Cauliflower deformation of the ear has been known for over a thousand years since the Greeks in paintings and sculptures imaged pugilists and wrestlers. Its cause, however, has only become more recently known as the result of auricular trauma and subsequent hematoma. Once a bleed and hematoma occur under the perichondrium (from shearing trauma to the ear), if it is not removed in a timely manner, will result in new cartilage formation. The delicate framework of the ear with its many concavities and ridges does not have more than a few millimeters of thickness. Cartilage thickening can easily deform how the ear looks.
Ear trauma and hematoma is a common injury occurring among high school and collegiate wrestlers in particular. Incision and drainage followed by the immediate application of a pressure dressing sutured to the ear is the treatment approach. In my Indianapolis plastic surgery practice, I prefer to shape a xeroform bolster, like that used for securing a skin graft, over the evacuated hematoma area and use through and through ear sutures to hold it into place. This precisely adapts the overlying skin back down to the cartilage, eliminating any chance of recurrence and preventing neocartilage formation.This stays in place for about seven to ten days and is easily removed. It also allows a rapid return to athletic competition.
Once a cauliflower ear is established, successful treatment is more difficult. I have found one treatment approach that is successful. Skin flaps are initially raised over the deformed part of the ear. The easiest method is to place an incision along the antihelix and raise it towards the face. Most of the ear skin can be degloved without vascular compromise if needed by using an incision on the backside of the helical rim. Cartilage must next be removed. Since the goal is usually to recreate an obscured concavity, the deformed cartilage can be thinned down on its outer surface or a new concavity can be made by removing full-thickness cartilage. Like making an ear cartilage framework, structure is only needed for the tiers or prominent ridges. Once the ear shape is recreated, the skin is put back and bolsters applied over the new concave areas.
Both the primary and secondary treatment of the cauliflower ear deformity is based on removal of the underlying cause (blood and cartilage growth) and eliminating any space afterwards between the cartilage and the overlying skin. Custom-shaped bolster dressings are critical to the success of this form of ear reconstruction.
Dr. Barry Eppley
Indianapolis, Indiana