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Auricular Hematoma Drainage

Overview

Auricular hematoma, shown below, is a complication that results from direct trauma to the anterior auricle and is a common facial injury in wrestlers.
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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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.
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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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.

Relevant Anatomy

The auricle and external acoustic meatus (or external auditory canal) compose the external ear. The external ear functions to collect and amplify sound, which then gets transmitted to the middle ear. The asymmetric shape of the external auricle introduces delays in the path of sound that assist in sound localization.

The arterial supply of the auricle is composed of the posterior auricular artery, the anterior auricular branch of the superficial temporal artery, and the occipital artery, which also contributes. Veins accompany the corresponding named arteries.

For more information about the relevant anatomy, see Ear Anatomy.

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