Prevention and Surgical Management of Auricular Hematoma and Cauliflower Ear.

BACKGROUND

The cauliflower ear or wrestler's ear deformity results from an untreated auricular hematoma. This is due to neocartilage deposition and fibrosis secondary to perichondritis caused by the hematoma leading to the characteristic cauliflower ear appearance. Though some treatment options have been studied, the results have been inconsistent. This review aims to provide a systematic evaluation of available therapeutic strategies for the prevention and treatment of cauliflower ear.

METHODS

We performed a search in the Medline and Scopus databases for all articles published until May 2024. The endpoints were therapeutical strategies for the prevention and treatment of cauliflower ear. Functional, surgical, and aesthetic outcomes were collected.

RESULTS

Twenty-five articles were included; 17 of these studies pertained to prevention; and 8 to treatment of cauliflower ear. The general surgical approach for treating a case of cauliflower ear relies on the excision of the fibrocartilage resulting from inflammation using a scalpel or an ultrasonic aspirator. By surgically addressing the auricular hematoma, inflammation is minimized and a cauliflower ear can be avoided. Incision and drainage (I&D) was the primary approach used, followed by pressure dressings to prevent blood or serous fluid accumulation. Outcomes were generally satisfactory to the physicians and patients, and complications were minimally reported.

CONCLUSIONS

I&D remains at the cornerstone of the management of auricular hematoma and prevention of cauliflower ear. Should the deformity occur, excision of the newly formed cartilage is essential in restoring normal ear contour. More rigorous clinical studies reporting successes and complications are warranted to better study the outcomes of the various surgical approaches.

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