Monday, August 4, 2008

Mangled Ear--a badge of honor?

Dr Sid Schwab alerted me to this news article.

A familiar chasm separates what women dig from what dudes imagine women dig. But for mixed martial arts, a combination of boxing, wrestling and jiu-jitsu that has found favor among young men, cauliflower ear has assumed a place alongside such evocative conditions as torn elbow ligaments in pitchers, knee tendinitis in marathon runners and torn anterior cruciate ligaments in female basketball players.

In gym locker rooms and online discussion forums, teenage boys trade advice on ways to gain that telltale look.

“It’s man’s ear,” said Nisar Loynab, 15, who trains at Capital Jiu-Jitsu in Alexandria, Va. “When you get cauliflower, you’re really a man.”

 

Interesting that this deformity is finding favor.  I posted the following on cauliflower ear last September. 

 

Cauliflower ear is an acquired deformity of the outer ear. It is not related to the vegetable--cauliflower and I have not been able to find why it came to be called such. Though there is some similarity between how the two look. Photo credit


Because of it's location, the ear is vulnerable to blunt trauma. A blunt blow to the external ear can cause bruising between the cartilage and the layer of connective tissue around it (perichondrium). When blood collects in this area, the external ear becomes swollen and purple. The collected blood (hematoma) can cut off the blood supply to the cartilage, allowing that portion of the cartilage to die, leading in time to a deformed ear. This deformity is common among wrestlers, boxers, and rugby players. (photos credit)

The cartilage of the ear has no other blood supply except that supplied by the overlying skin. When the skin is pulled from the cartilage, and/or separated from the cartilage by blood (as with accumulated blood from injury called a hematoma) or infection, the cartilage is deprived of important nutrients. Ultimately, the cartilage dies and the risk of infection is increased. Left untreated, the ear cartilage begins to contract on itself forming a shriveled up outer ear classically known as the cauliflower ear deformity. Once there is cartilage death and scarring (fibrosis), the resulting deformity is very difficult to reconstruct (if at all possible). Often the victim is left with a permanent deformity. (photo credit)

Common causes of cauliflower ear deformity include previous trauma, relapsing polychondritis, perichondritis, and Hansen’s disease. These are very diverse diseases, which vary significantly in their therapeutic strategies. With no history of trauma, these other causes should not be overlooked.

Treatment
"The review found no trials of good quality to demonstrate that any one technique, which removes the hematoma and prevents its recurrence, gives the best cosmetic outcome. The literature however generally suggests that treatment is better than leaving a hematoma untreated. Well designed studies are required."--4th reference below.

With that said, it is generally accepted that the hematoma needs to be evacuated. This may be done by incising the skin and removing the blood with suction or by inserting a needle and aspirating. After the hematoma is empty, a compression dressing is applied and left on for 3 to 7 days to prevent the hematoma from coming back. (photo set from sixth reference article)

The dressing keeps the skin and perichondrium in their normal positions, allowing blood to reach the cartilage again. Sometimes through-and-through ear sutures over dental gauze rolls or insertion of a Penrose drain plus a pressure dressing is used. Because these injuries are prone to infection, an oral antibiotic effective against staphylococci (eg, cephalexin 500 mg TID X 5 days).

When treated aggressively and promptly, the cauliflower ear deformity is unlikely. Any delay in diagnosis leads to more difficulty in managing this problem and the risk of deformity is greater.

Prevention

Wearing the right headgear when playing sports - especially contact sports - is a must. Helmets can not only save you from developing cauliflower ear but protect you from serious head injury as well. Always wear a helmet if you are biking, blading, riding your scooter, or playing any sport where helmets or other forms of headgear are recommended or required (like football, baseball, hockey, boxing, or wrestling). Products like Impact can add more protection when playing sports like rugby.

REFERENCES

Bilateral Cauliflower Ear Deformity: An Unusual Presentation of Cutaneous Rosai-Dorfman Disease; Plastic & Reconstructive Surgery. 113(3):967-969, March 2004; Oo, Kenneth K. K. M.B., B.S.; Pang, Yoke T. F.R.C.S., F.A.M.S.; Thamboo, Thomas P. M.B., Ch.B.

Relapsing Polychondritis, MedScape Article posted 02/24/2004; Peter D. Kent; Clement J. Michet, Jr; Harvinder S. Luthra

External Ear Trauma--Merck Medicus

Interventions for acute auricular haematoma; Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004166. DOI: 10.1002/14651858.CD004166.pub2; Jones SEM, Mahendran S

Cauliflower Ear--MedicineNet.com article

Management of Auricular Hematoma Using a Thermoplastic Splint; Arch Otolaryngol Head Neck Surg.2000;126:888-890; Henderson,JM, Salama, AR, Blanchaert Jr, RH

Wrestlers Cauliflower Ear; Care & Prevention; Anthony Donatelli, M.D.

2 comments:

gurdonark said...

This makes me curious whether, in fact, patients ask to have surgery to cure this condition. I know that many would not want to "have" cauliflower ear, but I wonder how many seek a treatment "remedy" for it.

rlbates said...

I don't have a good answer, and not sure I've seen one in my journals. I do know that once a "cauliflower" ear forms, it is almost impossible to return to normal. If caught when the hematoma forms and treated then, it can be prevented.