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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.
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Management and Disposition
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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 ED 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. Simple skin lacerations may be repaired primarily with nonabsorbable 6-0 sutures or surgical glue as appropriate. 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.
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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.
Failure to adequately drain a hematoma, reaccumulation of the hematoma owing to a faulty pressure dressing, ...