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10:40, 12 April 2024: 2406:2d40:20ba:6c10:4db2:729e:51f8:a8f6 (talk) triggered filter 1,296, performing the action "edit" on Cauliflower ear. Actions taken: none; Filter description: Mixed-use words (logging) (examine | diff)

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Old page wikitext, before the edit ($1) `(old_wikitext)`	'{{short description\|Permanent deformity caused by physical trauma to the ear}} {{Infobox medical condition (new) \| name = Cauliflower ear \| image = Erckscauliflowerear.jpg \| caption = Cauliflower ear \| field = [[Otorhinolaryngology]] \| width = 220 \| oMIM_mult = \| symptoms = \| complications = \| onset = \| duration = \| types = \| causes = \| risks = \| diagnosis = \| differential = \| prevention = \| treatment = \| medication = \| prognosis = \| frequency = \| deaths = }} '''Cauliflower ear''' is an irreversible condition that occurs when the [[Auricle (anatomy)\|external portion of the ear]] is hit and develops a [[Thrombus\|blood clot]] or other collection of fluid under the [[perichondrium]]. This separates the [[cartilage]] from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a [[cauliflower]], hence the name. The condition is common in [[martial art]]s such as [[Brazilian jiu-jitsu]], [[wrestling]], [[boxing]], [[kickboxing]], [[judo]], [[sumo]], or [[mixed martial arts]], and in full-contact sports such as [[rugby league]] or [[rugby union]]. == Presentation== People presenting with possible auricular [[hematoma]] often have additional injuries (for example, head/neck lacerations) due to the frequently traumatic causes of auricular hematoma. The ear itself is often tense, fluctuant, and tender with throbbing pain. However, because of potentially more remarkable injuries often associated with auricular hematoma, auricular hematoma can easily be overlooked without directed attention.<ref name="Ingvaldsen et al">{{cite journal \|last1=Ingvaldsen \|first1=Christoffer A. \|last2=Tønseth \|first2=Kim A. \|year=2017 \|title=Auricular haematoma \|journal=Tidsskrift for den Norske Laegeforening \|volume=137 \|issue=2 \|pages=105–107 \|doi=10.4045/tidsskr.15.1279 \|pmid=28127072 \|doi-access=free}}</ref> === Diagnosis === [[Perichondral\|Perichondral hematoma]] and consequently cauliflower ear are diagnosed clinically. This means that the medical provider will make the diagnosis by using elements of the history of the injury (examples: participation in contact sports, trauma to the ear, previous similar episodes) and combine this with findings on physical exam (examples: tenderness to the area, bruising, deformation of the ear contours) to confirm the diagnosis and decide on the appropriate treatment for the patient.<ref name=":1" /> [[File:Shawn's cauliflower ear.jpg\|thumb\|Cauliflower ear in an MMA fighter]] To assist with settling on the best form of treatment for cauliflower ear Yotsuyanagi et al. created a classification system for deciding when surgery is needed and to guide the best approach.<ref name=":2">{{Cite journal \|last1=Yotsuyanagi \|first1=Takatoshi \|last2=Yamashita \|first2=Ken \|last3=Urushidate \|first3=Satoshi \|last4=Yokoi \|first4=Katsunori \|last5=Sawada \|first5=Yukimasa \|last6=Miyazaki \|first6=Souichiro \|date=July 2002 \|title=Surgical correction of cauliflower ear \|journal=British Journal of Plastic Surgery \|volume=55 \|issue=5 \|pages=380–386 \|doi=10.1054/bjps.2002.3854 \|issn=0007-1226 \|pmid=12372365}}</ref> {\| class="wikitable" \|+Classification of cauliflower ear<ref name=":2" /> ! colspan="2" \|Type 1: Minimal deformity with no or slight changes to the outline of the ear ! colspan="2" \|Type 2: Substantial deformity of the outline of the ear \|- \|Type 1A \|Deformity is restricted to the concha of the ear \|Type 2A \|The structural integrity of the ear is intact \|- \|Type 1B \|Deformity that extends from the antihelix to the helix of the ear \|Type 2B \|Poor structural integrity of the ear \|- \|Type 1C \|Deformity that extends throughout the outer ear \| \| \|} ==Causes== The most common cause of cauliflower ear is [[blunt trauma]] to the ear leading to a hematoma which, if left untreated, eventually heals to give the distinct appearance of cauliflower ear. Most commonly coming from participating in grappling and combat sports such as [[Brazilian jiu-jitsu]] and [[mixed martial arts]]. The structure of the ear is supported by a cartilaginous scaffold consisting of the following distinct components: the helix, [[antihelix]], [[Auricle (anatomy)\|concha]], [[tragus (ear)\|tragus]], and [[antitragus]].<ref name="Ingvaldsen et al"/> The skin that covers this cartilage is extremely thin with virtually no subcutaneous fat while also strongly attached to the perichondrium, which is richly vascularized to supply the avascular cartilage.<ref name="Ingvaldsen et al"/> Cauliflower ear can also present in the setting of nontraumatic inflammatory injury of auricular connective tissue such as in [[relapsing polychondritis]] (RP), a rare [[rheumatologic]] disorder in which recurrent episodes of inflammation result in destruction of cartilage of the ears and nose.<ref name="Relapsing polychondritis">{{cite journal \|last1=Rapini \|title=Relapsing polychondritis. \|journal=Clin. Dermatol. \|volume=24 \|issue=6 \|pages=482–5 \|doi=10.1016/j.clindermatol.2006.07.018 \|pmid=17113965\|year=2006 }}</ref> Joints, eyes, audiovestibular system, cardiovascular system, and respiratory tract can also be involved.<ref name="Relapsing polychondritis"/> === Mechanism === The components of the ear involved in cauliflower ear are the outer skin, the [[perichondrium]], and the cartilage.<ref name=":1">{{Cite journal\|last1=Greywoode\|first1=Jewel\|last2=Pribitkin\|first2=Edmund\|author3-link=Howard Krein\|last3=Krein\|first3=Howard\|date=2010-11-17\|title=Management of Auricular Hematoma and the Cauliflower Ear\|journal=Facial Plastic Surgery\|language=en\|volume=26\|issue=6\|pages=451–455\|doi=10.1055/s-0030-1267719\|pmid=21086231\|s2cid=260133952 \|issn=0736-6825}}</ref> The outer ear skin is tightly adherent to the perichondrium because there is almost no subcutaneous fat on the anterior of the ear.<ref name=":1"/> This leaves the perichondrium relatively exposed to damage from direct trauma and shear forces, created by a force pushing across the ear like a punch, and increasing the risk of hematoma formation.<ref name=":1" /> In an auricular [[hematoma]], blood accumulates between the [[perichondrium]] and [[cartilage]]. The hematoma mechanically obstructs blood flow from the perichondrium to the avascular cartilage.<ref name="Ingvaldsen et al"/> This lack of perfusion puts the cartilage at risk for becoming necrotic and/or infected.<ref name="Ingvaldsen et al"/> If left untreated, disorganized fibrosis and cartilage formation will occur around the aforementioned cartilaginous components.<ref name="Ingvaldsen et al"/> Consequently, the concave pinna fills with disorganized connective tissue.<ref name="Ingvaldsen et al"/> The cartilage then deforms and kinks, resulting in the distinctive appearance somewhat resembling a cauliflower.<ref name="Ingvaldsen et al"/> Rapid evacuation of the hematoma restores close contact between the cartilage and perichondrium, thereby reducing the likelihood of deformity by minimizing the [[ischemia]] that would otherwise result from a remaining hematoma.<ref name="Ingvaldsen et al"/> Auricular hematoma most often occurs in the potential space between the helix and the [[antihelix]] (scapha) and extends anteriorly into the fossa triangularis.<ref name="Ingvaldsen et al"/> Less frequently, the hematoma may form in the concha or the area in and around the external auditory [[Meatus acusticus externus\|meatus]].<ref name="Ingvaldsen et al"/> Importantly, an auricular hematoma can also occur on the posterior ear surface, or even both surfaces.<ref name="Ingvaldsen et al"/> Risk of necrotic tissue is greatest when both posterior and anterior surfaces are involved, although posterior surface involvement is less likely given its increased quantity of impact-dampening subcutaneous tissue.<ref name="Ingvaldsen et al"/><ref name=":1" /> == Preventions == [[File:Tiger-print_scrum_cap.jpg\|thumb\|right\|A [[rugby union]] player wearing a tiger-print ''scrum cap'', a form of headgear used for shock absorption and protection to the head.]] Headgear called a "[[scrum cap]]" in rugby, or simply [[Headgear (martial arts)\|"headgear"]] or ear guard in wrestling and other martial arts, that protects the ears is worn to help prevent this condition. A specialty [[ear splint]] can also be made to keep the ear compressed, so that the damaged ear is unable to fill thus preventing cauliflower ear. For some athletes, however, a cauliflower ear is considered a badge of courage or experience.<ref>{{cite news \|first=Preston \|last=Williams \|title=For Wrestlers a Swelled Sense of Pride \|url=https://www.washingtonpost.com/wp-dyn/content/article/2008/03/04/AR2008030402360.html \|newspaper=The Washington Post \|page=14 \|date=2008-03-06 \|access-date=2008-04-02 \|archive-date=2012-11-10 \|archive-url=https://web.archive.org/web/20121110150725/http://www.washingtonpost.com/wp-dyn/content/article/2008/03/04/AR2008030402360.html \|url-status=live }}</ref> ==Treatment== [[File:AuricularHematoma.jpg\|thumb\|A mild auricular hematoma after drainage]] There are many types of treatment for the perichondral hematoma that can lead to cauliflower ear, but the current body of research is unable to identify a single best treatment or protocol.<ref name=":0">{{Cite journal\|last1=Jones\|first1=Stephen EM\|last2=Mahendran\|first2=Suresh\|date=2004-04-19\|title=Interventions for acute auricular haematoma\|journal=Cochrane Database of Systematic Reviews\|volume=2004 \|issue=2\|pages=CD004166\|doi=10.1002/14651858.cd004166.pub2\|pmid=15106240\|issn=1465-1858\|pmc=8078643}}</ref> There is definitive evidence that the drainage of this hematoma is better for the prevention of cauliflower deformity when compared to conservative treatment, but the use of bandages and/or splinting after drainage requires more research.<ref name=":0" /> Because an acute [[hematoma]] can lead to cauliflower ear, prompt evacuation of the blood can prevent permanent deformity.<ref>{{Cite journal \|url=http://emedicine.medscape.com/article/82793-overview \|title=Auricular Hematoma Drainage \|website=Medscape \|date=May 10, 2018 \|author=Inna Leybell \|access-date=October 26, 2011 \|archive-date=September 6, 2011 \|archive-url=https://web.archive.org/web/20110906113303/http://emedicine.medscape.com/article/82793-overview \|url-status=live }}</ref> There are many described techniques for the drainage of blood in the acute stage to prevent hematoma, including aspiration and drainage,<ref>{{Cite journal \|last=Brickman \|first=Kris \|last2=Adams \|first2=Daniel Z. \|last3=Akpunonu \|first3=Peter \|last4=Adams \|first4=Samuel S. \|last5=Zohn \|first5=Stephen F. \|last6=Guinness \|first6=Michael \|date=July 2013 \|title=Acute management of auricular hematoma: a novel approach and retrospective review \|url=https://pubmed.ncbi.nlm.nih.gov/22695406 \|journal=Clinical Journal of Sport Medicine\|volume=23 \|issue=4 \|pages=321–323 \|doi=10.1097/JSM.0b013e31825c4623 \|issn=1536-3724 \|pmid=22695406}}</ref> continuous suction devices, placing a wick, and incision and drainage.<ref name=":1" /> After the blood has been drained, the prevention of re-accumulation becomes the most pressing issue. This has been achieved with many techniques including: direct pressure dressings, in and out mattress sutures, buttons placed on sutures, [[Thermoplastic\|thermoplastic splints]], sutured cotton balls, and absorbable [[Horizontal mattress stitch\|mattress]] sutures.<ref name=":1" /> The use of simple drainage becomes less useful after six hours from the injury and when there is recurrent trauma. In these cases it has been suggested that open surgical treatment is more effective in returning the cosmetic appearance and prevention of recurrence.<ref name=":1" /> The outer ear is prone to infections, so [[antibiotic]]s are usually prescribed.<ref name=":1" /> Pressure can be applied by bandaging which helps the skin and the cartilage to reconnect. Clothes pegs, magnets, and custom molded ear splints<ref>{{Cite journal\|title=A Simple Splint for Wrestler's Ear\|first1=Thomas M.\|last1=Keating\|first2=John\|last2=Mason\|date=October 27, 1992\|journal=Journal of Athletic Training\|volume=27\|issue=3\|pages=273–274\|pmid=16558175\|pmc=1317260}}</ref> can also be used to ensure adequate pressure is applied to the damaged area<ref>{{cite web\|url= http://breakinggrips.com/cauliflower-ear-the-ultimate-guide/\|title= Cauliflower ear – How to avoid and treat\|date= 2019-01-28\|access-date= 2019-01-29\|archive-date= 2019-01-30\|archive-url= https://web.archive.org/web/20190130000050/http://breakinggrips.com/cauliflower-ear-the-ultimate-guide/\|url-status= live}}</ref> Without medical intervention the ear can sustain serious damage. Disruption of the ear canal is possible. The outer ear may wrinkle and can become slightly pale due to reduced blood flow; hence the common term "cauliflower ear".<ref>{{cite web \|url=http://www.nationwidechildrens.org/cauliflower-ear-article \|title=Cauliflower Ear Article \|work=Nationwide Children's Hospital: Sports Med Articles \|access-date=23 December 2011 \|archive-date=6 August 2012 \|archive-url=https://web.archive.org/web/20120806000036/http://www.nationwidechildrens.org/cauliflower-ear-article \|url-status=live }}</ref> [[cosmetic surgery\|Cosmetic procedures]] are available that can possibly improve the appearance of the ear.<ref>{{cite book\|last=Lukash\|first=Frederick\|title=The Safe and Sane Guide to Teenage Plastic Surgery\|url=https://books.google.com/books?id=oYYXt60L9LkC&pg=PT103\|date=21 August 2013\|publisher=BenBella Books, Inc.\|isbn=978-1-935618-63-8\|page=103}}</ref> ==History== [[File:Boxer of Quirinal, Greek Hellenistic bronze sculpture of a sitting nude boxer at rest, 100-50 BC, Palazzo Massimo alle Terme, Rome (13332971383).jpg\|thumb\|Depiction of cauliflower ear in the [[Boxer at Rest\|Boxer of Quirinal]], circa 100–50 BC]] The presentation of cauliflower ear was recorded in [[ancient Greece]].<ref>{{cite book\|last1=Smith\|first1=R. R. R.\|title=Hellenistic Sculpture\|url=https://archive.org/details/hellenisticsculp00smit\|url-access=registration\|date=1991\|location=London\|pages=[https://archive.org/details/hellenisticsculp00smit/page/54 54–55]\|isbn=9780500202494 }}</ref> In 19th-century Hong Kong [[opium den]]s, opium users would develop cauliflower ear from long periods sleeping on hard wooden pillows.<ref>{{cite journal \|first1=E \|last1=Vogelin \|first2=AO \|last2=Grobbelaar\| first3=JS \|last3=Chana\| first4=DT \|last4=Gault\|title=Surgical correction of the cauliflower ear \|journal=British Journal of Plastic Surgery \|volume=51 \|issue=5 \|pages=359–62 \|year=1998\|pmid= 9771361\|doi=10.1054/bjps.1997.0033 \|doi-access=free }}</ref> == References == {{reflist}} == External links == * [https://my.clevelandclinic.org/health/diseases/23146-cauliflower-ear Cauliflower ear], Cleveland Clinic * [https://www.emedicinehealth.com/image-gallery/cauliflower_ear_illustration/images.htm Cauliflower ear], medical illustration, eMedicineHealth {{Commons category}} * [http://www.medicinenet.com/cauliflower_ear/article.htm Medicinenet.com] {{Acquired deformities}} [[Category:Diseases of the ear and mastoid process]] [[Category:Ear]] [[Category:Skin conditions resulting from physical factors]] [[Category:Sports injuries]] [[Category:Martial arts culture]] [[Category:Wrestling culture]] [[Category:Rugby league terminology]] [[Category:Rugby union terminology]]'
New page wikitext, after the edit ($1) `(new_wikitext)`	'{{short description\|Permanent deformity caused by physical trauma to the ear}} {{Infobox medical condition (new) \| name = Cauliflower ear \| image = Erckscauliflowerear.jpg \| caption = Cauliflower ear \| field = [[Otorhinolaryngology]] \| width = 220 \| oMIM_mult = \| symptoms = \| complications = \| onset = \| duration = \| types = \| causes = \| risks = \| diagnosis = \| differential = \| prevention = \| treatment = \| medication = \| prognosis = \| frequency = \| deaths = }} '''Cauliflower ear''' is an irreversible condition that occurs when the [[Auricle (anatomy)\|external portion of the ear]] is hit and develops a [[Thrombus\|blood clot]] or other collection of fluid under the [[perichondrium]]. This separates the [[cartilage]] from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a [[cauliflower]], hence the name. There is also an alternative form of cauliflower ear that affects the rectal region specifically. First documented in Ryan Egan (considered patient zero) his colon was so heavily bruised and beaten from his sexual partners that he developed cauliflower ass hole. The condition is common in [[martial art]]s such as [[Brazilian jiu-jitsu]], [[wrestling]], [[boxing]], [[kickboxing]], [[judo]], [[sumo]], or [[mixed martial arts]], and in full-contact sports such as [[rugby league]] or [[rugby union]]. == Presentation== People presenting with possible auricular [[hematoma]] often have additional injuries (for example, head/neck lacerations) due to the frequently traumatic causes of auricular hematoma. The ear itself is often tense, fluctuant, and tender with throbbing pain. However, because of potentially more remarkable injuries often associated with auricular hematoma, auricular hematoma can easily be overlooked without directed attention.<ref name="Ingvaldsen et al">{{cite journal \|last1=Ingvaldsen \|first1=Christoffer A. \|last2=Tønseth \|first2=Kim A. \|year=2017 \|title=Auricular haematoma \|journal=Tidsskrift for den Norske Laegeforening \|volume=137 \|issue=2 \|pages=105–107 \|doi=10.4045/tidsskr.15.1279 \|pmid=28127072 \|doi-access=free}}</ref> === Diagnosis === [[Perichondral\|Perichondral hematoma]] and consequently cauliflower ear are diagnosed clinically. This means that the medical provider will make the diagnosis by using elements of the history of the injury (examples: participation in contact sports, trauma to the ear, previous similar episodes) and combine this with findings on physical exam (examples: tenderness to the area, bruising, deformation of the ear contours) to confirm the diagnosis and decide on the appropriate treatment for the patient.<ref name=":1" /> [[File:Shawn's cauliflower ear.jpg\|thumb\|Cauliflower ear in an MMA fighter]] To assist with settling on the best form of treatment for cauliflower ear Yotsuyanagi et al. created a classification system for deciding when surgery is needed and to guide the best approach.<ref name=":2">{{Cite journal \|last1=Yotsuyanagi \|first1=Takatoshi \|last2=Yamashita \|first2=Ken \|last3=Urushidate \|first3=Satoshi \|last4=Yokoi \|first4=Katsunori \|last5=Sawada \|first5=Yukimasa \|last6=Miyazaki \|first6=Souichiro \|date=July 2002 \|title=Surgical correction of cauliflower ear \|journal=British Journal of Plastic Surgery \|volume=55 \|issue=5 \|pages=380–386 \|doi=10.1054/bjps.2002.3854 \|issn=0007-1226 \|pmid=12372365}}</ref> {\| class="wikitable" \|+Classification of cauliflower ear<ref name=":2" /> ! colspan="2" \|Type 1: Minimal deformity with no or slight changes to the outline of the ear ! colspan="2" \|Type 2: Substantial deformity of the outline of the ear \|- \|Type 1A \|Deformity is restricted to the concha of the ear \|Type 2A \|The structural integrity of the ear is intact \|- \|Type 1B \|Deformity that extends from the antihelix to the helix of the ear \|Type 2B \|Poor structural integrity of the ear \|- \|Type 1C \|Deformity that extends throughout the outer ear \| \| \|} ==Causes== The most common cause of cauliflower ear is [[blunt trauma]] to the ear leading to a hematoma which, if left untreated, eventually heals to give the distinct appearance of cauliflower ear. Most commonly coming from participating in grappling and combat sports such as [[Brazilian jiu-jitsu]] and [[mixed martial arts]]. The structure of the ear is supported by a cartilaginous scaffold consisting of the following distinct components: the helix, [[antihelix]], [[Auricle (anatomy)\|concha]], [[tragus (ear)\|tragus]], and [[antitragus]].<ref name="Ingvaldsen et al"/> The skin that covers this cartilage is extremely thin with virtually no subcutaneous fat while also strongly attached to the perichondrium, which is richly vascularized to supply the avascular cartilage.<ref name="Ingvaldsen et al"/> Cauliflower ear can also present in the setting of nontraumatic inflammatory injury of auricular connective tissue such as in [[relapsing polychondritis]] (RP), a rare [[rheumatologic]] disorder in which recurrent episodes of inflammation result in destruction of cartilage of the ears and nose.<ref name="Relapsing polychondritis">{{cite journal \|last1=Rapini \|title=Relapsing polychondritis. \|journal=Clin. Dermatol. \|volume=24 \|issue=6 \|pages=482–5 \|doi=10.1016/j.clindermatol.2006.07.018 \|pmid=17113965\|year=2006 }}</ref> Joints, eyes, audiovestibular system, cardiovascular system, and respiratory tract can also be involved.<ref name="Relapsing polychondritis"/> === Mechanism === The components of the ear involved in cauliflower ear are the outer skin, the [[perichondrium]], and the cartilage.<ref name=":1">{{Cite journal\|last1=Greywoode\|first1=Jewel\|last2=Pribitkin\|first2=Edmund\|author3-link=Howard Krein\|last3=Krein\|first3=Howard\|date=2010-11-17\|title=Management of Auricular Hematoma and the Cauliflower Ear\|journal=Facial Plastic Surgery\|language=en\|volume=26\|issue=6\|pages=451–455\|doi=10.1055/s-0030-1267719\|pmid=21086231\|s2cid=260133952 \|issn=0736-6825}}</ref> The outer ear skin is tightly adherent to the perichondrium because there is almost no subcutaneous fat on the anterior of the ear.<ref name=":1"/> This leaves the perichondrium relatively exposed to damage from direct trauma and shear forces, created by a force pushing across the ear like a punch, and increasing the risk of hematoma formation.<ref name=":1" /> In an auricular [[hematoma]], blood accumulates between the [[perichondrium]] and [[cartilage]]. The hematoma mechanically obstructs blood flow from the perichondrium to the avascular cartilage.<ref name="Ingvaldsen et al"/> This lack of perfusion puts the cartilage at risk for becoming necrotic and/or infected.<ref name="Ingvaldsen et al"/> If left untreated, disorganized fibrosis and cartilage formation will occur around the aforementioned cartilaginous components.<ref name="Ingvaldsen et al"/> Consequently, the concave pinna fills with disorganized connective tissue.<ref name="Ingvaldsen et al"/> The cartilage then deforms and kinks, resulting in the distinctive appearance somewhat resembling a cauliflower.<ref name="Ingvaldsen et al"/> Rapid evacuation of the hematoma restores close contact between the cartilage and perichondrium, thereby reducing the likelihood of deformity by minimizing the [[ischemia]] that would otherwise result from a remaining hematoma.<ref name="Ingvaldsen et al"/> Auricular hematoma most often occurs in the potential space between the helix and the [[antihelix]] (scapha) and extends anteriorly into the fossa triangularis.<ref name="Ingvaldsen et al"/> Less frequently, the hematoma may form in the concha or the area in and around the external auditory [[Meatus acusticus externus\|meatus]].<ref name="Ingvaldsen et al"/> Importantly, an auricular hematoma can also occur on the posterior ear surface, or even both surfaces.<ref name="Ingvaldsen et al"/> Risk of necrotic tissue is greatest when both posterior and anterior surfaces are involved, although posterior surface involvement is less likely given its increased quantity of impact-dampening subcutaneous tissue.<ref name="Ingvaldsen et al"/><ref name=":1" /> == Preventions == [[File:Tiger-print_scrum_cap.jpg\|thumb\|right\|A [[rugby union]] player wearing a tiger-print ''scrum cap'', a form of headgear used for shock absorption and protection to the head.]] Headgear called a "[[scrum cap]]" in rugby, or simply [[Headgear (martial arts)\|"headgear"]] or ear guard in wrestling and other martial arts, that protects the ears is worn to help prevent this condition. A specialty [[ear splint]] can also be made to keep the ear compressed, so that the damaged ear is unable to fill thus preventing cauliflower ear. For some athletes, however, a cauliflower ear is considered a badge of courage or experience.<ref>{{cite news \|first=Preston \|last=Williams \|title=For Wrestlers a Swelled Sense of Pride \|url=https://www.washingtonpost.com/wp-dyn/content/article/2008/03/04/AR2008030402360.html \|newspaper=The Washington Post \|page=14 \|date=2008-03-06 \|access-date=2008-04-02 \|archive-date=2012-11-10 \|archive-url=https://web.archive.org/web/20121110150725/http://www.washingtonpost.com/wp-dyn/content/article/2008/03/04/AR2008030402360.html \|url-status=live }}</ref> ==Treatment== [[File:AuricularHematoma.jpg\|thumb\|A mild auricular hematoma after drainage]] There are many types of treatment for the perichondral hematoma that can lead to cauliflower ear, but the current body of research is unable to identify a single best treatment or protocol.<ref name=":0">{{Cite journal\|last1=Jones\|first1=Stephen EM\|last2=Mahendran\|first2=Suresh\|date=2004-04-19\|title=Interventions for acute auricular haematoma\|journal=Cochrane Database of Systematic Reviews\|volume=2004 \|issue=2\|pages=CD004166\|doi=10.1002/14651858.cd004166.pub2\|pmid=15106240\|issn=1465-1858\|pmc=8078643}}</ref> There is definitive evidence that the drainage of this hematoma is better for the prevention of cauliflower deformity when compared to conservative treatment, but the use of bandages and/or splinting after drainage requires more research.<ref name=":0" /> Because an acute [[hematoma]] can lead to cauliflower ear, prompt evacuation of the blood can prevent permanent deformity.<ref>{{Cite journal \|url=http://emedicine.medscape.com/article/82793-overview \|title=Auricular Hematoma Drainage \|website=Medscape \|date=May 10, 2018 \|author=Inna Leybell \|access-date=October 26, 2011 \|archive-date=September 6, 2011 \|archive-url=https://web.archive.org/web/20110906113303/http://emedicine.medscape.com/article/82793-overview \|url-status=live }}</ref> There are many described techniques for the drainage of blood in the acute stage to prevent hematoma, including aspiration and drainage,<ref>{{Cite journal \|last=Brickman \|first=Kris \|last2=Adams \|first2=Daniel Z. \|last3=Akpunonu \|first3=Peter \|last4=Adams \|first4=Samuel S. \|last5=Zohn \|first5=Stephen F. \|last6=Guinness \|first6=Michael \|date=July 2013 \|title=Acute management of auricular hematoma: a novel approach and retrospective review \|url=https://pubmed.ncbi.nlm.nih.gov/22695406 \|journal=Clinical Journal of Sport Medicine\|volume=23 \|issue=4 \|pages=321–323 \|doi=10.1097/JSM.0b013e31825c4623 \|issn=1536-3724 \|pmid=22695406}}</ref> continuous suction devices, placing a wick, and incision and drainage.<ref name=":1" /> After the blood has been drained, the prevention of re-accumulation becomes the most pressing issue. This has been achieved with many techniques including: direct pressure dressings, in and out mattress sutures, buttons placed on sutures, [[Thermoplastic\|thermoplastic splints]], sutured cotton balls, and absorbable [[Horizontal mattress stitch\|mattress]] sutures.<ref name=":1" /> The use of simple drainage becomes less useful after six hours from the injury and when there is recurrent trauma. In these cases it has been suggested that open surgical treatment is more effective in returning the cosmetic appearance and prevention of recurrence.<ref name=":1" /> The outer ear is prone to infections, so [[antibiotic]]s are usually prescribed.<ref name=":1" /> Pressure can be applied by bandaging which helps the skin and the cartilage to reconnect. Clothes pegs, magnets, and custom molded ear splints<ref>{{Cite journal\|title=A Simple Splint for Wrestler's Ear\|first1=Thomas M.\|last1=Keating\|first2=John\|last2=Mason\|date=October 27, 1992\|journal=Journal of Athletic Training\|volume=27\|issue=3\|pages=273–274\|pmid=16558175\|pmc=1317260}}</ref> can also be used to ensure adequate pressure is applied to the damaged area<ref>{{cite web\|url= http://breakinggrips.com/cauliflower-ear-the-ultimate-guide/\|title= Cauliflower ear – How to avoid and treat\|date= 2019-01-28\|access-date= 2019-01-29\|archive-date= 2019-01-30\|archive-url= https://web.archive.org/web/20190130000050/http://breakinggrips.com/cauliflower-ear-the-ultimate-guide/\|url-status= live}}</ref> Without medical intervention the ear can sustain serious damage. Disruption of the ear canal is possible. The outer ear may wrinkle and can become slightly pale due to reduced blood flow; hence the common term "cauliflower ear".<ref>{{cite web \|url=http://www.nationwidechildrens.org/cauliflower-ear-article \|title=Cauliflower Ear Article \|work=Nationwide Children's Hospital: Sports Med Articles \|access-date=23 December 2011 \|archive-date=6 August 2012 \|archive-url=https://web.archive.org/web/20120806000036/http://www.nationwidechildrens.org/cauliflower-ear-article \|url-status=live }}</ref> [[cosmetic surgery\|Cosmetic procedures]] are available that can possibly improve the appearance of the ear.<ref>{{cite book\|last=Lukash\|first=Frederick\|title=The Safe and Sane Guide to Teenage Plastic Surgery\|url=https://books.google.com/books?id=oYYXt60L9LkC&pg=PT103\|date=21 August 2013\|publisher=BenBella Books, Inc.\|isbn=978-1-935618-63-8\|page=103}}</ref> ==History== [[File:Boxer of Quirinal, Greek Hellenistic bronze sculpture of a sitting nude boxer at rest, 100-50 BC, Palazzo Massimo alle Terme, Rome (13332971383).jpg\|thumb\|Depiction of cauliflower ear in the [[Boxer at Rest\|Boxer of Quirinal]], circa 100–50 BC]] The presentation of cauliflower ear was recorded in [[ancient Greece]].<ref>{{cite book\|last1=Smith\|first1=R. R. R.\|title=Hellenistic Sculpture\|url=https://archive.org/details/hellenisticsculp00smit\|url-access=registration\|date=1991\|location=London\|pages=[https://archive.org/details/hellenisticsculp00smit/page/54 54–55]\|isbn=9780500202494 }}</ref> In 19th-century Hong Kong [[opium den]]s, opium users would develop cauliflower ear from long periods sleeping on hard wooden pillows.<ref>{{cite journal \|first1=E \|last1=Vogelin \|first2=AO \|last2=Grobbelaar\| first3=JS \|last3=Chana\| first4=DT \|last4=Gault\|title=Surgical correction of the cauliflower ear \|journal=British Journal of Plastic Surgery \|volume=51 \|issue=5 \|pages=359–62 \|year=1998\|pmid= 9771361\|doi=10.1054/bjps.1997.0033 \|doi-access=free }}</ref> == References == {{reflist}} == External links == * [https://my.clevelandclinic.org/health/diseases/23146-cauliflower-ear Cauliflower ear], Cleveland Clinic * [https://www.emedicinehealth.com/image-gallery/cauliflower_ear_illustration/images.htm Cauliflower ear], medical illustration, eMedicineHealth {{Commons category}} * [http://www.medicinenet.com/cauliflower_ear/article.htm Medicinenet.com] {{Acquired deformities}} [[Category:Diseases of the ear and mastoid process]] [[Category:Ear]] [[Category:Skin conditions resulting from physical factors]] [[Category:Sports injuries]] [[Category:Martial arts culture]] [[Category:Wrestling culture]] [[Category:Rugby league terminology]] [[Category:Rugby union terminology]]'
Unified diff of changes made by edit ($1) `(edit_diff)`	'@@ -23,5 +23,5 @@ \| deaths = }} -'''Cauliflower ear''' is an irreversible condition that occurs when the [[Auricle (anatomy)\|external portion of the ear]] is hit and develops a [[Thrombus\|blood clot]] or other collection of fluid under the [[perichondrium]]. This separates the [[cartilage]] from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a [[cauliflower]], hence the name. +'''Cauliflower ear''' is an irreversible condition that occurs when the [[Auricle (anatomy)\|external portion of the ear]] is hit and develops a [[Thrombus\|blood clot]] or other collection of fluid under the [[perichondrium]]. This separates the [[cartilage]] from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a [[cauliflower]], hence the name. There is also an alternative form of cauliflower ear that affects the rectal region specifically. First documented in Ryan Egan (considered patient zero) his colon was so heavily bruised and beaten from his sexual partners that he developed cauliflower ass hole. The condition is common in [[martial art]]s such as [[Brazilian jiu-jitsu]], [[wrestling]], [[boxing]], [[kickboxing]], [[judo]], [[sumo]], or [[mixed martial arts]], and in full-contact sports such as [[rugby league]] or [[rugby union]]. '
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Lines added in edit ($1) `(added_lines)`	[ 0 => ''''Cauliflower ear''' is an irreversible condition that occurs when the [[Auricle (anatomy)\|external portion of the ear]] is hit and develops a [[Thrombus\|blood clot]] or other collection of fluid under the [[perichondrium]]. This separates the [[cartilage]] from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a [[cauliflower]], hence the name. There is also an alternative form of cauliflower ear that affects the rectal region specifically. First documented in Ryan Egan (considered patient zero) his colon was so heavily bruised and beaten from his sexual partners that he developed cauliflower ass hole. ' ]
Lines removed in edit ($1) `(removed_lines)`	[ 0 => ''''Cauliflower ear''' is an irreversible condition that occurs when the [[Auricle (anatomy)\|external portion of the ear]] is hit and develops a [[Thrombus\|blood clot]] or other collection of fluid under the [[perichondrium]]. This separates the [[cartilage]] from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a [[cauliflower]], hence the name.' ]
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Parsed HTML source of the new revision ($1) `(new_html)`	'<div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Permanent deformity caused by physical trauma to the ear</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1218072481">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}body.skin-minerva .mw-parser-output .infobox-header,body.skin-minerva .mw-parser-output .infobox-subheader,body.skin-minerva .mw-parser-output .infobox-above,body.skin-minerva .mw-parser-output .infobox-title,body.skin-minerva .mw-parser-output .infobox-image,body.skin-minerva .mw-parser-output .infobox-full-data,body.skin-minerva .mw-parser-output .infobox-below{text-align:center}html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data div{background:#1f1f23!important;color:#f8f9fa}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data div{background:#1f1f23!important;color:#f8f9fa}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Cauliflower ear</th></tr><tr><td colspan="2" class="infobox-full-data"><span typeof="mw:File"><a href="/wiki/File:Erckscauliflowerear.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Erckscauliflowerear.jpg/220px-Erckscauliflowerear.jpg" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Erckscauliflowerear.jpg/330px-Erckscauliflowerear.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Erckscauliflowerear.jpg/440px-Erckscauliflowerear.jpg 2x" data-file-width="3024" data-file-height="4032" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Cauliflower ear</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Otorhinolaryngology" title="Otorhinolaryngology">Otorhinolaryngology</a></td></tr></tbody></table> <p><b>Cauliflower ear</b> is an irreversible condition that occurs when the <a href="/wiki/Auricle_(anatomy)" title="Auricle (anatomy)">external portion of the ear</a> is hit and develops a <a href="/wiki/Thrombus" title="Thrombus">blood clot</a> or other collection of fluid under the <a href="/wiki/Perichondrium" title="Perichondrium">perichondrium</a>. This separates the <a href="/wiki/Cartilage" title="Cartilage">cartilage</a> from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a <a href="/wiki/Cauliflower" title="Cauliflower">cauliflower</a>, hence the name. There is also an alternative form of cauliflower ear that affects the rectal region specifically. First documented in Ryan Egan (considered patient zero) his colon was so heavily bruised and beaten from his sexual partners that he developed cauliflower ass hole. </p><p>The condition is common in <a href="/wiki/Martial_art" class="mw-redirect" title="Martial art">martial arts</a> such as <a href="/wiki/Brazilian_jiu-jitsu" title="Brazilian jiu-jitsu">Brazilian jiu-jitsu</a>, <a href="/wiki/Wrestling" title="Wrestling">wrestling</a>, <a href="/wiki/Boxing" title="Boxing">boxing</a>, <a href="/wiki/Kickboxing" title="Kickboxing">kickboxing</a>, <a href="/wiki/Judo" title="Judo">judo</a>, <a href="/wiki/Sumo" title="Sumo">sumo</a>, or <a href="/wiki/Mixed_martial_arts" title="Mixed martial arts">mixed martial arts</a>, and in full-contact sports such as <a href="/wiki/Rugby_league" title="Rugby league">rugby league</a> or <a href="/wiki/Rugby_union" title="Rugby union">rugby union</a>. </p> <div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"><input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /><div class="toctitle" lang="en" dir="ltr"><h2 id="mw-toc-heading">Contents</h2><span class="toctogglespan"><label class="toctogglelabel" for="toctogglecheckbox"></label></span></div> <ul> <li class="toclevel-1 tocsection-1"><a href="#Presentation"><span class="tocnumber">1</span> <span class="toctext">Presentation</span></a> <ul> <li class="toclevel-2 tocsection-2"><a href="#Diagnosis"><span class="tocnumber">1.1</span> <span class="toctext">Diagnosis</span></a></li> </ul> </li> <li class="toclevel-1 tocsection-3"><a href="#Causes"><span class="tocnumber">2</span> <span class="toctext">Causes</span></a> <ul> <li class="toclevel-2 tocsection-4"><a href="#Mechanism"><span class="tocnumber">2.1</span> <span class="toctext">Mechanism</span></a></li> </ul> </li> <li class="toclevel-1 tocsection-5"><a href="#Preventions"><span class="tocnumber">3</span> <span class="toctext">Preventions</span></a></li> <li class="toclevel-1 tocsection-6"><a href="#Treatment"><span class="tocnumber">4</span> <span class="toctext">Treatment</span></a></li> <li class="toclevel-1 tocsection-7"><a href="#History"><span class="tocnumber">5</span> <span class="toctext">History</span></a></li> <li class="toclevel-1 tocsection-8"><a href="#References"><span class="tocnumber">6</span> <span class="toctext">References</span></a></li> <li class="toclevel-1 tocsection-9"><a href="#External_links"><span class="tocnumber">7</span> <span class="toctext">External links</span></a></li> </ul> </div> <h2><span class="mw-headline" id="Presentation">Presentation</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=1"title="Edit section: Presentation" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h2> <p>People presenting with possible auricular <a href="/wiki/Hematoma" title="Hematoma">hematoma</a> often have additional injuries (for example, head/neck lacerations) due to the frequently traumatic causes of auricular hematoma. The ear itself is often tense, fluctuant, and tender with throbbing pain. However, because of potentially more remarkable injuries often associated with auricular hematoma, auricular hematoma can easily be overlooked without directed attention.<sup id="cite_ref-Ingvaldsen_et_al_1-0" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> </p> <h3><span class="mw-headline" id="Diagnosis">Diagnosis</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=2"title="Edit section: Diagnosis" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h3> <p><a href="/wiki/Perichondral" class="mw-redirect" title="Perichondral">Perichondral hematoma</a> and consequently cauliflower ear are diagnosed clinically. This means that the medical provider will make the diagnosis by using elements of the history of the injury (examples: participation in contact sports, trauma to the ear, previous similar episodes) and combine this with findings on physical exam (examples: tenderness to the area, bruising, deformation of the ear contours) to confirm the diagnosis and decide on the appropriate treatment for the patient.<sup id="cite_ref-:1_2-0" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Shawn%27s_cauliflower_ear.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Shawn%27s_cauliflower_ear.jpg/220px-Shawn%27s_cauliflower_ear.jpg" decoding="async" width="220" height="255" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Shawn%27s_cauliflower_ear.jpg/330px-Shawn%27s_cauliflower_ear.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Shawn%27s_cauliflower_ear.jpg/440px-Shawn%27s_cauliflower_ear.jpg 2x" data-file-width="659" data-file-height="764" /></a><figcaption>Cauliflower ear in an MMA fighter</figcaption></figure> <p>To assist with settling on the best form of treatment for cauliflower ear Yotsuyanagi et al. created a classification system for deciding when surgery is needed and to guide the best approach.<sup id="cite_ref-:2_3-0" class="reference"><a href="#cite_note-:2-3">[3]</a></sup> </p> <table class="wikitable"> <caption>Classification of cauliflower ear<sup id="cite_ref-:2_3-1" class="reference"><a href="#cite_note-:2-3">[3]</a></sup> </caption> <tbody><tr> <th colspan="2">Type 1: Minimal deformity with no or slight changes to the outline of the ear </th> <th colspan="2">Type 2: Substantial deformity of the outline of the ear </th></tr> <tr> <td>Type 1A </td> <td>Deformity is restricted to the concha of the ear </td> <td>Type 2A </td> <td>The structural integrity of the ear is intact </td></tr> <tr> <td>Type 1B </td> <td>Deformity that extends from the antihelix to the helix of the ear </td> <td>Type 2B </td> <td>Poor structural integrity of the ear </td></tr> <tr> <td>Type 1C </td> <td>Deformity that extends throughout the outer ear </td> <td> </td> <td> </td></tr></tbody></table> <h2><span class="mw-headline" id="Causes">Causes</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=3"title="Edit section: Causes" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h2> <p>The most common cause of cauliflower ear is <a href="/wiki/Blunt_trauma" title="Blunt trauma">blunt trauma</a> to the ear leading to a hematoma which, if left untreated, eventually heals to give the distinct appearance of cauliflower ear. Most commonly coming from participating in grappling and combat sports such as <a href="/wiki/Brazilian_jiu-jitsu" title="Brazilian jiu-jitsu">Brazilian jiu-jitsu</a> and <a href="/wiki/Mixed_martial_arts" title="Mixed martial arts">mixed martial arts</a>. The structure of the ear is supported by a cartilaginous scaffold consisting of the following distinct components: the helix, <a href="/wiki/Antihelix" title="Antihelix">antihelix</a>, <a href="/wiki/Auricle_(anatomy)" title="Auricle (anatomy)">concha</a>, <a href="/wiki/Tragus_(ear)" title="Tragus (ear)">tragus</a>, and <a href="/wiki/Antitragus" title="Antitragus">antitragus</a>.<sup id="cite_ref-Ingvaldsen_et_al_1-1" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> The skin that covers this cartilage is extremely thin with virtually no subcutaneous fat while also strongly attached to the perichondrium, which is richly vascularized to supply the avascular cartilage.<sup id="cite_ref-Ingvaldsen_et_al_1-2" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> </p><p>Cauliflower ear can also present in the setting of nontraumatic inflammatory injury of auricular connective tissue such as in <a href="/wiki/Relapsing_polychondritis" title="Relapsing polychondritis">relapsing polychondritis</a> (RP), a rare <a href="/wiki/Rheumatologic" class="mw-redirect" title="Rheumatologic">rheumatologic</a> disorder in which recurrent episodes of inflammation result in destruction of cartilage of the ears and nose.<sup id="cite_ref-Relapsing_polychondritis_4-0" class="reference"><a href="#cite_note-Relapsing_polychondritis-4">[4]</a></sup> Joints, eyes, audiovestibular system, cardiovascular system, and respiratory tract can also be involved.<sup id="cite_ref-Relapsing_polychondritis_4-1" class="reference"><a href="#cite_note-Relapsing_polychondritis-4">[4]</a></sup> </p> <h3><span class="mw-headline" id="Mechanism">Mechanism</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=4"title="Edit section: Mechanism" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h3> <p>The components of the ear involved in cauliflower ear are the outer skin, the <a href="/wiki/Perichondrium" title="Perichondrium">perichondrium</a>, and the cartilage.<sup id="cite_ref-:1_2-1" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> The outer ear skin is tightly adherent to the perichondrium because there is almost no subcutaneous fat on the anterior of the ear.<sup id="cite_ref-:1_2-2" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> This leaves the perichondrium relatively exposed to damage from direct trauma and shear forces, created by a force pushing across the ear like a punch, and increasing the risk of hematoma formation.<sup id="cite_ref-:1_2-3" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> In an auricular <a href="/wiki/Hematoma" title="Hematoma">hematoma</a>, blood accumulates between the <a href="/wiki/Perichondrium" title="Perichondrium">perichondrium</a> and <a href="/wiki/Cartilage" title="Cartilage">cartilage</a>. The hematoma mechanically obstructs blood flow from the perichondrium to the avascular cartilage.<sup id="cite_ref-Ingvaldsen_et_al_1-3" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> This lack of perfusion puts the cartilage at risk for becoming necrotic and/or infected.<sup id="cite_ref-Ingvaldsen_et_al_1-4" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> If left untreated, disorganized fibrosis and cartilage formation will occur around the aforementioned cartilaginous components.<sup id="cite_ref-Ingvaldsen_et_al_1-5" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> </p><p>Consequently, the concave pinna fills with disorganized connective tissue.<sup id="cite_ref-Ingvaldsen_et_al_1-6" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> The cartilage then deforms and kinks, resulting in the distinctive appearance somewhat resembling a cauliflower.<sup id="cite_ref-Ingvaldsen_et_al_1-7" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> Rapid evacuation of the hematoma restores close contact between the cartilage and perichondrium, thereby reducing the likelihood of deformity by minimizing the <a href="/wiki/Ischemia" title="Ischemia">ischemia</a> that would otherwise result from a remaining hematoma.<sup id="cite_ref-Ingvaldsen_et_al_1-8" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> </p><p>Auricular hematoma most often occurs in the potential space between the helix and the <a href="/wiki/Antihelix" title="Antihelix">antihelix</a> (scapha) and extends anteriorly into the fossa triangularis.<sup id="cite_ref-Ingvaldsen_et_al_1-9" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> Less frequently, the hematoma may form in the concha or the area in and around the external auditory <a href="/wiki/Meatus_acusticus_externus" class="mw-redirect" title="Meatus acusticus externus">meatus</a>.<sup id="cite_ref-Ingvaldsen_et_al_1-10" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> Importantly, an auricular hematoma can also occur on the posterior ear surface, or even both surfaces.<sup id="cite_ref-Ingvaldsen_et_al_1-11" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup> Risk of necrotic tissue is greatest when both posterior and anterior surfaces are involved, although posterior surface involvement is less likely given its increased quantity of impact-dampening subcutaneous tissue.<sup id="cite_ref-Ingvaldsen_et_al_1-12" class="reference"><a href="#cite_note-Ingvaldsen_et_al-1">[1]</a></sup><sup id="cite_ref-:1_2-4" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> </p> <h2><span class="mw-headline" id="Preventions">Preventions</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=5"title="Edit section: Preventions" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h2> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Tiger-print_scrum_cap.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4d/Tiger-print_scrum_cap.jpg/220px-Tiger-print_scrum_cap.jpg" decoding="async" width="220" height="246" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4d/Tiger-print_scrum_cap.jpg/330px-Tiger-print_scrum_cap.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4d/Tiger-print_scrum_cap.jpg/440px-Tiger-print_scrum_cap.jpg 2x" data-file-width="2297" data-file-height="2571" /></a><figcaption>A <a href="/wiki/Rugby_union" title="Rugby union">rugby union</a> player wearing a tiger-print <i>scrum cap</i>, a form of headgear used for shock absorption and protection to the head.</figcaption></figure> <p>Headgear called a "<a href="/wiki/Scrum_cap" title="Scrum cap">scrum cap</a>" in rugby, or simply <a href="/wiki/Headgear_(martial_arts)" title="Headgear (martial arts)">"headgear"</a> or ear guard in wrestling and other martial arts, that protects the ears is worn to help prevent this condition. A specialty <a href="/wiki/Ear_splint" class="mw-redirect" title="Ear splint">ear splint</a> can also be made to keep the ear compressed, so that the damaged ear is unable to fill thus preventing cauliflower ear. For some athletes, however, a cauliflower ear is considered a badge of courage or experience.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5">[5]</a></sup> </p> <h2><span class="mw-headline" id="Treatment">Treatment</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=6"title="Edit section: Treatment" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h2> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:AuricularHematoma.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/98/AuricularHematoma.jpg/220px-AuricularHematoma.jpg" decoding="async" width="220" height="292" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/98/AuricularHematoma.jpg/330px-AuricularHematoma.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/98/AuricularHematoma.jpg/440px-AuricularHematoma.jpg 2x" data-file-width="2377" data-file-height="3157" /></a><figcaption>A mild auricular hematoma after drainage</figcaption></figure> <p>There are many types of treatment for the perichondral hematoma that can lead to cauliflower ear, but the current body of research is unable to identify a single best treatment or protocol.<sup id="cite_ref-:0_6-0" class="reference"><a href="#cite_note-:0-6">[6]</a></sup> There is definitive evidence that the drainage of this hematoma is better for the prevention of cauliflower deformity when compared to conservative treatment, but the use of bandages and/or splinting after drainage requires more research.<sup id="cite_ref-:0_6-1" class="reference"><a href="#cite_note-:0-6">[6]</a></sup> </p><p>Because an acute <a href="/wiki/Hematoma" title="Hematoma">hematoma</a> can lead to cauliflower ear, prompt evacuation of the blood can prevent permanent deformity.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7">[7]</a></sup> There are many described techniques for the drainage of blood in the acute stage to prevent hematoma, including aspiration and drainage,<sup id="cite_ref-8" class="reference"><a href="#cite_note-8">[8]</a></sup> continuous suction devices, placing a wick, and incision and drainage.<sup id="cite_ref-:1_2-5" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> After the blood has been drained, the prevention of re-accumulation becomes the most pressing issue. This has been achieved with many techniques including: direct pressure dressings, in and out mattress sutures, buttons placed on sutures, <a href="/wiki/Thermoplastic" title="Thermoplastic">thermoplastic splints</a>, sutured cotton balls, and absorbable <a href="/wiki/Horizontal_mattress_stitch" title="Horizontal mattress stitch">mattress</a> sutures.<sup id="cite_ref-:1_2-6" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> The use of simple drainage becomes less useful after six hours from the injury and when there is recurrent trauma. In these cases it has been suggested that open surgical treatment is more effective in returning the cosmetic appearance and prevention of recurrence.<sup id="cite_ref-:1_2-7" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> The outer ear is prone to infections, so <a href="/wiki/Antibiotic" title="Antibiotic">antibiotics</a> are usually prescribed.<sup id="cite_ref-:1_2-8" class="reference"><a href="#cite_note-:1-2">[2]</a></sup> Pressure can be applied by bandaging which helps the skin and the cartilage to reconnect. Clothes pegs, magnets, and custom molded ear splints<sup id="cite_ref-9" class="reference"><a href="#cite_note-9">[9]</a></sup> can also be used to ensure adequate pressure is applied to the damaged area<sup id="cite_ref-10" class="reference"><a href="#cite_note-10">[10]</a></sup> Without medical intervention the ear can sustain serious damage. Disruption of the ear canal is possible. The outer ear may wrinkle and can become slightly pale due to reduced blood flow; hence the common term "cauliflower ear".<sup id="cite_ref-11" class="reference"><a href="#cite_note-11">[11]</a></sup> <a href="/wiki/Cosmetic_surgery" class="mw-redirect" title="Cosmetic surgery">Cosmetic procedures</a> are available that can possibly improve the appearance of the ear.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12">[12]</a></sup> </p> <h2><span class="mw-headline" id="History">History</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=7"title="Edit section: History" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h2> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Boxer_of_Quirinal,_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest,_100-50_BC,_Palazzo_Massimo_alle_Terme,_Rome_(13332971383).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/24/Boxer_of_Quirinal%2C_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest%2C_100-50_BC%2C_Palazzo_Massimo_alle_Terme%2C_Rome_%2813332971383%29.jpg/220px-Boxer_of_Quirinal%2C_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest%2C_100-50_BC%2C_Palazzo_Massimo_alle_Terme%2C_Rome_%2813332971383%29.jpg" decoding="async" width="220" height="332" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/24/Boxer_of_Quirinal%2C_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest%2C_100-50_BC%2C_Palazzo_Massimo_alle_Terme%2C_Rome_%2813332971383%29.jpg/330px-Boxer_of_Quirinal%2C_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest%2C_100-50_BC%2C_Palazzo_Massimo_alle_Terme%2C_Rome_%2813332971383%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/24/Boxer_of_Quirinal%2C_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest%2C_100-50_BC%2C_Palazzo_Massimo_alle_Terme%2C_Rome_%2813332971383%29.jpg/440px-Boxer_of_Quirinal%2C_Greek_Hellenistic_bronze_sculpture_of_a_sitting_nude_boxer_at_rest%2C_100-50_BC%2C_Palazzo_Massimo_alle_Terme%2C_Rome_%2813332971383%29.jpg 2x" data-file-width="3264" data-file-height="4928" /></a><figcaption>Depiction of cauliflower ear in the <a href="/wiki/Boxer_at_Rest" title="Boxer at Rest">Boxer of Quirinal</a>, circa 100–50 BC</figcaption></figure> <p>The presentation of cauliflower ear was recorded in <a href="/wiki/Ancient_Greece" title="Ancient Greece">ancient Greece</a>.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13">[13]</a></sup> </p><p>In 19th-century Hong Kong <a href="/wiki/Opium_den" title="Opium den">opium dens</a>, opium users would develop cauliflower ear from long periods sleeping on hard wooden pillows.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14">[14]</a></sup> </p> <h2><span class="mw-headline" id="References">References</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=8"title="Edit section: References" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> <span class="minerva-icon minerva-icon--edit"></span> <span>edit</span> </a> </span> </h2> <style data-mw-deduplicate="TemplateStyles:r1217336898">.mw-parser-output .reflist{font-size:90%;margin-bottom:0.5em;list-style-type:decimal}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Ingvaldsen_et_al-1"><span class="mw-cite-backlink">^ <a 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BenBella Books, Inc. p. 103. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-935618-63-8" title="Special:BookSources/978-1-935618-63-8"><bdi>978-1-935618-63-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Safe+and+Sane+Guide+to+Teenage+Plastic+Surgery&rft.pages=103&rft.pub=BenBella+Books%2C+Inc.&rft.date=2013-08-21&rft.isbn=978-1-935618-63-8&rft.aulast=Lukash&rft.aufirst=Frederick&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DoYYXt60L9LkC%26pg%3DPT103&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACauliflower+ear" class="Z3988"></span></span> </li> <li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFSmith1991" class="citation book cs1">Smith, R. R. R. 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London. pp. <a rel="nofollow" class="external text" href="https://archive.org/details/hellenisticsculp00smit/page/54">54–55</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780500202494" title="Special:BookSources/9780500202494"><bdi>9780500202494</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hellenistic+Sculpture&rft.place=London&rft.pages=54-55&rft.date=1991&rft.isbn=9780500202494&rft.aulast=Smith&rft.aufirst=R.+R.+R.&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fhellenisticsculp00smit&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACauliflower+ear" class="Z3988"></span><span class="cs1-maint citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: CS1 maint: location missing publisher (<a href="/wiki/Category:CS1_maint:_location_missing_publisher" title="Category:CS1 maint: location missing publisher">link</a>)</span></span> </li> <li id="cite_note-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-14">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFVogelinGrobbelaarChanaGault1998" class="citation journal cs1">Vogelin, E; Grobbelaar, AO; Chana, JS; Gault, DT (1998). <a rel="nofollow" class="external text" href="https://doi.org/10.1054%2Fbjps.1997.0033">"Surgical correction of the cauliflower ear"</a>. <i>British Journal of Plastic Surgery</i>. <b>51</b> (5): 359–62. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1054%2Fbjps.1997.0033">10.1054/bjps.1997.0033</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9771361">9771361</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Plastic+Surgery&rft.atitle=Surgical+correction+of+the+cauliflower+ear&rft.volume=51&rft.issue=5&rft.pages=359-62&rft.date=1998&rft_id=info%3Adoi%2F10.1054%2Fbjps.1997.0033&rft_id=info%3Apmid%2F9771361&rft.aulast=Vogelin&rft.aufirst=E&rft.au=Grobbelaar%2C+AO&rft.au=Chana%2C+JS&rft.au=Gault%2C+DT&rft_id=https%3A%2F%2Fdoi.org%2F10.1054%252Fbjps.1997.0033&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACauliflower+ear" class="Z3988"></span></span> </li> </ol></div></div> <h2><span class="mw-headline" id="External_links">External links</span><span class="mw-editsection"> <a role="button" href="/w/index.php?title=Cauliflower_ear&action=edit&section=9"title="Edit section: External links" class="cdx-button cdx-button--size-large cdx-button--fake-button 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"}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Acquired_musculoskeletal_deformities" title="Template:Acquired musculoskeletal deformities"><abbr title="View this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Acquired_musculoskeletal_deformities" title="Template talk:Acquired musculoskeletal deformities"><abbr title="Discuss this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Acquired_musculoskeletal_deformities" title="Special:EditPage/Template:Acquired musculoskeletal deformities"><abbr title="Edit this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">e</abbr></a></li></ul></div><div id="Acquired_musculoskeletal_deformities" style="font-size:114%;margin:0 4em">Acquired <a href="/wiki/Musculoskeletal_system" class="mw-redirect" title="Musculoskeletal system">musculoskeletal</a> deformities</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Upper_limb" title="Upper limb">Upper limb</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Shoulder" title="Shoulder">shoulder</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adhesive_capsulitis_of_shoulder" class="mw-redirect" title="Adhesive capsulitis of shoulder">Adhesive capsulitis</a></li> <li><a href="/wiki/Rotator_cuff_tear" title="Rotator cuff tear">Rotator cuff tear</a></li> <li><a href="/wiki/Subacromial_bursitis" title="Subacromial bursitis">Subacromial bursitis</a></li> <li><a href="/wiki/Winged_scapula" title="Winged scapula">Winged scapula</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Elbow" title="Elbow">elbow</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cubitus_valgus" title="Cubitus valgus">Cubitus valgus</a></li> <li><a href="/wiki/Cubitus_varus" title="Cubitus varus">Cubitus varus</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hand_deformity" title="Hand deformity">hand</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Boutonniere_deformity" title="Boutonniere deformity">Boutonniere deformity</a></li> <li><a href="/wiki/Mallet_finger" title="Mallet finger">Mallet finger</a></li> <li><a href="/wiki/Swan_neck_deformity" title="Swan neck deformity">Swan neck deformity</a></li> <li><a href="/wiki/Wrist_drop" title="Wrist drop">Wrist drop</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_leg" title="Human leg">Lower limb</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hip" title="Hip">hip</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Coxa_valga" title="Coxa valga">Coxa valga</a></li> <li><a href="/wiki/Coxa_vara" title="Coxa vara">Coxa vara</a></li> <li><a href="/wiki/Protrusio_acetabuli" title="Protrusio acetabuli">Protrusio acetabuli</a></li> <li><a href="/wiki/Slipped_capital_femoral_epiphysis" title="Slipped capital femoral epiphysis">Slipped capital femoral epiphysis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_leg" title="Human leg">leg</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Angular_limb_deformity" title="Angular limb deformity">Angular limb deformity</a></li> <li><a href="/wiki/Unequal_leg_length" title="Unequal leg length">Unequal leg length</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Knee" title="Knee">knee</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chondromalacia_patellae" title="Chondromalacia patellae">Chondromalacia patellae</a></li> <li><a href="/wiki/Genu_recurvatum" title="Genu recurvatum">Genu recurvatum</a></li> <li><a href="/wiki/Luxating_patella" title="Luxating patella">Luxating patella</a></li> <li><a href="/wiki/Patella_alta" class="mw-redirect" title="Patella alta">Patella alta</a></li> <li><a href="/wiki/Patella_baja" class="mw-redirect" title="Patella baja">Patella baja</a></li> <li><a href="/wiki/Patellofemoral_pain_syndrome" title="Patellofemoral pain syndrome">Patellofemoral pain syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Foot_deformity" title="Foot deformity">foot</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Club_foot" class="mw-redirect" title="Club foot">Club foot</a></li> <li><a href="/wiki/Flat_feet" title="Flat feet">Flat feet</a></li> <li><a href="/wiki/Foot_drop" title="Foot drop">Foot drop</a></li> <li><a href="/wiki/Bunion" title="Bunion">Bunion/hallux valgus</a></li> <li><a href="/wiki/Hallux_varus" title="Hallux varus">Hallux varus</a></li> <li><a href="/wiki/Hallux_rigidus" title="Hallux rigidus">Hallux rigidus</a></li> <li><a href="/wiki/Hammer_toe" title="Hammer toe">Hammer toe</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_head" title="Human head">Head</a> and <a href="/wiki/Neck" title="Neck">neck</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Cauliflower ear</a></li> <li><a href="/wiki/Torticollis" title="Torticollis">Torticollis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General terms</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Joint_stiffness" title="Joint stiffness">Joint stiffness</a></li> <li><a href="/wiki/Contracture" title="Contracture">Contracture</a></li> <li><a href="/wiki/Ligamentous_laxity" title="Ligamentous laxity">Ligamentous laxity</a></li> <li>Abnormal angulation <ul><li><a href="/wiki/Valgus_deformity" title="Valgus deformity">Valgus deformity</a>/<a href="/wiki/Varus_deformity" title="Varus deformity">Varus deformity</a></li></ul></li> <li><a href="/wiki/Bone_malrotation" title="Bone malrotation">Bone malrotation</a></li> <li><a href="/wiki/Joint_dislocation" title="Joint dislocation">Joint dislocation</a></li></ul> </div></td></tr></tbody></table></div></div>'
Whether or not the change was made through a Tor exit node ($1) `(tor_exit_node)`	false
Unix timestamp of change ($1) `(timestamp)`	'1712918404'