Matthew Doyle, MS, LAT, ATC

     Definitions Pathogenesis Pathophysiology Treatment options What we do at the University of Iowa and why

UNTREATED OR MISMANAGED AURICULAR HEMATOMA FIBRO-NEOCARTILAGE FORMATION STARTS @ 7-10 DAYS

  Caused by blunt trauma Tangent/shearing forces, commonly occurs:   during a takedown or from the neutral position when athlete isn’t wearing headgear or wears a poor fitting protector and fails to adjust it properly

   Classic teaching Located between the perichondrium and cartilage Within cartilage itself?

Scaphoid fossa, helix, anti-helix, conchal bowl

  Proper management of auricular hematoma Protection  Headgear use became mandatory for NCAA wrestling competition in the late 1960s  Mandatory for wrestling practice in 2004  Not used in international competition or post collegiate wrestling; Rugby rules?

 Compliance?

  No randomized controlled trials, clinical trials, or cohort studies 48 Articles: Reviews, expert opinions, case series, case reports  Jones SE, Mahendran S. Interventions for acute auricular hematoma (Review). Cochrane Database of Systematic Reviews 2004 (2).

    Treatment: Remove hematoma and prevent recurrence   No clear consensus exists for best treatment Various interventions are effective Literature generally agrees that treatment is better than no treatment Small risk other than failure, leading to re accumulation or deformity Infection (acquired or induced by tx) may result in serious consequences of perichondritis and severe tissue loss

  Perichondritis and chondritis; erythema, tenderness, recurrent swelling Cartilage necrosis, contracture, and neocartilage

 Cosmesis  Reconstructive plastic surgery for cauliflower deformity  Functional  Hearing loss  Wax transport from the ear canal  Increased risk of otitis externa  Difficulty wearing earphones

      Time consuming Missed training and competition Viewed as cosmetic problem not worthy of time loss “A mark of pride and distinction” Cauliflower Ear Deformity remains a common stigmata to wrestlers, boxers, and rugby players Noncompliance due to refusal to stop training

     Adequate removal of hematoma Simple and effective method of maintaining pressure to prevent recurrence Satisfactory aesthetics Appropriate follow up Minimal impact on patient activity

  Removal of hematoma  Needle Aspiration  Incision and drainage  Incision and drainage with resection of cartilage Prevention of reaccumulation  Non-invasive  Invasive

 Invasive  Bolsters (Cotton, buttons, thermoplastic splint)  Through and through suturing  Tie over dressings  Placement of drains (passive or suction)  Antibiotic prophylaxis  Noninvasive  Application of plaster mold, silicone splints, cotton/wool impregnated with collodion, swimmer’s nose clip

 Divide into two categories  Fluctuant hematoma discovered acutely  Chronic, more fibrotic, recurrent after needle aspiration  Multiloculated geometry  Ghanem et al. Rethinking auricular trauma. Laryngoscope. 2005 .

     First line of treatment approved by Otolaryngology Needle aspiration Collodion Casting (Jaffee) Simple, effective, cosmetically satisfactory, allow quick return Many just want reduction of pain

   Koopman (1979) and Schuller et al (1989) technique preferred Cotton dental roll bolster sutured through and through, treatment with antibiotics Allowed to continue as tolerated

 Collodion Casting  Modified Headgear