1. Matthew Doyle, MS, LAT, ATC

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

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

5.  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.  Classic teaching- Located between the perichondrium and cartilage  Within cartilage itself?  Scaphoid fossa, helix, anti-helix, conchal bowl

7.  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?

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

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

16.  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

25.  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.  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.  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.  Collodion Casting  Modified Headgear