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External Ear Trauma

By Sam P. Most, MD, Chief, Division of Facial Plastic and Reconstructive Surgery, and Professor, Departments of Otolaryngology-Head & Neck Surgery (Plastic), Stanford University School of Medicine

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Trauma to the external ear may result in hematoma, laceration, avulsion, or fracture.

Subperichondrial hematoma (cauliflower ear)

The perichondrium supplies blood to the auricular cartilage. Blunt trauma to the pinna may cause a subperichondrial hematoma; the accumulation of large amounts of blood between the perichondrium and cartilage can interrupt the blood supply to the cartilage and render all or part of the pinna a shapeless, reddish purple mass. Avascular necrosis of the cartilage may follow. The resultant destruction causes the cauliflower ear characteristic of wrestlers and boxers.

Treatment consists of promptly evacuating the clot through an incision and preventing reaccumulation of the hematoma with through-and-through ear sutures over dental gauze rolls or insertion of a Penrose drain plus a pressure dressing. Because these injuries are prone to infection and abscess formation, an oral antibiotic effective against staphylococci (eg, cephalexin 500 mg tid) is given for 5 days.

Pearls & Pitfalls

  • Failure to drain a subperichondrial hematoma may lead to permanent external ear deformity.


In lacerations of the pinna, the skin margins are sutured whenever possible. If the cartilage is penetrated, it is repaired unless there is not enough skin to cover it. Damaged cartilage, whether repaired or not, is splinted externally with benzoin-impregnated cotton, and a protective dressing is applied. Oral antibiotics are given as for a hematoma.

Human bite wounds are at high risk of infection, including infection of the cartilage, a potentially severe complication. Treatment includes meticulous debridement of devitalized tissue, prophylactic antibiotics (eg, amoxicillin/clavulanate 500 to 875 mg po bid for 3 days) and possibly antivirals (see Table: Human and Mammal Bites : Antimicrobials). Wounds < 12 h old can be closed but older wounds should be allowed to heal secondarily, with cosmetic deformities treated later.


Complete or partial avulsions are repaired by an otolaryngologist, facial plastic surgeon, or plastic surgeon.

Trauma secondary to mandibular fractures

Forceful blows to the mandible may be transmitted to the anterior wall of the ear canal (posterior wall of the glenoid fossa). Displaced fragments from a fractured anterior wall may cause stenosis of the canal and must be reduced or removed surgically after a general anesthetic is given.

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