Cauliflower Ear

Cauliflower ear by Dr.Catherine Huang-Begovic

 

Cauliflower ear – we’ve all seen it.  What is it, what causes it, and how do you treat it?

Cauliflower ear is a deformity of the external ear resulting in thickening, scarring, and disfigurement of the ear.  Many fighters, wrestlers, and athletes develop this condition as a result of trauma to their ear.  The external ear is made of cartilage covered by perichonidrium (covering for cartilage) covered by skin.  When an ear is injured, a pool of blood (hematoma) forms over the cartilage and traumatically separates it from the skin.  The local inflammatory reaction to the blood causes formation of scar and new cartilage on top of the normal structure thus forming heaps of tissue that looks like cauliflower – giving this condition the name “cauliflower ear.”

The best treatment is to prevent this thick scar formation by draining the blood and re-draping the skin and perichondrium onto the cartilage as soon as possible.  The sooner this is done, the better.  This means within a few hours.  Waiting a day or two significantly increases your chances of forming thick scar.   Also, putting a pressure dressing on the site is crucial to prevent the hematoma from reforming.  I personally like to sew a bolster on each side of the ear to create a sandwich and re-shape the contour of the ear.  It’s worked well in preserving a nice cosmetic shape to the ear, even in extreme trauma cases.

In the cases where the scar forms, the treatment for cauliflower ear is very difficult.  Advanced reconstructive surgery will need to be performed.  The scar needs to be removed and sometimes the cartilage needs to be reshaped and covered with repositioned skin.  

Sometimes cartilage needs to be rebuilt with cartilage borrowed from other areas of the body.    Local flaps and skin grafting may be needed to try to reconstruct the ear.  Each patient needs to be assessed individually and the solution tailored specifically and precisely by an experienced plastic and reconstructive surgeon.  However, despite the best efforts, the ear will almost always never look completely back to normal and scar formation can recur.

Cauliflower ear is a difficult problem to fix and I cannot stress enough the importance of prevention.  Ear protection should be worn when possible.  In the cases where a hematoma forms, an experienced doctor should drain it immediately.  Otherwise, thick scar will form, and only complex surgery and often multiple surgeries may necessary to bring the ear back to a more normal shape.

Dr. Cat Huang Begovic
Plastic & Reconstructive Surgeon