eMedicine Specialties > Clinical Procedures > Otolaryngologic and Dental Procedures

Drainage, Auricular Hematoma

Author: Inna Leybell, MD, Staff Physician, Department of Emergency Medicine, North Shore University Hospital
Contributor Information and Disclosures

Updated: Oct 2, 2009

Introduction

Auricular hematoma, shown below, is a complication that results from direct trauma to the anterior auricle and is a common facial injury in wrestlers.1,2,3 Shearing forces to the anterior auricle can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage. This may lead to tearing of the perichondrial blood vessels and subsequent hematoma formation.

Auricular hematoma.

Auricular hematoma.

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Auricular hematoma.

Auricular hematoma.


The torn perichondrial vessels compromise the viability of the avascular underlying cartilage. Interestingly, the presence of a subperichondrial hematoma has been found to stimulate new and often asymmetric cartilage to form.4 This deformity, which is often referred to as cauliflower ear or wrestler’s ear (shown in the image below), is often considered a badge of honor among wrestlers and rugby players.

Cauliflower ear.

Cauliflower ear.

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Cauliflower ear.

Cauliflower ear.


The goal of treatment is to completely evacuate subperichondrial blood and to prevent its reaccumulation. The mechanism of hematoma drainage has been debated. To date, no randomized controlled trials have addressed this issue.

Indications

  • Tender anterior auricular swelling after trauma, which deforms the normal anatomy of the pinna
  • Presentation within 7 days after trauma (After 7 days, the formation of granulation tissue may complicate the procedure. At that point, patients should be referred to a specialist.)

Contraindications

  • Hematomas that are older than 7 days
  • Recurrent or chronic hematomas (In such cases, open surgical debridement by a specialist is indicated because the hematoma, granulation tissue, or both can be located within the cartilage instead of in the subperichondrial space.)

More on Drainage, Auricular Hematoma

Overview: Drainage, Auricular Hematoma
Treatment & Medication: Drainage, Auricular Hematoma
Multimedia: Drainage, Auricular Hematoma
References
Further Reading
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References

  1. Giffin CS. Wrestler's ear: pathophysiology and treatment. Ann Plast Surg. Feb 1992;28(2):131-9. [Medline].

  2. Schuller DE, Dankle SD, Strauss RH. A technique to treat wrestlers' auricular hematoma without interrupting training or competition. Arch Otolaryngol Head Neck Surg. Feb 1989;115(2):202-6. [Medline].

  3. Mudry A, Pirsig W. Auricular hematoma and cauliflower deformation of the ear: from art to medicine. Otol Neurotol. Jan 2009;30(1):116-20. [Medline].

  4. Giles WC, Iverson KC, King JD, Hill FC, Woody EA, Bouknight AL. Incision and drainage followed by mattress suture repair of auricular hematoma. Laryngoscope. Dec 2007;117(12):2097-9. [Medline].

  5. Ghanem T, Rasamny JK, Park SS. Rethinking auricular trauma. Laryngoscope. Jul 2005;115(7):1251-5. [Medline].

  6. Henderson JM, Salama AR, Blanchaert RH Jr. Management of auricular hematoma using a thermoplastic splint. Arch Otolaryngol Head Neck Surg. Jul 2000;126(7):888-90. [Medline].

  7. Bailey B, Calhoun K. Atlas of Head and Neck Surgery - Otolaryngology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:456-7.

  8. Davidson, TM. Ambulatory Healthcare Pathways for Ear, Nose, and Throat Disordershttp://drdavidson.ucsd.edu/Portals/0/Ambuindex.htm. UCSD Otolaryngology - Head & Neck Surgery. Available at http://drdavidson.ucsd.edu/. Accessed July 28, 2006.

  9. Kelly TF, Suby JS. Wrestling. In: Mellon MB. Team Physician's Handbook. 3rd ed. Philadelphia, Pa: Hanley & Belfus; 2002:614-28.

  10. Lalwani A. Diseases of External Ear. In: Current Diagnosis & Treatment in Otolaryngology-Head & Neck Surgery. Philadelphia, Pa: McGraw-Hill; 2004.

  11. Lane SE, Rhame GL, Wroble RL. A silicone splint for auricular hematoma. The Physician and Sports Medicine. 1998;26(9):77.

  12. Roberts JR, Hedges J, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: WB Saunders; 2003:1299-1300.

  13. Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:1470.

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Further Reading

UCSD Otolaryngology – Head & Neck Surgery: Ambulatory Healthcare Pathways for Ear, Nose, and Throat Disorders

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Keywords

auricular hematoma, auricular hematoma drainage, ear hematoma, cauliflower ear, wrestler’s ear, hematoma drainage, auricular drainage, ear hematoma drainage, ear compression dressing, ear pressure dressing, anterior auricular swelling, subperichondrial blood

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Contributor Information and Disclosures

Author

Inna Leybell, MD, Staff Physician, Department of Emergency Medicine, North Shore University Hospital
Inna Leybell, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Student Association/Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Prajoy P Kadkade, MD, Attending Physician and Assistant Professor, Department of Otolaryngology and Communicative Disorders, North Shore University Hospital (NSUH)-Long Island Jewish Hospital System, Albert Einstein College of Medicine; Director of Otolaryngology, North Shore University Hospital (NSUH)
Prajoy P Kadkade, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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