Cauliflower Ear Research Articles

Auricular Hematoma and Cauliflower Deformation of the Ear

Auricular hematoma and cauliflower deformation of the ear are unique in several respects. Knowledge about it began, in antiquity, through artists, particularly Greek and Roman, and then Japanese in the 18th century with their representation of cauliflower deformation of the ear on sculptures and paintings of pugilists and wrestlers. It is only in the 19th century that physicians began to make substantive progress in understanding this abnormality. It was first thought to be associated with mental disease, but by the beginning of the 20th century, its etiology was recognized as being caused by trauma and was then named auricular hematoma. The second step in the understanding of this affliction was the observation that auricular hematoma progresses toward cauliflower deformation of the ear, which was named cauliflower ear. Recognition of this evolution led to the development of therapies. During the second half of the 20th century, different treatments were developed. They included various hematoma drainage techniques with special bandages to prevent hematoma recurrence and ensuing progression to cauliflower ear. In summary, cauliflower deformation of the ear is an old artistic affliction that has only recently received medical attention.

Sixties

Sixties

Management of soft-tissue trauma to the face

The management of acute soft-tissue trauma can be very challenging for the facial plastic surgeon. The goals of management of facial trauma are the preservation of form and function. These goals are particularly important in facial soft-tissue trauma, where injuries can cause not only esthetic deformities but also can affect neural function, normal mastication, visual fields, and salivary outflow. This article outlines the evaluation and treatment of acute soft-tissue facial trauma. The key components include allowing for the stabilization of the patient, complete examination of the injury and face, thorough wound irrigation and debridement of necrotic tissue, preservation of all viable tissue, tension-free closure, and realignment of important facial esthetic structures. Special consideration must be given to injuries of functional structures such as the facial nerve, ductal systems or organs, and ensuring appropriated management of these structures.

Incision and Drainage Followed by Mattress Suture Repair of Auricular Hematoma

Auricular hematoma is a condition requiring early and effective management to prevent pathogenesis of the unsightly cauliflower ear. The objective of this study is to review cases of auricular hematoma and present incision and drainage followed by through-and-through whip-type absorbable mattress sutures without bolsters as an effective treatment. Retrospective chart review of auricular hematoma cases. A 5-year retrospective evaluation of auricular hematomas presenting to an otolaryngology group was performed. Patients' charts were reviewed and data regarding the treatment and follow-up of auricular hematomas were assembled and analyzed. Twenty-two patients were found to present with auricular hematoma. One patient was lost to follow-up. Twenty-eight treatments were performed on 23 ears. Seven hematomas were treated with needle aspiration, two were treated with incision and drainage with iodoform wick placement, and 19 were treated with incision and drainage followed by absorbable mattress sutures. There were five hematoma reaccumulations requiring an additional procedure after treatment by an otolaryngologist. Three followed needle drainage; one followed incision and drainage with wick placement, and one followed incision and drainage with absorbable mattress sutures. Incision and drainage followed by through-and-through absorbable mattress sutures appears to be a superior method of treatment with rare reaccumulation of hematoma. This method of treatment was shown to be simple and well tolerated, and it had few complications.

Be Prepared

Be Prepared

Relapsing polychondritis

Relapsing polychondritis is a rare disease most commonly presenting as inflammation of the cartilage of the ears and nose. Auricular chondritis, with red ears resembling infectious cellulitis, is the most common initial finding. Antibodies to type II collagen in cartilage are found, and the earlobes are classically spared. Chronic disease may result in a flabby, droopy ear, cauliflower ear, or saddle nose deformity. Acute involvement of the tracheal cartilage may cause collapse of the airway with obstruction and pulmonary infections. Arthritis may be oligoarticular or polyarticular, most often involving the costochondral junctions. Other manifestations include audiovestibular damage; heart valve disease; and neurologic, ocular, and renal disease. Corticosteroids remain the major treatment. Other therapies include nonsteroidal anti-inflammatory drugs, dapsone, colchicine, azathioprine, methotrexate, cyclophosphamide, hydroxychloroquine, cyclosporine, and infliximab.

Surgical treatment of cauliflower ear deformity

目的 探讨菜花耳的手术治疗方法.方法本组6例7只菜花耳,根据Bruns等的解剖学研究及Ohlsen等的实验结果作为手术治疗的指导原则进行手术治疗,切除新生纤维软骨层及受累的软骨膜,保留背侧正常软骨膜及薄层软骨,同时重塑外耳沟回.结果对7只菜花耳经手术治疗获得满意疗效,随访6个月至1年,均未见复发.结论手术治疗菜花耳,对新形成的纤维软骨层及受累的软骨膜必须彻底切除,才能获得良好疗效。

Rethinking Auricular Trauma

An unrecognized auricular hematoma can lead to a disfiguring deformity, the cauliflower ear, but it can be prevented with prompt and comprehensive management. Fine needle aspiration with pressure bandages remains the mainstay treatment but will occasionally fail. We review our experience with recurrent or recalcitrant auricular hematomas in terms of their pathophysiology and revision surgery. Retrospective chart review. A review of patients undergoing surgical incision, drainage, and debridement secondary to recurrent auricular hematomas was conducted. Demographic data was collected, intraoperative notes were reviewed, and follow-up results were obtained. Our management included an open incision, aggressive debridement, and long term bolsters to the ear. Ten patients presented with a persistent auricular hematoma and deformity following outpatient management with either incision and drainage or fine needle aspiration. All were male with a mean age of 25 years, presenting for surgery on average 19 days following initial trauma. The location of the hematoma within this group was not limited to the potential space between the cartilage and perichondrium. The hematoma was clearly located within the cartilage itself and it is postulated that this is one of the primary reasons for initial failure. Following surgical incision and drainage there were no recurrences or complications. There is a select group of patients with refractory auricular hematomas that require more aggressive treatment over a fine needle aspiration. Open debridement is indicated for this group. The location of the hematoma, granulation tissue, and neo-cartilage is found to be within the cartilage itself rather than between the cartilage and perichondrium, thus explaining why a needle aspiration alone can be ineffective.

Normolipemic xanthomas on the ears of an adolescent

To the Editor: A 15-year-old healthy black female reported a 1-year history of occasionally painful ear nodules. She denied antecedent trauma. Examination revealed multiple flesh-colored papules and nodules on the bilateral helices ranging in size from 0.5 to 2.7 cm (Figs 1 and 2). One nodule in the threshold of the left auditory canal caused a hearing deficit, which was corrected by pulling down on the earlobe. Family history was significant for keloids. Clinical differential diagnosis included epidermal cysts, lipomas, pseudocysts of the auricle, traumatic auricular hematoma (cauliflower ear), and angiolymphoid hyperplasia.

Interventions for acute auricular haematoma.

Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity. To assess the effectiveness of treatment options in acute auricular haematoma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003. Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma. Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria. Due to the lack of data from trials fulfilling selection criteria no results could be presented. There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.

Surgical correction of cauliflower ear

We have classified the cauliflower ear into different types according to the zone and the degree of deformity. One major group is deformity without change in the outline of the ear, and this is divided into four subgroups according to the zone. All of these subgroups can be treated by shaving the deformed cartilage through suitable incision lines. For deformities accompanied by a skin deficit, a postauricular skin flap should be used. The other major group is deformity accompanied by a change in the outline of the ear, which is divided into two subgroups. If the ear is rigid, a conchal cartilage graft is used. If the structural integrity of the ear is poor, costal cartilage is used to provide rigidity.

Redefinition of the helical rim in cauliflower-ear surgery

Cauliflower ear is a serious deformity of the auricle induced by single or repeated injury to the external ear. Few papers deal with surgical techniques for correcting this deformity. We describe the use of ipsilateral excess cartilage to restore the helical rim.

Could Ionizing Radiation Forestall Cauliflower Ear?

Repeated trauma to the ear very often results in "cauliflower ear." Many methods have been suggested to prevent an injured ear from demonstrating a cauliflowerlike deformity. The principles of treatment are evacuation of the hematoma, control of the reaccumulation of fluid, and maintenance of the cartilage contour. The authors studied the effect of ionizing radiation on deformed rabbit ears induced by repeated trauma. Twenty ears (10 rabbits) were used in the experiment. The animals were divided into four groups (control, preradiation, low dose, and high dose). Hematoma was produced by pounding the lateral side of the auricle 10 times with a 50-g weight at a height of 15 cm. The thickness of the injured and uninjured sites was measured, and histological analysis was performed for each group. The thickness of the ears of the irradiated groups was significantly less than the control group. The authors think that radiation treatment of repeatedly injured ears could prevent ear deformity, and could possibly be an adjunctive form of management of cauliflower ear in addition to hematoma evacuation and compression therapy.

The Surgical Treatment of Traumatic Hematoma of the Auricle

The auricular hematoma occurs secondary to trauma and can present a therapeutic dilemma for clinicians. Early intervention can be limited to simple incision and drainage. Delay in treatment may allow the growth of ectopic fibroneocartilage derived from the damaged perichondrium. Removal of this abnormal tissue is imperative to avoid permanent ear deformity. Surgical intervention was utilized to treat auricular hematomas in two teenage boys. The auricular hematomas were treated by raising a cutaneous flap over the injury site. The clot and serosanguinous fluid were drained and, because the injuries were 1 month old, the developing plate of fibroneocartilage and associated perichondrium was extirpated. The exposed cartilage was fenestrated prior to repairing the cutaneous flap. Both auricles healed without evidence of fibrosis or distortion. Appropriate surgical intervention can avoid the cosmetic deformity associated with an auricular hematoma (ie, cauliflower ear).

Surgical correction of the cauliflower ear: Vogelin E, Grobbelaar J, Chana J, et al. Br J Plast Surg 51:359, 1998

Surgical correction of the cauliflower ear: Vogelin E, Grobbelaar J, Chana J, et al. Br J Plast Surg 51:359, 1998

Surgical correction of the cauliflower ear

The cauliflower ear presents a challenge to the surgeon. Patients complain of discomfort and appearance. Three patients were treated surgically via a posterior approach to remove the hardened segment and re-sculpture a leaf of cartilage left in place. An acceptable cosmetic result was achieved and all patients are currently pain free.

Surgical correction of the cauliflower ear

Surgical correction of the cauliflower ear

Managing Ear Trauma.

In brief Sports in which the ear may sustain blows or experience changes in ambient pressure can pose dangers to the ear. Possible injuries include "cauliflower ear"- classic to wrestlers- auricular lacerations, auricular avulsions, and barotrauma. Prompt treatment can preserve ear structure and function. Properly protecting the ear is the best defense against trauma.

Wrestler's ear: pathophysiology and treatment.

Management of auricular hematomas has always been a challenge for physicians. This injury is very common among wrestlers since early olympic competition times. Initial treatment usually involves simple aspiration and a compression bandage. Most of these hematomas recur; then it must be decided how to manage this recurrent problem and the eventual "cauliflower ear." A treatment is proposed that directs attention to the pathophysiology of the injury and involves total excision of the newly formed fibroneocartilaginous layer. Unless this layer is successfully removed the hematoma will persist and a thickened ear will result. This treatment can be performed on an outpatient basis under local anesthesia and allows immediate resumption of wrestling competition.

Preventing Cauliflower Ear With a Modified Tie-Through Technique.

In brief: Hematoma following trauma to the external ear is a common problem among wrestlers and boxers. If the hematoma is not treated promptly, infection, fibrosis, scarring, and calcification may develop, leading to the gross deformity known as cauliflower ear or wrestler's ear. Evacuation of the hematoma followed by compression of the auricle is commonly regarded as the treatment of choice. However, fluid frequently reaccumulates after this procedure. The authors describe a tie-through suture technique in which a collodion packing is secured to the auricle with two buttons. Multiple treatments for fluid reaccumulation are rarely necessary when this technique is used.