58.30 Burnt face and ears

Burnt face

Warn the patient’s family that massive oedema may greatly distort his face, but that this will disappear. Raise his head to 30 $\ensuremath{^\circ }$ and have intubation and tracheostomy equipment ready. If you have to do a tracheostomy, do it in the theatre after intubating him first. Oedema will be at its maximum 12 to 24 hours after the burn, so watch him carefully, because respiratory obstruction may be sudden.

Full thickness burns of the beard area are rare, because the hair follicles extend so deep. Use thin split skin sheet grafts, not mesh grafts, and apply them to complete anatomic areas of his face. Sew the grafts in place, and hold them by the tieover method (57-8). The most common cause of failure to take is not keeping the graft still. So try to stop him talking and give him liquid food.

Burnt ears

Inflammation of the cartilages of the ears can occur 2 to 5 weeks after a severe facial burn, when the skin over a patient’s ear may have healed. His burnt ear becomes acutely, painful, red, and tender, because its cartilage has become necrotic.

If you don’t excise the dead cartilage, it becomes infected and sloughs. Once this has happened he will need his ear reconstructed.

$\includegraphics[scale=0.195]{/home/kumasi/Desktop/primsurg-tex/vol-2/ch-58/fig/58-28.eps}$

Figure 58.28: BURNS OF THE EARS. If the cartilage of a patient’s ear becomes necrotic, you may have to remove it.

CHONDRITIS OF THE EAR

PREVENTION Treat a burnt ear carefully. When you dress it, put a pad of gauze behind it to prevent it bending.

If a collection of fluid gathers on a patient’s ear, incise it urgently, if necessary, more than once. If you leave it, the cartilage under it may necrose.

If his ear cartilage becomes necrotic, block his greater auricular and auriculotemporal nerves with lignocaine (A 6.6). Incise the outer border of his ear, so as to separate its anterior and posterior surfaces. Remove any soft yellow cartilage which lacks the normal resilience of healthy hyaline cartilage. Pack his ear with fine gauze, being careful not to bend it. Keep it moist with saline. Examine it 24 hours later, under local anaesthesia. If necessary, remove more necrotic cartilage.

If there is sepsis and abscess formation, drain the septic area with a wide incision, and remove all necrotic cartilage. If you fail to do this, the whole cartilage will become infected.