Auricular hematoma in antiquity: Possible surgical drainage in the hellenistic boxer at rest

Injuries of the external ear caused by blunt trauma are among the most characteristic lesions of contact sports and have likely accompanied athletic competition since antiquity. Auricular hematoma is a well-recognized consequence of blunt trauma to the external ear and remains a common injury in modern contact sports. If untreated, subperichondrial blood accumulation may lead to cartilage ischemia and permanent auricular deformity, commonly known as cauliflower ear. Evidence of this condition may already appear in ancient artistic representations.1,2 The Hellenistic bronze statue known as the Boxer at Rest (late fourth-third century BCE) depicts an athlete with pronounced bilateral auricular deformities consistent with chronic auricular hematoma. In addition to these features, both ears display short, sharply defined linear lesions accentuated by copper inlays suggestive of active bleeding.3 This study reexamines these markings from a clinical and anatomical perspective. Their morphology, symmetry, and anatomical location closely correspond to sites commonly used in modern surgical drainage of auricular hematomas.1 This raises the possibility that the sculpture depicts not merely traumatic injury but a therapeutic intervention. Although classical medical texts do not explicitly describe the treatment of auricular hematoma, incision and evacuation of pathological fluid collections were well established in ancient medicine.4-6 The statue may therefore represent one of the earliest visual depictions of the management of sports-related ear trauma. This interpretation highlights the continuity of traumatic injuries associated with contact sports and their medical consequences across more than two millennia.