Rugby ears (petrified auricles)
A professional rugby player presented to the ED following a head clash during a match. There was loss of consciousness for 10 minutes, but on arrival he had a GCS of 15/15.
Unenhanced CT brain
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Indication: Blunt head injury with 10 minute loss of consciousness.
Incidental finding of petrified auricles, otherwise normal CT brain.
Petrified auricles as a complication of traumatic auricular haematoma is most common among forwards in the rugby union, but is also seen in participants of other contact sports such as boxing, wrestling, mixed martial arts and vale tudo1. Acrobatic manipulation of ears by teenagers has been described as the aetiology2. The condition has also been described as a complication of bluetooth headset use3.
Cauliflower ear is the name given to auricular hematoma that occurs due to blunt trauma, and is left untreated. The precise location of the hematoma is unclear, but positions between the perichondrium and cartilage, or intracartilaginous have been proposed. Complications include infection, cartilage necrosis, contracture, and neocartilage formation, with eventual ossification. This can be prevented by prompt treatment, such as aspiration and silicone splints (5).
- 1. Clarke JT, Clarke LE, Miller JJ. Petrified ears: calcification of the auricular cartilage. J. Am. Acad. Dermatol. 2004;51 (5): 799-800. doi:10.1016/j.jaad.2004.06.035 - Pubmed citation
- 2. Lari AA, Al-Rabah N, Dashti H. Acrobatic ears: a cause of petrified auricles. Br J Plast Surg. 1990;42 (6): 719-21. Pubmed citation
- 3. Britton KM, Schultz JC, Smith CF. Petrified ear: a complication of bluetooth headset use. Arch Dermatol. 01;145 (9): 1065-6. doi:10.1001/archdermatol.2009.196 - Pubmed citation
- 4. Kathryn E. Buikema and Erin G. Adams, “A Rare Case of Petrified Ear,” Case Reports in Dermatological Medicine, vol. 2012, Article ID 410601, 4 pages, 2012. doi:10.1155/2012/410601
- 5. Macdonald DJ, Calder N, Perrett G et-al. Case presentation: a novel way of treating acute cauliflower ear in a professional rugby player. Br J Sports Med. 2005;39 (6): e29-e29. Br J Sports Med (full text) - doi:10.1136/bjsm.2004.015115 - Free text at pubmed - Pubmed citation