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Prevention and Surgical Management of Auricular Hematoma and Cauliflower Ear
Charbel Saad1, Christèle Asmar2, Ramza Ishak3
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. csaad2@jh.edu.
Insights
Cauliflower ear (wrestler's ear) stems from untreated auricular hematoma. Incision and drainage (I&D) is key for prevention, while cartilage excision treats the deformity, with generally good outcomes.
Area of Science:
- Orthopedics
- Sports Medicine
- Otolaryngology
Background:
- Cauliflower ear deformity arises from untreated auricular hematoma, leading to neocartilage and fibrosis.
- This condition results in a characteristic, often undesirable, ear appearance.
- Existing treatment options for cauliflower ear have yielded inconsistent results.
Purpose of the Study:
- To systematically review therapeutic strategies for cauliflower ear prevention.
- To evaluate available treatments for existing cauliflower ear deformities.
- To assess functional, surgical, and aesthetic outcomes of interventions.
Main Methods:
- A comprehensive literature search was conducted in Medline and Scopus databases.
- Articles published up to May 2024 were included in the review.
- Data on therapeutic strategies, outcomes, and complications were extracted.
Main Results:
- Seventeen studies focused on prevention and eight on treatment of cauliflower ear.
- Surgical approaches involve fibrocartilage excision (scalpel or ultrasonic aspirator) to minimize inflammation.
- Incision and drainage (I&D) followed by pressure dressings is a primary method, with satisfactory outcomes and minimal complications reported.
Conclusions:
- Incision and drainage (I&D) is the cornerstone for managing auricular hematoma and preventing cauliflower ear.
- Excision of new cartilage is crucial for correcting the deformity if it occurs.
- Further rigorous studies are needed to better evaluate surgical outcomes and complications.
Background:
The cauliflower ear or wrestler's ear deformity results from an untreated auricular hematoma. This is due to neocartilage deposition and fibrosis secondary to perichondritis caused by the hematoma leading to the characteristic cauliflower ear appearance. Though some treatment options have been studied, the results have been inconsistent. This review aims to provide a systematic evaluation of available therapeutic strategies for the prevention and treatment of cauliflower ear.
Methods:
We performed a search in the Medline and Scopus databases for all articles published until May 2024. The endpoints were therapeutical strategies for the prevention and treatment of cauliflower ear. Functional, surgical, and aesthetic outcomes were collected.
Results:
Twenty-five articles were included; 17 of these studies pertained to prevention; and 8 to treatment of cauliflower ear. The general surgical approach for treating a case of cauliflower ear relies on the excision of the fibrocartilage resulting from inflammation using a scalpel or an ultrasonic aspirator. By surgically addressing the auricular hematoma, inflammation is minimized and a cauliflower ear can be avoided. Incision and drainage (I&D) was the primary approach used, followed by pressure dressings to prevent blood or serous fluid accumulation. Outcomes were generally satisfactory to the physicians and patients, and complications were minimally reported.
Conclusions:
I&D remains at the cornerstone of the management of auricular hematoma and prevention of cauliflower ear. Should the deformity occur, excision of the newly formed cartilage is essential in restoring normal ear contour. More rigorous clinical studies reporting successes and complications are warranted to better study the outcomes of the various surgical approaches.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
