Auricular subchondral haematoma

A cauliflower ear is a deformity of the ear caused by degeneration of the underlying cartilage structure of the ear, usually as a result of improperly treated subchondral haematoma.

Auricular haematoma occurs following blunt trauma when blood and serum accumulate between the perichondrium and cartilage

• most commonly affects the helical rim of the pinna but sometimes, as in our case, can affect the conchal bowl
  • if left untreated a 'plate' of fibroneocartilage develops from the damaged perichondrium and the resulting scarring and regeneration of the cartilage leaves the cosmetically unsightly 'cauliflower ear', characterised by thickening and irregular projection of the ear
    
    
  • anecdotal evidence would suggest that it is a relatively common condition in contact sports, particularly in rugby and boxing.

Treatment options

• in the early stages following injury, simple aspiration is an option
  • however, it is complicated by re-accumulation which occurs unless adequate pressure can be maintained with packing
• a more definitive result can be obtained by incision and drainage and either leaving a suction drain in situ or suturing a 'button' over the area to force apposition of the skin, perichondrium, and cartilage
  
  
• if treatment is delayed and a plate of fibroneocartilage has formed, then permanent ear deformity will result unless formal surgical excision is undertaken, which has been done up to 1 month following injury
  
  
• once a mature cauliflower ear has formed, then reconstructive plastic surgery is required to restore normal form to the pinna

Notes:

• a professional rugby player was treated successfully by aspiration and the use of silicone splints which allowed the player to continue training and competing (1)

Reference:

• 1) Macdonald D et al. Case presentation: a novel way of treating acute cauliflower ear in a professional rugby player. Br J Sports Med. 2005 Jun;39(6):e29