Pinna haematoma and cauliflower ear
A pinna haematoma is blood collecting in the visible outer ear, lifting the perichondrium (the layer that wraps the cartilage) and, if untreated, can leave a thick, lumpy cauliflower ear.
Remember
Blood under the perichondrium starves the cartilage, which has no blood vessels of its own, so a pinna haematoma needs prompt drainage and splinting to prevent cauliflower ear.
Memory aid
Think of the perichondrium as the delivery van and the cartilage as a shop with no other supplier.
When blood lifts the perichondrium away, the van no longer reaches the shop, so the cartilage is starved.
The pinna is the visible part of the outer ear. It is built around cartilage, the springy framework of the outer ear, and the cartilage is covered by a thin connective-tissue layer called the perichondrium. The cartilage of the outer ear is avascular, meaning it has no blood vessels of its own, so it depends on the perichondrium for its nutrients.
A blow to the ear can tear tiny vessels and let blood collect in the thin plane between the cartilage and the perichondrium. That collection is a pinna haematoma. Boxers, wrestlers and rugby players are the classic patients. The clot lifts the perichondrium away, so the cartilage loses its nutrient supply, and the pressure of the blood makes matters worse.
If the haematoma is left, the cartilage can die (necrosis). It then heals with scar tissue (fibrosis) and irregular new cartilage, which leaves a thick, lumpy ear called cauliflower ear, and the change is permanent. Infection of the perichondrium (infective perichondritis) is also a recognised complication, but the deformity is the classic outcome.
Treatment is to drain the blood promptly and then splint the ear or apply a pressure dressing. Once the blood is drained, splinting or a pressure dressing holds the perichondrium against the cartilage, so the cartilage's blood supply is restored and the blood is stopped from collecting again.
Key facts
- Site
- the blood sits between the cartilage and its covering perichondrium, in the outer ear (the pinna).
- Mechanism
- the cartilage has no blood vessels of its own, so lifting the perichondrium off starves it of oxygen and nutrients.
- If untreated
- cartilage necrosis and fibrosis can leave a permanent cauliflower ear.
- Treatment
- prompt drainage, then splinting or a pressure dressing.
- Typical patients
- boxers, wrestlers and rugby players.
- Complication
- infection of the perichondrium (infective perichondritis) is also recognised, but the classic outcome is the deformity.
Exam traps
- A pinna haematoma is drained to save the cartilage, not to protect hearing, because the collection of blood lies on the pinna, outside the ear canal, and the danger is loss of the cartilage's blood supply.
- Infection of the cartilage can complicate an untreated pinna haematoma, but it is not what directly produces cauliflower ear, which follows cartilage ischaemia even when the collection is not infected.
- A fracture of the cartilage is not the main mechanism of cauliflower ear: the real problem is blood lifting the perichondrium off and starving the cartilage, and fibrosis follows that loss of blood supply rather than the break.
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