The external ear, or auricle, is a delicate structure composed of cartilage which provides the “shape” of the ear, perichondrium which provides the blood supply to the cartilage, and skin. The perichondrium is located between the cartilage and skin.
With trauma to the auricle, a hematoma may develop between the cartilage and perichondrium (picture #2). This is a bad situation as the perichondrium brings the blood supply (and as such, oxygen and nutrients) to the cartilage. If the cartilage is without this essential blood supply for a long period of time, the cartilage starts to die resulting in deformation of the ear (picture #3). Once deformation has occurred, the ear is called a “cauliflower ear” due to the similarity in appearance to the vegetable.
Picture #1: Normal Ear
Picture #2: Auricular Hematoma
Picture #3: Cauliflower Ear
Such ear trauma is commonly found in wrestlers and is why headgear use is so important in this sport. However, such trauma may also occur with boxing, martial arts, as well as any type of assault where the ear gets hit.
Once the hematoma develops, in order to prevent cauliflower ear formation, the hematoma needs to be drained and pressure applied to allow the perichondrium to heal back attached to the cartilage. Drainage and pressure are the 2 essential ingredients for successful treatment and several strategies exist to accomplish this.
- Needle Aspiration: In essence, you stick the needle into the hematoma, and suck the contents out.
- Advantage: Quick, easy, and minimal pain
- Disadvantage: High risk of the hematoma coming back.
- Incision & Drainage (I&D): After an anesthetic is injected around the ear, a scalpel is used to create a long incision extending the entire length of the hematoma and the hematoma allowed to drain out the incision.
- Advantage: Quick and easy. Lower chance of hematoma recurrence.
- Disadvantage: More painful. Hematoma may still come back.
- Head dressing: Through cotton balls, gauze, and ace/kling bandage, continuous pressure is exerted over the hematoma (after drainage), to prevent the hematoma from reaccumulating.
- Bolster placement: A cotton plug is sutured through the ear to another cotton plug on the other side.
- Ear splint: An ear “cast” is probably the best way of describing this method.
- Quilting suture: An absorbable suture is performed back and forth completely through one side of the ear to the other side (like a quilt blanket). The sutures keep the skin and perichondrium in approximation to the cartilage. It is not meant to close an incision which should remain OPEN! See pictures above.
At least in our office, it is recommended that I&D be performed followed by quilting suture with or without head dressing. Drain placement is not necessary. We have found that a quilting suture offers the best chance of recovery AND allows the patient to stay active. Depending on the size of the hematoma, as many as 10-20 suture passes may need to be performed. Keep in mind that a quilting suture is NOT the same as sutures placed when closing an incision which should remain OPEN to allow drainage.
If you are a wrestler, boxer or are involved in martial arts, contact Dagan MD to prevent Cauliflower ear today.