Patient will present as → a 22-year-old mixed martial arts practitioner who was injured during a match which has resulted in a fluctuant, mildly tender edematous lesion of the anterior-superior outer portion of the right pinna
Results from direct trauma to the anterior auricle. Shearing forces to the anterior auricle lead to separation of the anterior auricle perichondrium from the underlying cartilage.
- This is frequently caused by blunt trauma such as that experienced by wrestlers, boxers, and martial artists
- Because the cartilage's blood supply is provided by the perichondrium, separation of the perichondrium from both sides of the cartilage may lead to avascular necrosis and a deformed pinna (cauliflower ear) if not treated promptly
- Septic necrosis may also ensue, often with infection by gram-negative bacilli
All auricular hematomas should be drained as soon as possible after injury
- Hematomas greater than seven days old may have begun to organize and form granulation tissue and warrant referral to an otolaryngologist or plastic surgeon
Refer to otolaryngology for definitive treatment with I & D and pressure dressing
Perform I & D only if the pinna becomes erythematous and extremely tender
See A for explanation
Prescribe a 10-day course of amoxicillin/clavulanate (Augmentin) and schedule a follow-up appointment in 2 weeks
Although antibiotics are frequently given in addition to I & D, they will not prevent tissue necrosis.
Apply a soft bulky dressing to the pinna and recommend no further treatment, but have the patient follow-up only if he develops a temperature greater than 101 degrees
A pressure dressing is applied after I & D.