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Trauma to the external ear may result in hematoma, laceration, avulsion, or fracture.
Subperichondral hematomas:
Blunt trauma to the pinna may cause a subperichondrial hematoma; the accumulation of blood between the perichondrium and cartilage renders all or part of the pinna a shapeless, reddish purple mass. Because the perichondrium supplies blood to the cartilage, infection, abscess formation, or avascular necrosis of the cartilage may follow. The resultant destruction causes the cauliflower ear characteristic of wrestlers and boxers.
Treatment consists of 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, an oral antibiotic effective against staphylococci (eg, cephalexin 500 mg tid) is given for 5 days.
Lacerations:
If lacerations of the pinna penetrate the cartilage and skin on both sides, the skin margins are sutured; then the cartilage is splinted externally with benzoin-impregnated cotton, and a protective dressing is applied. If there is sufficient skin to fully cover the cartilage, the cartilage should be repaired. Otherwise, external splinting suffices. Oral antibiotics are given as for a hematoma.
Avulsions:
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.
Last full review/revision November 2006 by Sam P. Most, MD
Content last modified February 2010
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