Blunt auricular trauma, most commonly in wrestlers and boxers, may shear the perichondrium from the underlying cartilage, leading to a hematoma. The presence of a fluctuant swelling with loss of normal auricular landmarks helps to distinguish a hematoma from ecchymosis. If left untreated, an auricular hematoma may cause fibrosis and neocartilage formation, leading to a deformity of the auricle termed cauliflower ear. Therefore, treatment in a timely manner is recommended.
Although a Cochrane review could not define the best treatment for an acute auricular hematoma, a frequently successful treatment involves incision and drainage with dental rolls sutured to the anterior and posterior auricle (Fig. 19-5). Needle aspiration alone will often lead to recurrences. The bolster is usually left in place for 4 to 7 days, with the patient permitted to return to wrestling or boxing with headgear. Prophylactic antistaphylococcal antibiotics are given. For a long-standing hematoma or a cauliflower ear, debridement of fibrosis and cartilage is necessary (Jones and Mahendran, 2008).
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