Matthew Doyle, MS, LAT, ATC. Definitions Pathogenesis Pathophysiology Treatment options What we do at the University of Iowa and why.

Matthew Doyle, MS, LAT, ATC

Definitions Pathogenesis Pathophysiology Treatment options What we do at the

University of Iowa and why

UNTREATED OR MISMANAGED AURICULAR HEMATOMA

FIBRO-NEOCARTILAGE FORMATION STARTS @ 7-10 DAYS

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

Classic teaching- Located between the perichondrium and cartilage

Within cartilage itself? Scaphoid fossa, helix,

anti-helix, conchal bowl

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?

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).

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

Perichondritis and chondritis; erythema, tenderness, recurrent swelling

Cartilage necrosis, contracture, and neocartilage

Cosmesis Reconstructive plastic surgery for cauliflower deformity

Functional Hearing loss Wax transport from the ear canal Increased risk of otitis externa Difficulty wearing earphones

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

Adequate removal of hematoma Simple and effective method of maintaining

pressure to prevent recurrence Satisfactory aesthetics Appropriate follow up Minimal impact on patient activity

Removal of hematoma Needle Aspiration Incision and drainage Incision and drainage with resection of cartilage

Prevention of reaccumulation Non-invasive Invasive

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

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

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

Collodion Casting Modified Headgear