Image of the Day 38: Approach to Ear Trauma

A 20 year old Indonesian worker was using a bamboo pole during working at palm oil plantation when the pole break and piece of the bamboo penetrate his right ear. The bamboo was removed under procedural sedation and analgesia. The defect was then sutured and he was discharged with antibiotic and pain medication

This 5 year old kid was playing with fish hook and accidentally hit his left ear. The tip of the fish hook was cut using the wire cutter and the hook was then pulled out.

This 50 year old gentleman accidentally cut his with the sickle during farming. noted that the ear already avulsed and anatomically disfigured. The external meatus of the ear also came out from it's place. Patient was posted for ear repair under general anesthesia. 

 Discussion

After lips injury, ear trauma come seconds in term of difficulty in repairing the facial injury. In managing ear trauma, it is important to treat the current presenting complaint as well as preventing the complication.

The aim of managing ear trauma are as follow; 1) Maintaining the cosmesis by repairing the injury as symmetrical to the counter ear. 2) Avoidance of hematoma, and 3) Prevention of infection.

Whenever patient come with ear trauma, it is very important to rule out presence of other injury especially basal skull fracture and tympanic membrane perforation.

Superficial laceration wound can be sutured using 6-0 non absorb-able suture material for five to six days. It is very important to maintain the homeostasis in order to prevent hematoma formation.

Untreated hematoma formation may lead to abnormal cartilage production that will calcify and producing deformed ear known as cauliflower ear.

Whenever present, exposed cartilage must be covered to reduce infection, erosive chondritis and subsequent necrosis.

It is best to refer ear injury with avulsed tissue, crushed cartilage and auricular hematoma to plastic surgeon or ENT specialist.