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Auricular Haematoma

Auricular Haematoma is when blood collects in the space between the cartilage of the pinna and the overlying skin i.e the sub-perichondral plane. This normally occurs due to trauma, hence it is seen in rugby players and wrestlers. The blood leads to a loss of vascular supply to the cartilage and the production of new cartilage formation. This leads to a disfiguring appearance known commonly as ‘Cauliflower ear’ .

Management

All of these patients require drainage of the blood as a matter of urgency. One may aspirate or incise the collection open. As long as the blood comes out and a pressure dressing is applied around the head after (to avoid recollection) there should be a good result.

With respect to incisions try not to make them too large as they can lead to exposure of the cartilage beneath whilst healing. This may result in increased infections and poor cosmetic results (which is what we are trying to avoid!). Try and make the incision over an area that would ensure the whole haematoma can be drained rather than making multiple incisions. Consider making the incision over the inferior aspect of the haematoma as that would theoretically lead to dependent drainage and reduce the likelihood of re-accumulation. For the sake of cosmesis try and make the incision in an area which would reduce the visibility of any scar.

Patients should be sent home with analgesia and broad-spectrum antibiotics to prevent perichondritis.

The patient should be seen in an ENT clinic within 24-48 hours to check for re-accumulation and signs of infection.

Further Reading

You Tube - draining a haematoma and some good examples of cauliflower ears



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