Cauliflower Ear

Excerpt

Cauliflower ear deformity descriptions date back to early Roman and Greek history. Literary and artistic collections from those periods are replete with accounts of the deformed or damaged ears of wrestlers, boxers, and other pugilists. Notably, the term "earmark" was coined during this period because wrestlers could be recognized by the characteristic appearance of their misshapen pinnae.

Medical appreciation for this affliction has a similar storied past. Though case descriptions may be found in Hippocrates' works, formal research into the disease did not begin until the mid-1800s. A second idiopathic mechanism was thought at the time to be responsible for cauliflower ear deformity besides direct trauma. The idiopathic hypothesis is derived from observations of people of advanced age or with mental health conditions.

The more conventional understanding of cauliflower ear developed in the 20th century, relating the pathology to a maladaptive and overly exuberant inflammatory response to the presence of an auricular hematoma or abscess (see Image. Auricular Hematoma). However, patients often find cauliflower ear deformity to be both unsightly and inconvenient, regardless of the cause. The condition may interfere with earphone-wearing, which is popular in modern times. Thus, preventing and treating this condition are important for emergency healthcare providers and surgical specialists.

Auricular Histology

The outer ear comprises several layers crucial for its function and protection. The skin covers both the external ear canal and auricle. The outer ear skin has essential structures, including hair follicles, sebaceous glands, and sweat glands, offering defense against environmental factors and aiding in temperature regulation. The epidermis is comprised of stratified squamous epithelium, providing a barrier against pathogens and preventing water loss. The dermis is situated below the epidermis, housing blood vessels, nerves, and connective tissue, providing structural support, and supplying nutrients to the overlying layers.

The auricle's core structural component is elastic cartilage, responsible for its shape and flexibility. Chondrocytes lie within a matrix of collagen and elastin fibers, though cartilage is poorly vascularized. The perichondrium is a layer of fibrous tissue surrounding the cartilage. This layer offers structural support to the elastic cartilage, supplies oxygen and nutrients to cartilage cells through its rich vascular supply, and contains chondroblasts responsible for cartilage repair and growth. The perichondrium also serves as an attachment site for the overlying skin, anchoring it in place and ensuring the auricle's integrity.

Notably, the outer ear's anatomy exhibits distinct features. The concave (inner or anterior) side has a thin subcutaneous layer and is closely attached to the auricular perichondrium. In contrast, the auricle's convex (outer or posterior) side has a thicker subcutaneous stratum and a muscle layer superficial to the perichondrium. The auricle remains susceptible to environmental influences and trauma despite its protective layers. Structural disruption can lead to complications like cauliflower ear deformity.