Auricular haematoma an avoidable cosmetic deformity: A chance or negligence.

PURPOSE: This study highlights the importance of immediate intervention needed in cases of auricular trauma cases so as to prevents complications leading to cauliflower ear, loss of cartilage, necrosis. MATERIALS & METHODS: Total 10 cases of primary haematoma & recurrent cases were included in the study. A detailed history was entered in proforma. Procedure was done under local anaesthesia with all aseptic precautions. A cruciate incision was given over the most dependent part of the swelling and flaps were raised. The collection was drained and the under surface of the flap was scraped using Rosen''s knife followed by insertion of small drain tube and pressure dressing was done. Patients were followed up for three months. RESULTS: Out of the 10 cases 6 were primary cases and 4 were recurrent cases out of which males were 80% and females 20%. None of them showed recurrence. Overall cosmetic deformity was negligible with most of the patients. 1 patient developed perichondrial reaction with pain and inflammation which required long course of analgesics and antibiotics. In 3 cases a thickening of the auricle at the site of incision was noticed. CONCLUSION: Auricular haematoma most commonly is seen in male players of contact sports. These patients may land up in emergency department. Thus, by developing collaborative relationships with ENT specialists, emergency department can help ensure that patients experience possible treatment. This will help reduce the cosmetic deformities of pinna which are seen as complication of auricular haematoma.

Preventing Cauliflower Ear.

Traumatic auricular hematomas may be encountered in emergency care settings due to blunt trauma such as assaults or contact sports. Emergency nurse practitioners should be able to recognize and treat this injury to prevent complications. Treatment usually consists of evacuation of the hematoma by aspiration or incision and drainage using local or regional anesthesia, followed by the application of a pressure dressing or suturing. Without proper evacuation and steps to prevent reaccumulation, tissue necrosis and deformity (i.e., cauliflower ear) may occur.

Correction and Prevention of the Pixie Ear Deformity: A Combined Technique.

Background: Ear and earlobe deformities after surgical rhytidectomy are common and can significantly diminish the aesthetic outcome. The main causes of ear/earlobe distortion are skin overresection, an imbalance between vertical/horizontal skin-lift vectors, and tractional distortions through superficial muscularaponeurotic system (SMAS) tension. Objectives: To demonstrate a new method for earlobe suturing and ear fixation that would prevent aesthetics-related complications after facelift surgery. Methods: A total of 105 primary SMAS facelift surgeries were performed between 2015 and 2016 by the first author. A combination technique consisting of a posterior earlobe rotation flap (PERF) and a concha-mastoid suspension suture (CMSS) was executed bilaterally within each facelift procedure (n = 210). A retrospective data analysis was conducted (preoperatively and one year postoperatively) using our hospital information system and a photometric data analysis to assess auricular displacement, earlobe distortion, and hypertrophic scarring. Results: Pseudoptosis of the earlobe was noted in two cases, and auricular displacement was observed in four cases. Bilateral mild hypertrophic scarring was seen in one patient. The postoperative photometric analysis showed a natural ptosis grade I/II in all the patients, with a statistically significantly reduced postoperative earlobe size (P < 0.05). The total rate of aesthetics-related complications was 4% in our cohort (earlobe distortion with pseudoptosis: 1%; auricular displacement: 2%; hypertrophic scarring: 1%). Conclusions: Our modification of the facial flap anchoring at the ear base in combination with a CMSS stabilizes the natural position of the ear and prevents distortion while allowing better control over the earlobe's aesthetic shaping. This novel method reduces the incidence of ear/earlobe deformities and hypertrophic scarring at the ear base after rhytidectomy and, therefore, promises to be a valuable advancement.

Prosthetic conformer as a pressure device in the prophylactic management of postsurgical auricular keloid formation: a clinical report.

Keloids form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus, and contractures, keloids significantly affect the patient's quality of life, both physically and psychologically. Multiple studies have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate keloid formation, of which no single treatment has proven to be widely effective. Also, there is a dearth of information in the prosthodontic literature regarding appropriate management of such cases, especially when located in cosmetic areas. This clinical report presents an interdisciplinary cooperative approach between maxillofacial prosthetics and dermatology in prophylactic management of postsurgical auricular keloid. A new and an innovatively designed custom prosthesis for the management of the same is presented.

Managing auricular haematoma to prevent 'cauliflower ear'.

This article describes the typical signs of auricular haematoma, how people who have the condition should be treated in emergency departments and the problems that can arise if they are managed inappropriately.

High ear-piercing: an increasingly popular procedure with serious complications. Is good clinical practice exercised?

This study aimed to explore the current practice of performing high ear-piercing regarding consent protocols, and methods of practice using questionnaire-based survey in Hertfordshire and North London. Recommendations for good clinical practice are also made. 100 establishments performing ear piercing were identified. A 16-item questionnaire on techniques used, methods of high-ear piercing, methods of sterilization, consent issues and aftercare was completed. Seventy-six establishments agreed to participate. All practitioners prepared the skin before piercing. 58 (76%) used a needle for piercing, 11 (15%) used a spring-loaded gun and seven (9%) used both. 97% of the practitioners obtained written consent before proceeding. 9 (12%) had a lower age limit of 16 years and three (4%) of 18 years. 27 piercers (36%) provided an aftercare leaflet, 41 (54%) warned the patients about risks of infection, 16 (21%) warned about cosmetic deformity and 1 (1%) specifically mentioned cauliflower ear. Results indicated that high ear piercing is an invasive procedure with a significant risk of complications leading to cosmetic deformity. Establishments should be required to counsel patients properly about the risks and potential complications of the procedure. A code of practice should be drawn up with a minimum age for piercing, requirement for proper consent, excellent hygiene and good information for postoperative care.

Prevention of auricular deformity in children with diastrophic dysplasia.

In diastrophic dysplasia, auricular swelling commonly occurs in early infancy, inevitably leading to deformity. Till date, no description exists in the literature for the initial treatment of auricular swelling in this population. We present two siblings with diastrophic dysplasia on whom auricular swelling was treated with incision and drainage or conforming auricular molds. The ear treated with incision and drainage had worse outcome than those treated with pressure alone. This paper presents a novel but simple approach to the compression of auricular swelling in the setting of diastrophic dysplasia, using conforming molds with the goal of preventing permanent deformity.

A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters).

PURPOSE: This study aimed to describe a "bolsterless" technique for managing auricular hematomas in professional fighters. METHODS: Eight auricular hematomas were drained under local anesthesia by incising along an anatomical auricular crease. After evacuation of the hematoma and copious irrigation, the resultant skin flap was replaced in anatomical position, and through-and-through absorbable mattress sutures were used to secure the flap in place. Incision sites were left open and dressed with antimicrobial ointment. No bolsters were placed. The patients were given 1 week of oral antibiotic therapy. RESULTS: All 8 hematomas resolved without further intervention. All 8 ears returned to their preinjury cosmetic state. Fighters were able to return to training within a week of the initial injury. No postoperative infections or other complications were noted. CONCLUSIONS: In contrast to wrestlers, mixed martial artists (also called "ultimate fighters") do not routinely wear protective head gear. As a result, they are at increased risk of recurrent auricular hematomas, often resulting in severe auricular deformities (cauliflower ear). These patients are anxious to return to training and fighting, and are reluctant to wear a bolster after repair. At their urging, we agreed to attempt this bolsterless technique. Although 2 patients in this series already had a significant cauliflower ear before being treated for the current hematoma, in all cases the auricle returned to its preinjury condition. Bolsterless treatment using mattress sutures and cosmetically placed incisions represents a successful technique for management of auricular hematomas in this population.

Reducing the incidence of ear deformity in facelift.

BACKGROUND: The telltale signs associated with facelift procedures, including tightening of the lower face (lateral sweep), visible scars, a distorted hairline, and the "pixie ear" deformity are grounds for concern among both patients and aesthetic surgeons. It is the author's belief that facelift results can be improved with correct positioning of the ears, so that these signs are reduced or eliminated altogether. OBJECTIVE: The purpose of this paper is to study the causes of ear deformity and describe the advantages of the author's technique for the prevention of ear deformities in facelift surgeries. METHODS: Between January 2005 and November 2007, the author performed facelifts on 106 patients using a technique that included autologous fat injections to improve facial volume, hidden incisions in and around the ear, and absorbable bidirectional barbed sutures. Patient charts and photographs were reviewed retrospectively. Pre- and postoperative angles were measured with respect to the ear and face and were documented to determine the degree of improvement or deformity. RESULTS: Significant improvement of the specified angles was noted in 70% of cases following facelift surgery; in these cases, the ear position was elevated. No change in ear position occurred in 10% of cases. Some distortion and lowering of the ear was seen in the remaining cases. CONCLUSIONS: Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures can aid in achieving improved aesthetic results. The advantages of the author's technique include shorter incisions, a diminished need to remove redundant skin, ear elevation, and a smoother repair with improved contour. Further investigation of long-term results is necessary.

How to harvest the maximal amount of conchal cartilage grafts.

SUMMARY: Using the conchal cartilage as a graft has been widely accepted, but the deformities that can result have been underestimated. The deformities range from a visible scar to the total collapse of the ear framework. A simplified technique of harvesting the maximal amount of the conchal cartilage graft is suggested, based on the results of 16 consecutive cases. The technique involved (1) using a postauricular incision to minimise visible scars, (2) harvesting the entire cymba concha and cavum concha separately, with at least 5mm of the helical crus, leaving a lateral extension as a strut between them, as well as a 2mm outer rim along the conchal wall, and (3) by using a tie-over bolster dressing that can serve as a mould for the conchal bowl. This technique has been used on 16 patients with neither contour irregularity nor any deformity, from a case of a step deformity to the total collapse of the ear.

Treatment of pinna haematoma with compression using Leonard buttons.

The standard treatment of a pinna haematoma involves drainage and compression to prevent recurrence and subsequent disfigurement. Compressive methods can be non-invasive or invasive, utilising a head bandage or through and through sutures, respectively, to keep compression in place. Leonard buttons are effective alternative compressive devices. They are simple to use and easily available.

Case presentation: a novel way of treating acute cauliflower ear in a professional rugby player.

Acute auricular haematoma is a common problem in rugby players and can be difficult to treat due to re-accumulation of the fluid and can subsequently cause the unsightly cauliflower ear. We present a case of auricular haematoma affecting the central part of the pinna in a professional rugby player. This was treated successfully by aspiration and the use of silicone splints which allowed the player to continue training and competing.

Simple compressive method for treatment of auricular haematoma using dental silicone material.

Most of the previous treatment methods for auricular haematoma are inconvenient for both patients and doctors because they are time-consuming and complex and must be performed under sterile conditions. The purpose of this study was to evaluate the effectiveness of a simple compressive method using a dental (silicone) impression material and comparing it with other methods for treatment of auricular haematomas. The authors aspirated a haematoma and then placed a mixed base and catalyst of silicone putty material on the anterior and posterior surfaces of the auricle in the shape of an inverted U for seven days. From the 24 cases managed with this method, 23 cases (95.8 per cent) were successfully healed. Eight patients were treated with a collodion-cotton wool cast and 16 of 19 patients were successfully treated with dental cotton-wool rolls. The average number of those visiting the hospital was 2.7 for the collodion-cotton wool cast, 6.9 for the dental cotton-wool roll, and 3.1 for dental silicone. The mean treatment durations were 8.1 days for the collodion-cotton wool cast, 13.8 days for the dental cotton-wool roll, and 8.6 days for dental silicone. The authors believe that this compressive method using dental silicone material is simple and appropriate for the treatment of auricular haematoma.

Otoplasty: sequencing the operation for improved results.

LEARNING OBJECTIVES: : After studying this article, the participant should be able to: 1. Understand the anatomy and embryology of the external ear. 2. Understand the anatomic causes of the prominent ear. 3. Understand the operative maneuvers used to shape the external ear. 4. Be able to sequence the otoplasty for consistent results. 5. Understand the possible complications of the otoplasty procedure. Correction of prominent ears is a common plastic surgical procedure. Proper execution of the surgical techniques is dependent on the surgeon's understanding of the surgical procedure. This understanding is best founded on an understanding of the historical bases for the operative steps and the execution of these operative steps in a logical fashion. This article describes the concept of sequencing the operation of otoplasty to produce predictable results combining the technical contributions from many authors. The historical, embryological, and anatomic bases for the operation are also discussed. Finally, the authors' preferred techniques are presented. Sequencing the steps in the preoperative assessment, preoperative planning, patient management, operative technique, and postoperative care will produce reproducible results for the attentive surgeon. Careful attention to the details of the operation of otoplasty will avoid many postoperative problems.

Interventions for acute auricular haematoma.

BACKGROUND: Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity. OBJECTIVES: To assess the effectiveness of treatment options in acute auricular haematoma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003. SELECTION CRITERIA: Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma. DATA COLLECTION AND ANALYSIS: Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria. MAIN RESULTS: Due to the lack of data from trials fulfilling selection criteria no results could be presented. REVIEWERS' CONCLUSIONS: There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.