View source for Auricular hematoma

==Background==
[[File:Slide2COR.jpg|thumb|Ear anatomy]]
*Caused by blunt trauma to external ear
**Associated with contact sports such as boxing, wrestling, etc. 
*Separation of perichondrium from underlying cartilage tears the adjoining blood vessels<ref name="Roy">Roy S, Smith LP. A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters). Am J Otolaryngol. 2010 Jan-Feb;31(1):21-4.</ref>
**Usually occurs on anterior surface, since skin is firmly adherent to cartilage (on posterior ear, there is underlying muscle and adipose is it loosely adherent to cartilage)<ref name="Vuyk">Vuyk HD, Bakkers EJ. Absorbable mattress sutures in the management of auricular hematoma. Laryngoscope. 1991 Oct;101(10):1124-6.</ref>
**Recurrent hematomas lead to infection and/or cartilage necrosis and neocartilage formation (i.e. "cauliflower ear")
**Goal of treatment is to prevent "cauliflower ear" deformity by draining the hematoma in a timely fashion

==Clinical Features==
[[File:Cauliflower ear by dr vikram yadav.jpg|thumb|Auricular hematoma]]
*Gross deformity/swelling to pinna after recent blunt trauma
*Loss of typical auricular landmarks/anatomy<ref name="Giles">Giles WC, Iverson KC, King JD, Hill FC, Woody EA, Bouknight AL. Incision and drainage followed by mattress suture repair of auricular hematoma. Laryngoscope. 2007 Dec;117(12):2097-9.</ref>
*[[earache|Pain]] out of proportion<ref name="Giles" />
*Hematoma most commonly collects in the scaphoid fossa and the concha

==Differential Diagnosis==
{{Ear DDX}}

{{Maxillofacial trauma DDX}}

==Evaluation==
[[File:AuricularHematoma.jpg|thumb|A small auricular hematoma after drainage.]]
*Clinical diagnosis

==Management==
===Indications for drainage<ref>Laybell I et al. Auricular Hematoma Drainage. Aug 7, 2015. http://emedicine.medscape.com/article/82793-overview#a8</ref>===
*Traumatic swelling that deforms pinna
*Within 7 days of trauma

===Contraindications===
''In these cases, refer to ENT due to formation of granulation tissue that may require debridement''
*Recurrent or chronic hematomas
*> 7 days from trauma

===Procedure===
#Perform an [[Nerve block: Auricular|auricular block]]
#Evacuate the clot
#*Option 1: Make semi-circle incision inside the inner curvature of the helix or antihelix
#**Make incisions along natural auricular crease for cosmesis
#**Remove hematoma by milking of the hematoma toward the incision.  Suction or curettage may also be helpful 
#**Use a butterfly hemostat or suture kit needle driver to break up any hematoma that is not easily coming out
#*Option 2: Use large-bore needle/syringe to aspirate hematoma<ref name="Vuyk" /> 
#**Needle aspiration generally is not sufficient treatment<ref name="Giles" />, especially for larger hematomas as clot has usually already formed and cannot be aspirated
#Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage<ref name="Roy" />). Multiple methods available:
#*Option 1: Compression dressing
#**Pack the helix with petroleum jelly-impregnated gauze
#**Place regular gauze both in front of and behind the ear
#**Circle the head with a compressive wrap
#**Generally only moderately successful, and subject to poor compliance (especially with athletes<ref name="Roy" />)
#**Alternative to petroleum jelly gauze is to splint the ear with a molded piece of plaster <ref>Trick of the Trade: Splinting the ear from AliEM https://www.aliem.com/trick-of-trade-splinting-ear/</ref> <ref>Ear Lacerations, Part II from Lacerationrepair.com https://lacerationrepair.com/techniques/anatomic-regions/ear-lacerations-part-ii/</ref>which fits better and does not need as tight of a compression dressing.
#*Option 2: Suture
#**Use fast-absorbing sutures
#**Place running or interrupted sutures through cartilage and both anterior and posterior skin of auricle in mattress fashion<ref name="Vuyk" />
#**This should reappose the perichondrium
#**Consider leaving incision open (with wound edges approximated by mattress sutures) to allow for continued drainage<ref name="Roy" />
#*Option 3: Bolster sutured in place- combination of the above two methods
#**Use non-absorbable 2-0 or 3-0 nylon
#**Pack the helix with petroleum jelly impregnated gauze.  Place a thick layer of gauze behind the ear
#**Perform a running quilt stitch through the anterior gauze, through the pinna, and through the posterior gauze
#Antibiotics
#*Often used by our ENT colleagues in all patients though it is actually only recommended for immunocompromised patients
#*Cover [[pseudomonas]] and [[S. aureus]]- Cipro is the most commonly used

==Disposition==
*Discharge
*ENT followup in 2-3 days for suture removal or dressing removal and wound check

==Complications==
[[File:Erckscauliflowerear.jpg|thumb|"Cauliflower" ear.]]
[[File:Shawn's cauliflower ear.jpg|thumb|"Cauliflower" ear.]]
*Failure to fully drain and maintain drainage of an auricular hematoma can result in "Cauliflower ear," a permament cosmetic defect.

==Prevention==
[[File:Wrestling_falconfrenzy093.jpg|thumb|Wrestling protective headgear.]]
[[File:Tiger-print scrum cap.jpg|thumb|Rugby protective headgear.]]
*Auricular hematoma can be prevented by use of appropriate headgear in sports prone to repeat ear trauma (e.g., wrestling, rugby, MMA).

==See Also==
*[[Maxillofacial Trauma]]

==External Links==
*Auricular Hematoma Management https://rebelem.com/auricular-hematoma-management/

==References==
<references/>

[[Category:ENT]]