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Assessment and management of auricular hematoma and cauliflower ear

Kelly Michele Malloy, MD
Section Editors
Anne M Stack, MD
Allan B Wolfson, MD
Deputy Editor
James F Wiley, II, MD, MPH


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).


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) [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 [1]. 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.

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Literature review current through: Nov 2017. | This topic last updated: Aug 31, 2017.
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