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Management of Auricular Hematoma

Management of Auricular Hematoma. Matthew Doyle, MS, LAT, ATC. Goals for today. Definitions Pathogenesis Pathophysiology Treatment options What we do at the University of Iowa and why. Cauliflower Ear Deformity. Untreated or mismanaged auricular hematoma.

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Management of Auricular Hematoma

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  1. Management of Auricular Hematoma Matthew Doyle, MS, LAT, ATC

  2. Goals for today • Definitions • Pathogenesis • Pathophysiology • Treatment options • What we do at the University of Iowa and why

  3. Cauliflower Ear Deformity Untreated or mismanaged auricular hematoma Fibro-neocartilage formation starts @ 7-10 days

  4. Wrestler’s Ear

  5. Auricular Hematoma • 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

  6. Auricular Hematoma • Classic teaching- Located between the perichondrium and cartilage • Within cartilage itself? • Scaphoid fossa, helix, anti-helix, conchal bowl

  7. Prevention of Cauliflower Ear • 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?

  8. Modified Headgear

  9. Background • 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).

  10. Summary • 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

  11. Complications • Perichondritis and chondritis; erythema, tenderness, recurrent swelling • Cartilage necrosis, contracture, and neocartilage

  12. More Complications • Cosmesis • Reconstructive plastic surgery for cauliflower deformity • Functional • Hearing loss • Wax transport from the ear canal • Increased risk of otitis externa • Difficulty wearing earphones

  13. Treatment Barriers • 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

  14. Treatment Goals • Adequate removal of hematoma • Simple and effective method of maintaining pressure to prevent recurrence • Satisfactory aesthetics • Appropriate follow up • Minimal impact on patient activity

  15. Treatment Options • Removal of hematoma • Needle Aspiration • Incision and drainage • Incision and drainage with resection of cartilage • Prevention of reaccumulation • Non-invasive • Invasive

  16. Preventing Reaccumulation • 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

  17. Silicone Ear Splints

  18. Dental Silicone

  19. Simple Gauze Packing

  20. Cotton Bolster Dressing

  21. Thermoplastic Splint

  22. Leonard Buttons and Drain

  23. Through and through Buttons

  24. Removal of Neocartilage

  25. Treatment Algorithm • 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 .

  26. Acute Hematoma • 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

  27. Chronic and Recurrent • 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

  28. Short Videos • Collodion Casting • Modified Headgear

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