EAR AND NOSE INJURIES

EAR INJURIES

If there is any devitalized skin on the patient’s ear, remove it. Don’t leave cartilage uncovered! The skin over the ear is not very mobile, so you may have to graft it or excise the injury. Depending on the site, you may be able to remove up to 5 mm without this being noticeable.

If a patient’s ear has been incised, insert the first stitch at the edge of the helix. This will avoid a ridge forming which can be very conspicuous when his wound has healed. Then align his antihelix. Try to repair his ear by suturing its perichondrium. If you have to suture the cartilage, use fine monofilament.

If a minor part of a patient’s pinna is missing, suture the skin edges together, over the edge of the cartilage. Refer him for a plastic repair later.

If a major part of his pinna is missing, toilet the wound, spread the injured pinna slightly, and suture it in two layers to an incision immediately beneath it in his postauricular scalp, as in A, B, and C, Fig. 61-6. Refer him for a plastic repair later. Alternatively, suture the skin of his ear together over its cartilage, as in F, and G, in that figure.

If you are worried about the formation of a haematoma, pack his ear with moist cotton wool to maintain its shape, and bandage it firmly.

Leave most wounds exposed, don’t dress them. Remove his stitches at 14 days.

If a haematoma forms, with or without a laceration, aspirate it and apply a pressure dressing. If it recurs following aspiration, incise it and insert a short length of rubber band for a drain.

NOSE INJURIES

See also Section 62.4. Try to align the edge of the patient’s nose accurately, as in B, Fig. 61-2. Insert the first suture at the edge.

If an injury penetrates all layers of a patient’s nose, repair the mucous membrane first using 4/0 catgut. Bring his nasal cartilages together, and try to hold them in place by suturing the skin with fine monofilament.

Only pack his nose if a pack is necessary to hold it in place. Avoid leaving packs in place,if you can.

CAUTION! If he has a septal haematoma, evacuate it immediately through a small mucosal incision. If you fail to do this it will be absorbed, but in doing so, it will destroy his septal cartilage and cause a saddle nose.