna include the helix, the antihelix, the concha, tragus, and antitragus (figure 1) . The lobule, or ear lobe, is composed of fibroadipose tissue and lacks cartilage. The skin overlying the cartilaginous auricle, or pinna, is thin, without significant subcutaneous adipose tissue, and is densely adherent to the underlying perichondrium. The perichondrium, in turn, supplies nutrients to the auricular cartilage.
When traumatic hematoma occurs, the blood accumulates within the subperichondrial space (between the perichondrium and cartilage). This collection of blood is a mechanical barrier between the cartilage and its perichondrial blood supply . Deprived of perfusion, the underlying cartilage necroses and may become infected. These pathologic changes result in cartilage loss followed by fibrosis and neocartilage formation. This healing process is disorganized and results in the cosmetic deformity of cauliflower ear (picture 1). Early drainage of the hematoma and re-apposition of the perichondrial layer to the underlying cartilage restores perfusion to the cartilage and reduces the likelihood of cauliflower ear.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ANATOMY AND PATHOPHYSIOLOGY
- MECHANISM OF INJURY
- CLINICAL FEATURES AND DIAGNOSIS
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR TREATMENT AND SUBSPECIALTY CONSULTATION OR REFERRAL
- Evaluation and patient counseling
- Small, acute auricular hematomas
- Larger auricular hematomas
- - Incision and drainage
- - Intravenous catheter evacuation
- RETURN TO SPORTS
- SUMMARY AND RECOMMENDATIONS