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
Auricular hematoma typically results from blunt trauma to the auricle (outer ear) 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).
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".)
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.
MECHANISM OF INJURY
Auricular hematoma and cauliflower ear are common sports injuries. While epidemiologic data are lacking, rugby, boxing, wrestling, and mixed martial arts or "ultimate fighting" are the sports typically associated with these injuries. Fighters who do not wear protective head gear are at greater risk. As an example, in a survey of collegiate wrestlers, auricular injuries occurred more frequently among wrestlers who were not wearing headgear (52 versus 26 percent for auricular hematoma and 27 versus 11 percent for cauliflower ear, respectively) . Fighters with auricular hematoma also tend to ignore the injury and, even if treated, risk recurrent injury with ultimate development of cauliflower ear .
- Greywoode JD, Pribitkin EA, Krein H. Management of auricular hematoma and the cauliflower ear. Facial Plast Surg 2010; 26:451.
- Schuller DE, Dankle SK, Martin M, Strauss RH. Auricular injury and the use of headgear in wrestlers. Arch Otolaryngol Head Neck Surg 1989; 115:714.
- Roy S, Smith LP. A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters). Am J Otolaryngol 2010; 31:21.
- Riviello RJ, Brown NA. Otolaryngologic procedures. In: Clinical Procedures in Emergency Medicine, 5th edition, Roberts JR, Hedges JR. (Eds), Saunders Elsevier, Philadelphia, PA 2010. p.1178.
- Jones SE, Mahendran S. Interventions for acute auricular haematoma. Cochrane Database Syst Rev 2004; :CD004166.
- Martinez NJ, friedman MJ. External ear procedures. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Lippincott, Williams & Wilkins, Philadelphia, PA 2008. p.593.
- Brickman K, Adams DZ, Akpunonu P, et al. Acute management of auricular hematoma: a novel approach and retrospective review. Clin J Sport Med 2013; 23:321.
- Giles WC, Iverson KC, King JD, et al. Incision and drainage followed by mattress suture repair of auricular hematoma. Laryngoscope 2007; 117:2097.
- Kakarala K, Kieff DA. Bolsterless management for recurrent auricular hematomata. Laryngoscope 2012; 122:1235.
- Ghanem T, Rasamny JK, Park SS. Rethinking auricular trauma. Laryngoscope 2005; 115:1251.
- Mohamad SH, Barnes M, Jones S, Mahendran S. A new technique using fibrin glue in the management of auricular hematoma. Clin J Sport Med 2014; 24:e65.
- 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