You are on page 1of 11

Assessment and management of auricular hematoma and

cauliflower ear

Assessment and management of auricular hematoma and cauliflower ear


Author
Kelly Michele Malloy, MD
Section Editors
Anne M Stack, MD
Allan B Wolfson, MD
Deputy Editor
James F Wiley, II, MD, MPH
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Oct 2013. | This topic last updated: Apr 8, 2013.

INTRODUCTION — Auricular hematoma typically results from blunt trauma to the


auricle (outer ear) during sports (eg, amateur wrestling, rugby, boxing, or mixed martial
arts). This injury warrants prompt drainage and measures to prevent reaccumulation of
blood. Cauliflower ear is the permanent deformity caused by fibrocartilage overgrowth
that occurs when an auricular hematoma is not fully drained, recurs, or is left untreated
( picture 1 ).

This topic reviews the assessment and management of auricular hematoma focusing on
an approach that best avoids the long-term complication of cauliflower ear. The
assessment and management of auricle (ear) lacerations is discussed separately.
(See "Assessment and management of auricle (ear) lacerations" .)

ANATOMY AND PATHOPHYSIOLOGY — The uniquely protuberant nature of the


external ear makes it particularly susceptible to trauma. The cartilaginous subunits of
the pinna include the helix, the antihelix, the concha, tragus, and antitragus ( figure 1 )
[ 1 ]. The lobule, or ear lobe, is composed of fibroadipose tissue and lacks cartilage. The
skin overlying the cartilaginous auricle, or pinna, is thin, without significant
subcutaneous adipose tissue, and is densely adherent to the underlying perichondrium.
The perichondrium, in turn, supplies nutrients to the auricular cartilage.

When traumatic hematoma occurs, the blood accumulates within the subperichondrial
space (between the perichondrium and cartilage). This collection of blood is a mechanical
barrier between the cartilage and its perichondrial blood supply [ 1 ]. Deprived of
perfusion, the underlying cartilage necroses and may become infected. These pathologic
changes result in cartilage loss followed by fibrosis and neocartilage formation. This
healing process is disorganized and results in the cosmetic deformity of cauliflower ear
( picture 1 ). Early drainage of the hematoma and re-apposition of the perichondrial
layer to the underlying cartilage restores perfusion to the cartilage and reduces the
likelihood of cauliflower ear.

MECHANISM OF INJURY — Auricular hematoma and cauliflower ear are common


sports injuries. While epidemiologic data are lacking, rugby, boxing, wrestling, and
mixed martial arts or “ultimate fighting” are the sports typically associated with these
injuries. Fighters who do not wear protective head gear are at greater risk. As an
example, in a survey of collegiate wrestlers, auricular injuries occurred more frequently
among wrestlers who were not wearing headgear (52 versus 26 percent for auricular
hematoma and 27 versus 11 percent for cauliflower ear, respectively) [ 2 ]. Fighters with
auricular hematoma also tend to ignore the injury and, even if treated, risk recurrent
injury with ultimate development of cauliflower ear [ 3 ].

CLINICAL FEATURES AND DIAGNOSIS — The diagnosis of auricular hematoma or


cauliflower ear is made by the characteristic clinical appearance in patients with a history
of blunt trauma to the auricle.

Acute auricular hematoma presents as a tender, tense, fluctuant collection of blood,


typically on the anterior aspect of the pinna and often within the scaphoid fossa, the
depression between the helix and antihelix ( figure 1 ). The overlying skin can be
erythematous or ecchymotic. If the hematoma has begun to clot and organize
(approximately 24 hours after injury), it may become firmer.

By contrast, cauliflower ear is a chronic, bulbous deformity of the pinna in the area of a
former auricular hematoma ( picture 1 ).

Most auricular hematomas result from an isolated blow to the ear during sports and have
few associated injury. Less commonly, auricular hematomas may accompany serious
injury to the head, ear drum, or middle ear during motor vehicle collisions or other high
energy mechanisms. The assessment and management of these injuries are discussed
separately. (See "Assessment and management of auricle (ear) lacerations", section on
'Evaluation' and"Evaluation and management of middle ear trauma", section on 'Clinical
features' and "Minor head trauma in infants and children", section on 'Clinical
features' and "Concussion and mild traumatic brain injury", section on 'Clinical
features' .)

DIFFERENTIAL DIAGNOSIS — In most patients, the diagnosis of auricular hematoma


or cauliflower ear is straightforward. Infections of the ear cartilage or inflammation from
relapsing polychondritis may occasionally mimic these injuries.

Perichondritis, chondritis, or auricular abscess present with pain, swelling, and erythema
of the overlying skin. Fluctuant swelling indicates an abscess. These infections typically
accompany a recent helical ear piercing or laceration but have physical findings that may
be difficult to differentiate from an auricular hematoma in some patients. The presence
of pus rather than blood at the time of drainage indicates an auricular abscess. A prior
break in the skin followed by erythema often identifies perichondritis or chondritis.
Further therapy includes antibiotic treatment which is discussed separately.
(See"Assessment and management of auricle (ear) lacerations", section on
'Perichondritis or chondritis' .)

Relapsing polychondritis (RPC) is an uncommon autoimmune condition in adults that can


mimic traumatic cauliflower ear ( picture 2 and picture 3 ). Auricular involvement is the
most frequent feature of RPC, but other anatomic areas and organs may be involved,
including the costal cartilage, eyes, nose, airways, heart, vascular system, skin, joints,
kidney, and nervous system ( table 1 ). Involvement of other anatomic areas or organs
and the presence of nonspecific constitutional symptoms such as fatigue, malaise, and
fever help to distinguish RPC from cauliflower ear. (See "Clinical manifestations of
relapsing polychondritis", section on 'Clinical manifestations' .)

INDICATIONS FOR TREATMENT AND SUBSPECIALTY CONSULTATION OR


REFERRAL — All auricular hematomas should be drained as soon as possible after
injury. Hematomas greater than seven days old may have begun to organize and form
granulation tissue and warrant referral to an otolaryngologist or plastic surgeon [ 4 ].

Most auricular hematomas occur in healthy young athletes. However, anticoagulated


patients may develop auricular hematomas after incidental trauma. The approach to
these patients depends upon the indication for anticoagulation, the individual risk of
thromboembolism if anticoagulation is interrupted, and the type of anticoagulant the
patient is receiving. In some cases, referral to an otolaryngologist or plastic surgeon for
delayed drainage after anticoagulation is reduced or interrupted may be necessary.
Consultation with a hematologist is advised to guide management of anticoagulation
before and after hematoma drainage. (See "Management of anticoagulation before and
after elective surgery", section on 'Problem overview' .)

PREPARATION

Evaluation and patient counseling — The patient’s ear should be examined both
visually and by palpation to determine the location and extent of the hematoma. Physical
findings determine the type of drainage (needle aspiration versus incision and drainage)
and the surgical approach. (See 'Approach'below.)

The patient or caregiver should be informed regarding the need for drainage to reduce,
but not eliminate the chances of cauliflower ear, and the need for appropriate follow-up.
They should also be counseled regarding the need to avoid reinjury to the ear while it is
healing; this is important in the case of athletes who are anxious to return to training.
The clinician should emphasize that re-accumulation of blood will result in a poor
cosmetic outcome. (See'Return to sports' below.)

Additional risks that should be reviewed during the informed consent process include
bleeding, infection, pain, scar formation, and need for further surgery. For
anticoagulated patients, consultation with a hematologist is advised to guide
management of anticoagulation before and after hematoma drainage.
(See "Management of anticoagulation before and after elective surgery", section on
'Problem overview' .)

Analgesia — A regional auricular block using a local anesthetic, such as 1 or 2 percent


buffered lidocaine with epinephrine usually provides adequate anesthesia for drainage of
an auricular hematoma in the cooperative patient. Of note, lidocaine with epinephrine is
helpful for regional blocks but is generally avoided in direct infiltration of the ear itself as
the vasoconstrictive properties of epinephrine can compromise the auricular blood
supply. The discomfort of infiltration may be further decreased by the use of
nonpharmacologic interventions such as biobehavioral and cognitive distraction.
(See"Assessment and management of auricle (ear) lacerations", section on 'Local
anesthesia' and "Procedural sedation in children outside of the operating room", section
on 'Nonpharmacologic interventions' .)

The technique for performing a regional auricular block is discussed in detail separately
( figure 2 ). (See "Assessment and management of auricle (ear) lacerations", section on
'Regional auricular block' .)
Procedural sedation is infrequently required for drainage of auricular hematoma, unless
the patient is young or otherwise uncooperative. The performance of procedural sedation
in children and adults is discussed in more detail elsewhere. (See "Procedural sedation in
children outside of the operating room"and "Procedural sedation in adults" .)

Equipment — The following equipment should be assembled for auricular hematoma


incision and drainage:

 Sterile gloves
 Surgical mask
 Eye protection
 Buffered 1 percent lidocaine or similar local anesthetic ( table 2 )
 Moderate volume syringe (eg, 5 or 10 mL)
 Small gauge needle (eg, 27 or 30 gauge, 1.5 inch if performing an auricular
block) for infiltration of local anesthetic
 Sterile saline
 18 gauge needle attached to a small to moderate volume syringe (eg, 3 to 6 mL)
if needle aspiration is performed
 18 gauge intravenous catheter if needle aspiration with indwelling catheter
technique is used
 Suture material: for skin- 5-0 absorbable (eg, Monocryl or fast absorbing gut), for
bolster, 4-0 or 3-0 non-absorbable (eg, nylon or Prolene)
 Needle holder
 Hemostat
 Scalpel with handle (#15 blade or #11 blade)
 Tissue forceps
 Scissors
 Sterile 4 x 4 gauze
 Absorbent towels
 Sterile field drapes

Emergency departments generally are well equipped with minor surgical or suture trays
that contain the instruments, sterile gauze, towels, and drapes listed above.

PROCEDURE

Approach — Evidence for the best treatment of auricular hematomas is limited and
based largely upon case reports and anecdotal experience [ 5 ]. Our approach depends
upon the size and age of the auricular hematoma [ 1,4,6,7 ]. Auricular hematomas that
are more than seven days old warrant referral to a surgical subspecialist for debridement
of new perichondrial growth and any remaining hematoma [ 4 ]. (See 'Indications for
treatment and subspecialty consultation or referral' above.)

We suggest that patients with auricular hematomas that are <2 cm in diameter and
present for up to 48 hours undergo needle aspiration rather than either incision and
drainage, or evacuation using an intravascular catheter [ 4,6 ]. (See 'Small, acute
auricular hematomas' below.)

We suggest that patients with auricular hematomas ≥2 cm in diameter and all


hematomas present from 48 hours up to seven days receive either incision and drainage
or evacuation using an intravascular catheter rather than needle aspiration [ 1,4,6,7 ].
(See 'Larger auricular hematomas' below.)

Some experts favor incision and drainage over needle aspiration for all auricular
hematomas to avoid recurrent hematoma and its sequelae. In one small observational
study of 22 patients undergoing 28 treatments, hematoma reaccumulation occurred in
three out of seven patients after needle aspiration (18 to 22 gauge needles were used)
versus two out of 21 patients undergoing incision and drainage, although this difference
was not statistically significant [ 8]. However, outcomes were not controlled for age and
size of the hematomas. Our experience suggests that needle aspiration of small, acute
auricular hematomas is frequently successful.

In another series of 53 wrestlers with auricular hematoma at least 2 cm in size and


present for up to three weeks, reaccumulation was seen in only three patients after
evacuation with an indwelling 18 gauge intravenous catheter; the catheter had fallen out
in all of these patients during the first three days after treatment [ 7 ]. This technique
permitted return to sports within seven days in 91 percent of patients. Cauliflower ear
developed in one athlete who did not use headgear.

Thus, limited observational evidence suggests that either incision and drainage or
evacuation with an indwelling intravenous catheter effectively treats large auricular
hematomas (≥2 cm) with similar rates of reaccumulation or development of cauliflower
ear.

Small, acute auricular hematomas — The clinician may perform needle aspiration for
small (less than approximately 2 cm in diameter) and acute hematomas that are 24 to
48 hours old as follows [ 4,6 ] (see 'Approach' above):

 Cleanse the ear with antiseptic (eg, povidone-iodine solution).


 Provide local anesthesia ( figure 2 ). (See "Assessment and management of
auricle (ear) lacerations", section on 'Local anesthesia' and "Assessment and
management of auricle (ear) lacerations", section on 'Regional auricular
block' .)
 Identify and aspirate the most fluctuant part of the hematoma with an 18 gauge
needle while milking the hematoma to ensure complete drainage (figure 3 ).
 After needle aspiration, apply pressure for 5 to 10 minutes and then place a
pressure dressing as follows ( figure 4 ):

 Place sterile gauze with the center cut out to provide padding behind the ear.
 Mold sterile petrolatum-impregnated gauze or saline-soaked cotton balls within
the contours of the auricle. If the skin was incised, this portion of the dressing
needs to reapproximate the skin at the incision site.
 Place sterile gauze over the entire ear.
 Wrap the ear and head with sterile rolled gauze to hold in place.

Larger auricular hematomas — For larger (≥2 cm) hematomas up to seven days old,
the clinician may perform incision and drainage or evacuation with an intravenous
catheter [ 1,4,6,7 ]:

Incision and drainage — Incision and drainage is performed as follows [ 1,4,6 ]:

 Cleanse the ear with antiseptic (eg, povidone-iodine solution).


 Provide local anesthesia ( figure 2 ). (See "Assessment and management of
auricle (ear) lacerations", section on 'Local anesthesia' and "Assessment and
management of auricle (ear) lacerations", section on 'Regional auricular
block' .)
 Incise along the curvature of the auricle at the base of the hematoma using a 15
or 11 blade ( figure 3 ). The incision should be adequate to drain clotted blood
completely and is best performed parallel to the helical curve for cosmesis
( figure 1 ).
 Carefully evacuate the hematoma and any clots by gently using a sterile mosquito
hemostat to bluntly open the hematoma pocket without damaging the
perichondrium.
 Irrigate the pocket copiously with sterile saline.
 After incision and drainage is performed, suture the incision closed with mattress
stitches or a bolster to effectively reduce the dead space and to prevent
reaccumulation of blood or fluid. Either method restores the relationship of the
cartilage with its blood supply from the overlying perichondrium [ 1,3,5,8,9 ]:

 If mattress sutures are used, appose the skin and perichondrial flap to the
underlying cartilage using absorbable (eg, 5-0 Monocryl or fast absorbing gut)
or nonabsorbable suture (eg, 5-0 nylon or Prolene) and place the mattress
stitch through and through the cartilage [ 3,9 ]. Leave a small area open to
drain.
 If a bolster is used, we typically use sterile petrolatum-impregnated gauze which
is molded to the ear and sutured into place with through and
through nonabsorbable suture (eg, 3-0 or 4-0 nylon or Prolene)
[ 1,3,5,8,10 ]. Alternatively, the bolster can be molded from thermoplast
splinting material and sutured into place. Bolsters are typically removed at
seven days.

Intravenous catheter evacuation — The following steps describe evacuation of an


auricular hematoma with an intravenous catheter [ 7 ]:

 Cleanse the ear with antiseptic (eg, povidone-iodine solution).


 Provide local anesthesia ( figure 2 ). (See "Assessment and management of
auricle (ear) lacerations", section on 'Local anesthesia' and "Assessment and
management of auricle (ear) lacerations", section on 'Regional auricular
block' .)
 Along the inferior border of the hematoma, insert an 18 gauge intravenous
catheter that permits syringe attachment, and evacuate it as described above
for needle aspiration [ 7 ]. (See 'Small, acute auricular hematomas' above.)
 Remove the needle but leave the catheter in position.
 Clip the catheter so that approximately 1 cm protrudes from the insertion site to
allow further drainage.
 Dress as for needle aspiration as previously discussed and then apply a three inch
elastic bandage over the gauze bandage. (See 'Small, acute auricular
hematomas' above.)

AFTERCARE — Patients who have undergone evacuation of an auricular hematoma


should be reevaluated every 24 hours for three to five days to evaluate for possible
reaccumulation of the hematoma or signs of infection and, if evacuation with an
indwelling catheter is performed, reapplication of the pressure dressing. In patients who
do have recurrence of an auricular hematoma, repeated incision and drainage or
catheter aspiration can be performed [7,10 ].

To prevent continued bleeding, patients should also avoid aspirin and other nonsteroidal
antiinflammatory drugs. For anticoagulated patients, consultation with a hematologist is
warranted to guide adjustment of anticoagulant therapy after hematoma drainage.
(See "Management of anticoagulation before and after elective surgery", section on
'Problem overview' .)
Patients should be educated to return for treatment if swelling, redness, or pain occurs.
If sutures are placed, antibiotic ointment or other emollients can be used to dress
incisions and mattress sutures while bolsters should be kept clean until removed. Further
care depends upon the initial treatment:

 If an indwelling intravenous (IV) catheter is present, it should be gently removed


at five days and external compression applied for three to five minutes [ 7 ].
 If nonabsorbable mattress sutures are used, they should be removed at seven to
10 days.
 Bolsters should be removed at seven days.
 Pressure dressings may be changed daily during the initial wound checks and
then discontinued after 72 hours, or, in patients with an indwelling IV catheter,
five days.

Although evidence is lacking, because of the risk of infection to an area with tenuous
blood supply, we suggest that all patients who undergo auricular hematoma drainage
receive a 7 to 10 day course of empiric antibiotics with activity against skin flora
and Pseudomonas aeruginosa as follows [ 1,4 ]:

 In older adolescents and adults, levofloxacin to cover skin flora and Pseudomonas
aeruginosa .
 In younger children, amoxicillin and clavulanic acid to cover skin flora.
Fluoroquinolones are not recommended for routine use in children <18 years of
age because studies in immature animals have demonstrated the development
of arthropathy with erosions of the cartilage in weight-bearing joints.
(See "Fluoroquinolones", section on 'Use in children' .)

If infection develops after drainage while on prophylactic antibiotics, patients should be


admitted for intravenous antibiotics that cover Staphylococcus aureus and Pseudomonas
aeruginosa (eg, vancomycin and ceftazidime ).

RETURN TO SPORTS — All patients should refrain from activity that places their ear at
risk for additional trauma until the ear is healed [ 1 ]. Return to sports can occur as early
as seven days after the initial injury if the hematoma does not reaccumulate [ 3,7 ].
Athletes should be strongly advised to wear protective headgear to prevent reinjury.

COMPLICATIONS — Potential complications of auricular hematoma drainage include


infection, recurrence of hematoma, and cauliflower ear [ 6 ]. Infection should be treated
with intravenous antibiotics. Drainage is necessary for hematomas or abscesses that
develop during follow-up. (See 'Aftercare'above.)

Cauliflower ear usually poses no functional loss to hearing. However, patients who want
an improved cosmetic appearance warrant referral to an otolaryngologist or plastic
surgeon.

SUMMARY AND RECOMMENDATIONS

 Auricular hematoma occurs after direct trauma to the ear, typically during sports
(eg, rugby, wrestling, boxing, or mixed martial arts). If the hematoma is not
drained, disruption of blood supply to the auricular cartilage causes necrosis,
increases the chance of infection, and usually results in a cauliflower ear
( picture 1 ). Wrestlers, boxers, and participants in mixed martial arts are
predisposed. (See 'Anatomy and pathophysiology'above and 'Mechanism of
injury' above.)
 The diagnosis of auricular hematoma or cauliflower ear is made by the
characteristic clinical appearance in patients with history of blunt trauma to the
auricle. Infections of the ear cartilage or inflammation from relapsing
polychondritis ( picture 2 and picture 3 ) may occasionally mimic these injuries.
(See 'Clinical features and diagnosis' above and 'Differential diagnosis' above.)
 All auricular hematomas should be drained as soon as possible after injury.
Auricular hematomas that are more than seven days old warrant referral to an
otolaryngologist or plastic surgeon for debridement of new perichondrial growth
and any remaining hematoma. (See 'Indications for treatment and subspecialty
consultation or referral' above.)
 A regional auricular block using local anesthetic, such as 1 or 2 percent
buffered lidocaine with epinephrine, usually provides adequate anesthesia for
auricular hematoma drainage in the cooperative patient ( figure 2 ). The
discomfort of infiltration may be further decreased by the use of
nonpharmacologic interventions. (See 'Analgesia' above.)
 The necessary equipment and procedure for drainage of an auricular hematoma is
listed above. (See 'Equipment' above and 'Procedure' above.)
 We suggest that patients with auricular hematomas that are <2 cm in diameter
and present for up to 48 hours undergo needle aspiration rather than either
incision and drainage or evacuation using an intravascular catheter ( Grade
2C ). (See 'Approach' above and 'Small, acute auricular hematomas' above.)
 We suggest that patients with auricular hematomas ≥2 cm in diameter and all
hematomas present from 48 hours up to seven days receive either incision and
drainage or evacuation using an intravascular catheter rather than needle
aspiration ( Grade 2C ). (See 'Approach' above and 'Larger auricular
hematomas' above.)
 After auricular hematoma drainage, patients warrant daily follow-up for three to
five days to evaluate for reaccumulation of the hematoma or infection. Further
care depends upon the technique used for drainage. (See 'Aftercare' above.)
 Although evidence is lacking, because of the risk of infection to an area with
tenuous blood supply, we suggest that all patients who undergo auricular
hematoma drainage receive a 7 to 10 day course of empiric antibiotics with
activity against skin flora and Pseudomonas aeruginosa ( Grade 2C ).
(See 'Aftercare' above.)
 All patients should refrain from activity that places their ear at risk for additional
trauma until the ear is healed. Return to sports can occur as early as seven
days after the initial injury if the hematoma does not reaccumulate. Athletes
should be strongly advised to wear protective headgear to prevent recurrence.
(See 'Return to sports' above.)

REFERENCES
1. Greywoode JD, Pribitkin EA, Krein H. Management of auricular hematoma and
the cauliflower ear. Facial Plast Surg 2010; 26:451.
2. Schuller DE, Dankle SK, Martin M, Strauss RH. Auricular injury and the use of
headgear in wrestlers. Arch Otolaryngol Head Neck Surg 1989; 115:714.
3. Roy S, Smith LP. A novel technique for treating auricular hematomas in mixed
martial artists (ultimate fighters). Am J Otolaryngol 2010; 31:21.
4. Riviello RJ, Brown NA. Otolaryngologic procedures. In: Clinical Procedures in
Emergency Medicine, 5th edition, Roberts JR, Hedges JR. (Eds), Saunders
Elsevier, Philadelphia, PA 2010. p.1178.
5. Jones SE, Mahendran S. Interventions for acute auricular haematoma.
Cochrane Database Syst Rev 2004; :CD004166.
6. Martinez NJ, friedman MJ. External ear procedures. In: Textbook of Pediatric
Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Lippincott,
Williams & Wilkins, Philadelphia, PA 2008. p.593.
7. Brickman K, Adams DZ, Akpunonu P, et al. Acute Management of Auricular
Hematoma: A Novel Approach and Retrospective Review. Clin J Sport Med
2012.
8. Giles WC, Iverson KC, King JD, et al. Incision and drainage followed by
mattress suture repair of auricular hematoma. Laryngoscope 2007; 117:2097.
9. Kakarala K, Kieff DA. Bolsterless management for recurrent auricular
hematomata. Laryngoscope 2012; 122:1235.
10. Ghanem T, Rasamny JK, Park SS. Rethinking auricular trauma. Laryngoscope
2005; 115:1251.

Penilaian dan pengelolaan hematoma aurikuler dan telinga kembang kol

Penilaian dan pengelolaan hematoma aurikuler dan telinga kembang kol

Penulis

Kelly Michele Malloy, MD

Bagian editor

Anne M Stack, MD

Allan B Wolfson, MD

Wakil Editor

James F Wiley, II, MD, MPH

Pengungkapan

Semua topik diperbarui saat ada bukti baru dan proses peer review kami selesai.

Tinjauan literatur terkini melalui: Okt 2013. | Topik terakhir diperbarui: 8 Apr 2013.

PENDAHULUAN - Bahaya hematoma biasanya diakibatkan oleh trauma tumpul pada auricle (telinga
luar) selama olahraga (misalnya gulat amatir, rugby, tinju, atau seni bela diri campuran). Waran
cedera ini meminta drainase dan tindakan untuk mencegah reakumulasi darah. Telinga kembang kol
adalah deformitas permanen yang disebabkan oleh pertumbuhan berlemak fibrokartil yang terjadi
bila hematoma aurikuler tidak terkuras habis, berulang, atau tidak diobati (gambar 1).

Topik ini mengulas penilaian dan pengelolaan hematoma aurikular yang berfokus pada pendekatan
yang paling baik menghindari komplikasi jangka panjang dari telinga kembang kol. Penilaian dan
pengelolaan laserasi telinga (telinga) dibahas secara terpisah. (Lihat "Penilaian dan pengelolaan
laserasi auricle (telinga)".)

ANATOMI DAN PATOFISIOLOGI - Sifat unik dari telinga luar membuatnya sangat rentan terhadap
trauma. Subunit tulang rawan kartun termasuk heliks, antihelix, concha, tragus, dan antitragus
(gambar 1) [1]. Lobus, atau cuping telinga, tersusun dari jaringan fibroadipose dan tidak memiliki
tulang rawan. Kulit yang menutupi auricle cartilaginous, atau pinna, tipis, tanpa jaringan adiposa
subkutan yang signifikan, dan berpegang teguh pada perichondrium yang mendasarinya.
Perichondrium, pada gilirannya, memasok nutrisi ke tulang rawan aurikular.

Ketika terjadi hematoma traumatis, darah terakumulasi di dalam ruang subperichondrial (antara
perichondrium dan tulang rawan). Kumpulan darah ini adalah penghalang mekanis antara tulang
rawan dan suplai darah perikondriumnya [1]. Kehilangan perfusi, necroses tulang rawan yang
mendasari dan bisa menjadi terinfeksi. Perubahan patologis ini menyebabkan hilangnya tulang
rawan diikuti oleh fibrosis dan pembentukan neokartilase. Proses penyembuhan ini tidak teratur dan
berakibat pada deformitas kosmetik dari telinga kembang kol (gambar 1). Pengeringan awal
hematoma dan aposisi ulang lapisan perikondrial ke kartilago yang mendasari mengembalikan
perfusi ke tulang rawan dan mengurangi kemungkinan telinga kembang kol.

MEKANISME INJUR - Basis hematoma dan kembang kol adalah cedera olahraga yang umum terjadi.
Sementara data epidemiologi kurang, rugby, tinju, gulat, dan seni bela diri campuran atau
"pertarungan terakhir" adalah olahraga yang biasanya dikaitkan dengan cedera ini. Pejuang yang
tidak memakai pelindung gigi berada pada risiko lebih besar. Sebagai contoh, dalam sebuah survei
pegulat perguruan tinggi, cedera aurikular terjadi lebih sering di antara pegulat yang tidak memakai
tutup kepala (52 banding 26 persen untuk hematoma hemataris dan 27 banding 11 persen untuk
telinga kembang kol). [2]. Pejuang dengan hematoma hemataris juga cenderung mengabaikan
cedera dan, bahkan jika diobati, berisiko mengalami cedera rekuren dengan perkembangan akhir
dari telinga kembang kol [3].

FITUR KLINIK DAN DIAGNOSA - Diagnosis hematoma aurikular atau telinga kembang kol dibuat oleh
penampilan klinis khas pada pasien dengan riwayat trauma tumpul pada auricle.

Hematoma aurikular akut hadir sebagai koleksi darah yang lembut, tegang, fluktuatif, biasanya pada
aspek anterior pinna dan seringkali di dalam fosa skafoid, depresi antara heliks dan antihelix (gambar
1). Kulit di atasnya bisa eritematosa atau ekimotik. Jika hematoma mulai menggumpal dan mengatur
(kira-kira 24 jam setelah cedera), mungkin akan menjadi lebih kencang.
Sebaliknya, telinga kembang kol adalah deformitas kronis dan berat pada pinna di daerah hematoma
aurikular mantan (gambar 1).

Sebagian besar hematoma aurikular diakibatkan oleh pukulan terisolasi ke telinga selama olahraga
dan sedikit mengalami cedera. Yang kurang umum, hematoma aurikular dapat menyertai cedera
serius pada kepala, gendang telinga, atau telinga tengah selama tabrakan kendaraan bermotor atau
mekanisme energi tinggi lainnya. Penilaian dan pengelolaan luka-luka ini dibahas secara terpisah.
(Lihat "Penilaian dan pengelolaan laserasi telinga (telinga)", bagian 'Evaluasi' dan "Evaluasi dan
pengelolaan trauma telinga bagian tengah", bagian 'Gambaran Klinis' dan "Trauma kepala ringan
pada bayi dan anak-anak", bagian ' Gambaran klinis 'dan "Gegar otak dan cedera otak traumatis
ringan", bagian tentang' Gambaran klinis '.)

DIAGNOSIS DIFERENSIAL - Pada kebanyakan pasien, diagnosis hematoma aurikular atau telinga
kembang kol sangat mudah. Infeksi tulang rawan telinga atau pembengkakan dari polychondritis
kambuh kadang kala meniru luka ini.