Tuesday, February 14, 2017

External Ear Injuries - Brief Description With Pictures.

Injuries to the external ear may be open or closed.

  • Blunt external ear trauma may cause a hematoma (otohematoma) of the pinna, which, if untreated, may result in cartilage necrosis and chronic scarring or further cartilage formation and permanent deformity (“cauliflower ear”). 
  • Open injuries include lacerations (with and without cartilage exposure) and avulsions

Pinna Hematoma. A hematoma has developed, characterized by swelling, discoloration, ecchymosis, and flocculence.  Immediate incision and drainage or aspiration is indicated, followed by an ear compression dressing.

Management: Pinna hematomas must undergo incision and drainage or large needle aspiration using sterile technique, followed by a pressure dressing to prevent reaccumulation of the hematoma.
This procedure may need to be repeated several times; hence, after Emergency department drainage, the patient is treated with antistaphylococcal antibiotics and referred to ENT or plastic surgery for follow- up in 24 hours. Lacerations must be carefully examined for cartilage involvement; if this is present, copious irrigation, closure, and postrepair oral antibiotics covering skin flora are indicated.

Pinna Contusion. Contusion without hematoma is present. Reevaluation in 24 hours is recommended to ensure a drainable hematoma has not formed.

Simple skin lacerations may be repaired primarily with nonabsorbable 6-0 sutures. The dressing after laceration repair is just as important as the primary repair. If a compression dressing is not placed, hematoma formation can occur.
Complex lacerations or avulsions normally require ENT or plastic surgery consultation.

Important Points: 
1. Pinna hematomas may take hours to develop, so give patients with blunt ear trauma careful discharge instructions, with a follow-up in 12 to 24 hours to check for hematoma development.
2. Failure to adequately drain a hematoma, reaccumulation of the hematoma owing to a faulty pressure dressing, or inadequate follow-up increases the risk of infection of the pinna (perichondritis) or of a disfiguring cauliflower ear.

Cauliflower Ear. Repeated trauma to the pinna or undrained hematomas can result in cartilage necrosis and subsequent deforming scar formation.

3. Copiously irrigate injuries with lacerated cartilage, which can usually be managed by primary closure of the overlying skin.
Direct closure of the cartilage is rarely necessary and is indicated only for proper alignment, which helps lessen later distortion. Use a minimal number of absorbable 5-0 or 6-0 sutures through the perichondrium.
4. Lacerations to the lateral aspect of the pinna should be minimally debrided because of the lack of tissue at this site to cover the exposed cartilage.
5. In the case of an avulsion injury, the avulsed part should be cleansed, wrapped in saline-moistened gauze, placed in a sterile container, and then placed on ice to await reimplantation by ENT.

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