Dead Cartilage or Mark of Distinction⁉️ Cauliflower Ear
Cauliflower ear is a deformation of the ear typically caused by direct blunt trauma to the auricle and surrounding tissue. Classically experienced by wrestlers or boxers, the condition can be seen in any activity where significant shearing or impact forces are experienced by the pinna, leading to an auricular hematoma. The hematoma then elevates the auricular perichondrium from the underlying cartilage, devascularizing the cartilage. The blood accumulates in the subperichondrial space and if left untreated can lead to necrosis, infection, and loss of cartilage. Cauliflower ear is the product of the fibrocartilage and fibrosis that occurs upon the destruction of the auricular cartilage once it loses its blood supply.
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The primary treatment for cauliflower ear is prevention. The best possible outcomes require early identification/management of the hematoma before cartilage death has occurred. Typically, this requires a patient be seen within the first 6 hrs after injury so that an emergency department provider can aspirate the underlying auricular hematoma and secure a bolster to prevent re-accumulation. This involves anesthetizing the distribution of the greater auricular nerve (best achieved via circum-auricular block) using lidocaine. This is followed by the insertion of an 18-gauge needle into the area of greatest fluctuance. If the patient is unfortunate enough to present outside the 6-hr period where aspiration is likely to be successful, a more invasive incision may be required to be sure to remove any blood that has begun to coagulate. Aspiration is always an appropriate first step, and if any palpable clot is still present, the needle incision can be gently probed with a hemostat or enlarged with a scalpel to allow bimanual expression of the clot before placing a bolster dressing #cauliflowerear #earinjury
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