2023-08-15 11:59:02
Othematoma: a pathology of wrestlers, rugby players and judokas
At the level of the anterior surface of the pavilion of the ear, the skin is tightly adherent to the perichondrium – namely the connective tissue membrane that envelops the cartilage – due to the absence of subcutaneous tissue. Thus, during repeated trauma related to contacts during the scrum in particular, the anterior surface is often subject to ruptures of the perichondrium. “It is a vascular rupture between the perichondrium and the cartilage, causing bleeding and the formation of a hematoma: we speak of an othematoma” describes Dr. Durand.
This thematoma is characterized by swelling, often painful and purplishat the level of the anterior surface of the pavilion.
The othématome corresponds to the acute phase of the pathology and it is at this moment that the management must be done to prevent the ears from keeping this deformed cauliflower appearance. Dr Nicolas Durand, ENT doctor
The othématome is not only the prerogative of rugby players, and can concern all contact and combat sports such as judo, MMA, wrestling or even kick-boxing.
Explanations: How do puffy, so-called “cauliflower” ears form?
The othématome therefore corresponds to the acute phase ear deformity. “The cauliflower aspect that you see in former players is the long-term consequence of a succession of insufficiently evacuated othematomas. A breach forms in the perichondrium, allowing the cells that make the cartilage to come and colonize the hematoma, and ultimately causing necrosis and deformation of the cartilaginous structure of the pinna of the ear“explains the specialist.
What are the potential complications ?
In the acute phase of the thematoma, the main possible complications are cartilage inflammation – chondrite – or infection of the perichondrium – perichondritis – requiring antiseptic care and prolonged antibiotic therapy. This infection needs to be treated quickly at the risk that it progresses to necrosis or even destruction of the cartilage tissue.
Treatment: How to evacuate the hematoma and treat the cauliflower ear?
The first thing to do in case of a thematoma is toevacuate the blood collection in the pavilionto avoid scarring.
“The players must be punctured quickly, in the days following the trauma” insists the specialist.
While there are several techniques, the simplest and least invasive is to puncture the hematoma with a needle of good caliber (18 Gauges), under strict aseptic conditions and under local anesthesia.
“If hematoma is too old or recurrent, we prefer a drainage chirurgical in the operating room, using an incision at the level of the hematoma” specifies Dr Durand.
What regarding cosmetic surgery?
Once the lesions are scarred and the ear looks like a cauliflower, there are cosmetic surgery procedures that can be offered to try to restore the normal shape of the ear. “It’s regarding a modeling resection during which the damaged cartilage is removed. But the results are generally unsatisfactory and the risk of infections is real” Tempers the surgeon. This malformation generally has no impact on health.
Repair surgery is rarely requested by players, who see these cauliflower ears as a sign of belonging to the great family of professional rugby and sometimes even take a certain pride in it.
Like the former player of the XV of France, Marc de Rougemont, who always speaks with pleasure of his deformed ears.
How to protect the ears in rugby?
The prevalence of othematomas has decreased significantly since the early 2000s, following adaptations of the rules, in particular concerning the scrum. “La phase d’melee entry has notably become less brutal. Players must be placed before pushing, whereas before, they suddenly entered the fray” describes the specialist.
The risks vary greatly depending on the position. “Those most affected by ear injuries are those who play in front, on the first 3 linesnamely the numbers 1 to 8“ emphasizes Dr. Durand.
For these players, prevention mainly involves wearing protective gear – headband or helmet – and the application of vaseline, allowing the skin to slip and thus limiting the risk of tearing the connective tissue membrane.
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