PANCE Blueprint EENT (7%)

Hematoma of the external ear

Patient will present as → a 22-year-old mixed martial arts practitioner who was injured during a match which has resulted in a fluctuant, mildly tender edematous lesion of the anterior-superior outer portion of the right pinna.

Results from direct trauma to the anterior auricle.  Shearing forces to the anterior auricle lead to separation of the anterior auricle perichondrium from the underlying cartilage. 

  • This is frequently caused by blunt trauma such as that experienced by wrestlers, boxers, and martial artists.
  • Because the cartilage's blood supply is provided by the perichondrium, separation of the perichondrium from both sides of the cartilage may lead to avascular necrosis and a deformed pinna (cauliflower ear) if not treated promptly.
  • Septic necrosis may also ensue, often with infection by gram-negative bacilli.

The diagnosis is clinical

All auricular hematomas should be drained as soon as possible after injury.

  • Hematomas greater than seven days old may have begun to organize and form granulation tissue and warrant referral to an otolaryngologist or plastic surgeon
Hematoma of ear

Hematoma of ear

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Question 1
A 16-year-old high school wrestler presents after an injury during a match which has resulted in a fluctuant, mildly tender edematous lesion of the anterior-superior outer portion of the right pinna. Which of the following is the most appropriate treatment?
A
Refer to otolaryngology for definitive treatment with I & D and pressure dressing
B
Perform I & D only if the pinna becomes erythematous and extremely tender
Hint:
See A for explanation
C
Prescribe a 10-day course of amoxicillin/clavulanate (Augmentin) and schedule a follow-up appointment in 2 weeks
Hint:
Although antibiotics are frequently given in addition to I & D, they will not prevent tissue necrosis.
D
Apply a soft bulky dressing to the pinna and recommend no further treatment, but have the patient follow-up only if he develops a temperature greater than 101 degrees
Hint:
A pressure dressing is applied after I & D.
Question 1 Explanation: 
The most appropriate course of action for this patient is to refer immediately for I & D by an ENT specialist for the best results. The cartilage of the pinna requires vascular supply from the perichondrium. If deprived of blood, the devascularized tissue can become permanently damaged resulting in the so-called “cauliflower ear.” This is frequently caused by blunt trauma such as that experienced by wrestlers, boxers, and martial artists. Although antibiotics are frequently given in addition to I & D, they will not prevent tissue necrosis. A pressure dressing is applied after I & D.
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