From the Guidelines
Cauliflower ear does not return to normal because the injury permanently changes the ear's structure, leading to the formation of a hematoma that separates the cartilage from its blood supply, causing parts of the cartilage to die and be replaced with fibrous tissue and abnormally grown cartilage. This condition is often a result of trauma to the ear, which can be caused by various factors such as falls, motor vehicle crashes, contact sports, or accidental pulling of an earring, as mentioned in the study on adolescent and young adult tattooing, piercing, and scarification 1. The study highlights the importance of prompt treatment of ear injuries to prevent complications such as auricular perichondritis and perichondrial abscess, which can lead to permanent damage to the ear's structure.
When the ear experiences trauma, blood collects between the cartilage and perichondrium, forming a hematoma. This blood pocket separates the cartilage from its blood supply, causing parts of the cartilage to die. As the body heals, it replaces the damaged area with fibrous tissue and new cartilage that grows abnormally, creating the characteristic lumpy, cauliflower-like appearance. Prevention requires prompt treatment within 48-72 hours of injury, which involves draining the blood collection with a needle aspiration and applying compression to prevent reaccumulation, as would be done for other ear injuries such as auricular perichondritis 1.
Some key points to consider in the treatment and prevention of cauliflower ear include:
- Prompt treatment within 48-72 hours of injury to prevent permanent damage
- Draining the blood collection with a needle aspiration and applying compression to prevent reaccumulation
- Using sterile technique and local anesthetic when performing the procedure
- Wearing compression bandages or specialized ear protectors continuously for 3-7 days after drainage
- Avoiding further trauma to the ear to prevent exacerbating the condition
Without this timely intervention, the deformity becomes permanent as the cartilage hardens in its new, misshapen form. Once fully healed in the deformed state, only surgical reconstruction can improve the appearance, but even surgery cannot completely restore the ear's original form. It is essential to prioritize prompt treatment and prevention to minimize the risk of permanent damage and improve outcomes for individuals with cauliflower ear.
From the Research
Causes of Permanent Deformity
- Cauliflower ear, also known as wrestler's ear, is a condition that can result from an auricular hematoma if left untreated or not managed properly 2, 3.
- The hematoma can obstruct the nutrient supply from the perichondrium to the avascular cartilage, leading to infection, necrosis, and fibrocartilaginous deposition, causing the ear to deform 3.
- If the hematoma is not evacuated promptly, it can lead to the formation of neocartilage from disrupted perichondrium, resulting in a permanent deformity 4.
Reasons for Ineffectiveness of Treatment
- Fine needle aspiration may not be effective in treating auricular hematoma if the hematoma is located within the cartilage itself rather than between the cartilage and perichondrium 2.
- The presence of granulation tissue and neo-cartilage within the cartilage can also make it difficult to treat the condition with needle aspiration alone 2.
- Open debridement may be necessary in some cases to effectively treat the condition and prevent further complications 2.
Complications of Untreated Auricular Hematoma
- Untreated auricular hematoma can result in complications such as perichondritis, infection, and necrosis 3, 4.
- Cauliflower ear can also result from long-standing loss of blood supply to the ear cartilage and formation of neocartilage from disrupted perichondrium 4.
- Management of cauliflower ear may involve excision of deformed cartilage and reshaping of the auricle 4.