Nasal Septal Hematoma uye Auricular Hematoma: Kudzivirira Cartilage Necrosis Mushure mekushungurudzika.¶

Kana munhu achinge arwara nemhino kana panzeve yekunze panguva yemutambo wekusangana, kudonha, kudhumhana kwemota, kana kupokana kwemuviri, kubuda ropa kunoonekwa kana maronda kunowanzovhara chiitiko chakakosha chenguva pasi pedenga. Zvose septum yemhino nenzeve yekunze (auricle kana pinna) inovimba neavascular hyaline uye elastic cartilage iyo isina tsinga dzemukati dzeropa zvayo. Pane kudaro, cartilage iyi inorarama zvachose nekutora mweya weokisijeni uye chikafu kuburikidza nekusarudzika kubva paganda rakasungirirwa rine fibrous lining inonzi perichondrium. Pakuveura masimba anobvisa perichondrium kure nekashwa uye kuzadza homwe inobuda nedziva reropa, shwashwa rinobva rafa nenzara yeropa rayo. Pasina kukurumidza kuvhiyiwa incision, drainage, uye bolster compression, irreversible ischemic cartilage necrosis inotanga mukati me24 kusvika kumaawa 48 uye inogona kukonzera kuparara zvachose kwemaitiro mukati meawa makumi manomwe nemaviri. Kana munhu wacho aine kukuvara kwakanyanya kumeso, kushanduka kwekuziva, kana kubuda ropa kusingadzoreki, fonera nharaunda yako. nhamba dze emergency nekukasira uye ongorora madhairekitori edu pa nosebleeds, kukuvara mumusoro,uye orbital cellulitis uye cavernous sinus thrombosis.

Ita izvi ikozvino¶

1. **Sikirini yekutyisidzira hupenyu hwemusoro, mutsipa, uye kukuvadzwa kwemhepo kutanga **: Chero kurova kwakasimba zvekupwanya mhino kana kugera shwashwa renzeve kunogona kukonzera kudhumhana, dehenya rekutsemuka kwedehenya, kana kukuvara kwecervical spine. Kana murwere ane mvura yakachena inodonha kubva mumhino kana nzeve (cerebrospinal fluid rhinorrhea kana otorrhea), maonero maviri, kurutsira, kuvhiringidzika, kana kurwadziwa kwemutsipa, danai nhamba yako yekukurumidzira yemunharaunda (911 muUnited States neCanada, 112 mhiri kweEuropean Union, 999 muUnited Kingdom) uye chengetedza musoro nemutsipa zvisingaite.
2. **Ongorora mukati memhino dzose nechiedza chakajeka mushure mekukuvara kwemhino kwese **: Simudza zvinyoro nyoro muromo wemhino uye vhenekera peni kana tochi ye smartphone mumhino dzese. Tarisa zvakananga pamadziro epakati ekuparadzanisa (the nasal septum). Septum ine hutano yakasimba, pink, uye yakatetepa. A nasal septal hematoma inoratidzika seyakapfava, inoputika, cherry-tsvuku, bluish, kana yepepuru yakaita semazambiringa-yakafanana kuzvimba ichivharira imwe kana mhino mbiri.
3. Gadzira cheki yecotton-tipped applicator palpation (chete kana akadzidziswa kana kurairwa): Kusiyana neakajairika kuzvimba mumhino turbinates ayo anoderera mushure mekupfapfaidza decongestant uye anonzwa akasimba pamadziro ekunze emhino, septal hematoma inobuda kunze kubva pakati inopatsanura uye inonzwa yakapfava, ine boggy, uye fluctuant inobata semvura yakachena swab.
4. Tsvaga mvura yekukurumidzira yekurapa mukati memaawa ekufungirwa kuzvimba kweseptal: Usambofa wakamirira mazuva mashoma kuti kuzvimba kwekunze kudzika usati waita kuti chiremba aongorore mukati memhino yakakuvara, kunyanya mumwana. A nasal septal hematoma izuva rimwechete redhipatimendi rekukurumidzira rinoda sterile incision uye mvura ine anterior nasal packing.
5. Isa kudzvanya kunotonhora kwekunze kwenzeve yakazvimba (auricular hematoma): Kana nzeve yekunze ikaita huturu, nyoro, tsvuku-tsvuku-tsvuku inoparadza mapete ayo emuzvarirwo mushure memutsimba, rugby, martial arts, kana kukuvadzwa kwakashata, putira ice pack mumucheka wakachena uye wakanyorovesa munzeve. 15 kusvika 20 maminetsi kunonoka kubuda ropa mukati uchironga kukurumidza kuongororwa mukati memaawa makumi maviri nemana.
6. ** Usamboedza kutsveta, kupuruzira, kana kushuvira mhino kana nzeve hematoma kumba netsono dzisina utachiona **: Kubaya perichondrial kuunganidzwa kweropa pasina kuvhiyiwa antisepsis uye tsika yekumanikidza inosimudzira * Staphylococcus aureus * kana *Pseudomonas aeruginosa kushandura asterile vascular carmamato kurwisa asterilely vascular carmata zvakanangana neasterivascular akafa. ronda rinoparadza.

Muti wesarudzo: Nasal uye auricular trauma triage¶

flowchart TD
    Trauma["Blunt Trauma kuMhuno kana Nzeve Yekunze"] --> NeuroCheck{"Zviratidzo zveDehenya Kutsemuka, CSF Leak, Kuvhiringidzika, kana Kunyanya Kubuda Kweropa Kwemhepo?"}
    NeuroCheck -->|"Hongu"| Call911["Dana 911/112/999 Pakarepo; Gadzirisa Neck uye Airway"]
    NeuroCheck -->|"Aihwa"| Site{"Ndechipi Chimiro Chakakuvadzwa?"}
    Site -->|"Mhuno / Central Face"| LightCheck["Penya Chiedza Chinopenya Mukati meMhino Dzese uye Tarisa Airflow"]
    LightCheck --> SeptumLook{"Yepepuru/Dzvuku Mazambiringa-SeBulge paCentral Wall KANA Kuzadza Bilateral Nasal Blockage?"}
    SeptumLook -->|"Hongu"| SeptalER["URGENTE EMERGENCY BATO SHANYI ZVINO: Incision, Drainage, uye Bolster Inodiwa Mukati Maawa"]
    SeptumLook -->|"Kwete, Pachena Septum"| FeverCheck{"Fivha, Kurwadza Kurwadza, kana Kuwedzera Kuvhara 2 kusvika ku5 Mazuva Gare gare?"}
    FeverCheck -->|"Hongu"| AbscessER["IMMEDIATE ER TRANSFER: Inofungidzirwa Septal Abscess uye Danger-Triangle Intracranial Risk"]
    FeverCheck -->|"Aihwa"| FractureCheck["Kudzora Nyore Epistaxis; Outpatient ENT Fracture Evaluation mukati me3 kusvika ku5 Mazuva"]
    Site -->|"Nzeve Yekunze (Pinna / Auricle)"| EarCheck{"Tense, Boggy, Fluctuant Kuzvimba Kudzima Normal Cartilage Folds?"}
    EarCheck -->|"Hongu"| EarDrain["Shandisa Cold Molded Compression; Urgent ENT kana Emergency Drainage uye Bolster Mukati 24 kusvika 48 Maawa"]
    EarCheck -->|"Kwete, Laceration Inofumura Cartilage"| EarLac["Kuvhara NeSterile Moist Gauze; Urgent Suturing uye Cartilage-Inopinda Antibiotic Coverage"]

Pathophysiology: Sei mhuno nenzeve cartilage inofa kana yakapwanyika¶

Kuti unzwisise kuti sei kuputika mukati memhino kana pamucheto wenzeve kunoda mvura yekuvhiya apo ronda paruoko kana gumbo rinopora roga, zvakakosha kuongorora microvascular anatomy yefacial cartilage.

Avascular nutrition ne perichondrial diffusion¶

Kana iyo quadrangular hyaline cartilage yenasal septum kana yakaoma elastic cartilage yeauricle ine intrinsic capillaries, arterioles, kana lymphatic channels. Pane kudaro, rimwe nerimwe pepa re cartilage rakasungirirwa zvakasimba pakati pezvikamu zviviri zve dense, vascularized connective tissue inonzi ** perichondrium ** (kunyanya iyo ** mucoperichondrium ** mukati memhino, umo mucous membrane uye perichondrium fuse mune imwechete yakaoma layer).

• Mamiriro emazuva ose: Oxygen, glucose, uye amino acids zvinopararira nepakati pechinhambwe chisingasviki 0.5 millimeters (0.02 inches) kubva kucapillary plexus mukati me perichondrium yakananga mumachondrocytes (cartilage cells) akaiswa mumatrix.
• Kukuvara uye kugera: Kana chibhakera, gokora, bhegi remhepo, kana meti yewrestling ikarova mhuno kana nzeve, shwashwa rinochinjika rinokotama zvine simba uye rinodzokera kumashure. Izvi zvinongoerekana zvaveura tsinga dzeropa uye dzinobvarura perichondrium kubva pasi pe cartilage matrix, ichisiya ganda rekunze kana mucosal pamusoro.
• Chipingamupinyi chekuparadzira: Ropa reArterial uye venous rinodururira munzvimbo ichangobva kugadzirwa yesubperichondrial, ichikwidza homwe yakagadzikana, yakamanikidzwa pakati peperichondrium ne cartilage isina chinhu. Muchikamu chemhino, shwashwa rinowanzoputika panguva yekukanganisa, zvichiita kuti ropa riparadze kuburikidza nemutsara wekuputsika uye kubvisa mucoperichondrium kubva ** mativi ose ** e septum panguva imwe chete (a ** bilateral septal hematoma **).
• ** Chondrocyte death and enzymatic liquefaction **: Yakaparadzaniswa negumbeze rayo revascular nemamilimita akawanda eropa risina kumira, deoxygenated, chondrocytes inotanga kufa kubva kune ischemia mukati me 12 kusvika kumaawa 24 . Ne48 kusvika kumaawa 72, masero machena eropa anodzika uye mabhakitiriya anoburitsa collagenase uye maenzayimu eprotease anonyungudutsa matrix eproteoglycan, achiita kuti mudhuri weshwashwa unyunguduke kuita urwa nemarara.

Vascular supply uye hemorrhage sources¶

Kunzwisisa kuti ndeipi tsinga dzeropa dzinoputika mukati memhino nenzeve zvinotsanangura kuti sei mahematoma aya achikura nekukurumidza pasi pekumanikidzwa kweropa:

• Nasal septal vasculature (Kiesselbach's plexus / Little's area): The anterior nasal septum inopihwa neanastomotic network panosangana ma arterial system mana: anterior and posterior ethmoidal arteries, sphenopalatine artery, the great palatine artery, uye septal branch ye superior labial artery. Apo trauma inogera mucoperichondrium, mapazi eiyi arterial plexus anobuda ropa zvakananga muhomwe yakavharwa ye subperichondrial pane kudonha kubva mumhino.
• Auricular vasculature: The anterior surface of the pinna inogamuchira ropa rayo kubva kumapazi anoputika eposterior auricular artery uye superficial temporal artery inobaya nepadiki foramina mucartilage yekudyisa anterior perichondrium. Tangential friction shears iyi midziyo inoputika ipapo painobuda pamusoro pecartilage.

Kuziva nasal septal hematoma panzvimbo¶

Ngozi huru imwe chete yenasal septal hematoma ndeyokuti vanopindura zvechimbichimbi, varairidzi vemitambo, vabereki, uye kunyange varapi vanokurumidzira vanotarisa chete pakumisa kubuda ropa kwemhino kwekutanga kana kutarisa kuti mapfupa epamusoro emhino anotaridzika akatsveyama here, akatarisisa mhango yemhino.

Nhanho-nhanho yekuona uye yemuviri kuongorora¶

Kana uchinge washanda anterior epistaxis yadzikira zvakakwana kuti uone mukati memhino, ita ongororo yakarongeka uchishandisa chiedza chakajeka chechiedza:

1. Simudza murwere akagara akati twasu: Ita kuti munhu agare akati twasu uye akarerekera chirebvu mudenga zvishoma nemadhigirii gumi neshanu kuitira kuti uve nemutsara wakajeka wekuona pauriri hwemhino.
2. Simudza muromo wemhino ("Nguruve-Mhino" maonero): Isa chigunwe chakachena zvinyoro nyoro pamuromo wemhino uye sundira kumusoro kukudza mhino (nares). Usambofa wakapinza zviridzwa zvesimbi zvakapinza kana zvekumanikidza mumhino kunze kwechipatara.
3. **Enzanisa mativi ese emadziro epakati **: Tarisa kumadziro epakati (chikamu chepakati chinoparadzanisa mhino dzekuruboshwe nekurudyi):
4. Normal septum: Iyo yepakati partition yakati sandara, yakatwasuka (kana zvinyoro nyoro mumutsara wakaoma, wakaomarara), uye yakafukidzwa nepingi yakachenuruka kusvika kune mutsvuku mucosa ine mukaha wakavhurika wemhepo pakati peseptum nemadziro eparutivi.
5. Septal hematoma: Rimwe kana mativi ese ari maviri epakati anofuratira kunze senge rakatsetseka, rakatenderedzwa, cherry-tsvuku, rima rebhuruu, kana violaceous plum inozadza mhino nekubata lateral nasal madziro.
6. Kusiyanisa septal hematoma kubva kune yakazvimba yakaderera turbinate kana nyore yakatsauka septum:
7. Nzvimbo: Inferior turbinates project mukati kubva kunze (lateral) wall yemhino; septal hematoma mapurojekiti kunze kubva ku **pakati (yemukati) madziro **.
8. Kunyanyira: Katurike kakatsemuka kana kutyoka septum inonzwa yakasimba uye yakaoma sepurasitiki yebhonzo kana yakaoma kana yakabatwa zvinyoro nyoro nedonje rakanyorova. Septal hematoma inonzwa yakapfava, yakapfava, uye yakapfava: kuidzvanya zvinyoro nyoro nedonje swab inopinza pamusoro, iyo inodzoka pakarepo kana kumanikidzwa kwaburitswa.
9. Kutadza kudzikira nemavasoconstrictors: Mukiriniki kana dhipatimendi rekukurumidzira, kumwaya oxymetazoline (0.05%) kana phenylephrine mumhino inokonzera kuputika kwemucosal turbinates kuderera zvakanyanya mukati memaminitsi e3, nepo subperichondrial hematoma inoramba yakanyatsofanana.

Red-flag zviratidzo zvinoda kukurumidza kutamiswa mukamuri yekukurumidzira¶

Kunyangwe iwe usina tochi yakajeka kuti uone zvakajeka mukati memhino, endesa murwere kune dhipatimendi rekukurumidzira nekukurumidza kana chimwe chezviratidzo zvinotevera chikaonekwa mushure mekukuvadzwa kwemhino:

• **Kusakwanisa zvachose kufema nemumhino imwe chete kana mbiri ** iyo inotanga pakarepo kana mukati maawa makumi maviri nemana mushure mekurohwa kumhino uye haina kujeka mushure mekuputika zvinyoronyoro kunze kweropa rakasununguka.
• **Kuramba, kugomera, kurovera kudzvanya kana kuwedzera kunzwa kuyambuka zambuko uye kumuromo wemhino ** izvo zvinowedzera kupfuura ekutanga 24 kusvika 72 maawa pane kugadzirisa.
• Mireza yakatsvuka yevana: Mucheche, mucheche, kana mwana anoramba kuyamwisa kana kunwa kubva mubhodhoro nekuti mhino yake yakavharika, anoridza ngonono zvine ruzha kekutanga mushure mekudonha, kana kuti ane muromo wakafara, wekuzvitutumadza wekumusoro uye mhino (columella)
• Zviratidzo zvekufambira kubuda mumhuno (Mazuva 2 kusvika ku5): Spike mutembiricha yemuviri iri pamusoro pe38.0 degrees celsius (100.4 degrees Fahrenheit), musoro unorwadza zvakanyanya, erythema uye kuzvimba kupararira paganda remumhino nepamatama, kana kuchinja kwekuona.

Clinical manejimendi ye nasal septal hematoma uye abscess¶

Kunzwisisa zvinoitika mudhipatimendi rekukurumidzira kana otolaryngology (ENT) surgical suite inobatsira varwere nevabereki kuziva kurapwa kwekutarisira uye nei nyore kushuvira tsono chete isina kukwana.

1. Definitive surgical incision and drainage¶

Under topical vasoconstrictive anesthesia muvanhu vakuru vanobatana, kana pfupi procedural sedation muvana vadiki:

• Horizontal mucoperichondrial incision: Achishandisa nasal speculum uye chiedza chemusoro chakajeka, murapi anocheka yakachinjika (horizontal mucoperichondrial incision)Killian kana hemitransfixion incision) mhiri kwakadzikira uye kwakawanda kwepamberi bulge yehematoma kuburikidza nemucoperichondrium, ichiramba yakatarisana nemhino pasi kuti isacheke shwashwa riri pasi.
• Bilateral evacuation without overlapping incision: Kana hematoma iri mativi maviri, kudhonza divi rimwe chete kunobuditsa mativi ese kana shwashwa ratsemuka. Kana chechipiri chechipiri chichidiwa kune rumwe rutivi, chiremba anovhiya anozunungusa zvinyorwa pamazinga akasiyana-siyana kuti adzivirire septal perforation zvachose.
• Kusveta, kudiridza, nekuiswa kwemvura: Ropa rakasviba rakagwamba kana kuti urwa hunotorwa zvachose, uye homwe inodiridzwa nesaline isina utachiona. Murapi anozoisa ingave diki inouraya latex-isina Penrose drain kana inotorwa kuburikidza-uye-kuburikidza nequilting sutures (4-0 chromic gut kana Vicryl Rapide) anosonanidza machira emucoperichondrial zvakasimba kumashure achitarisana nechepakati shwashwa.

2. Bilateral anterior nasal packing uye antibiotic prophylaxis¶

Kana ropa rabviswa, perichondrium inofanirwa kubatwa yakasimba pakatarisana nekashasha isina chinhu kuitira kuti kuparadzirwa kweokisijeni nekudya kunotangisa nekukasika.

• Bilateral splinting: Mhino dzese dziri mbiri dzakarongedzerwa zvakaenzana nemaponji edoro epolyvinyl anowedzerwa.Merocel), antibiotic-impregnated gauze, kana silicone intranasal splints (Doyle splints) kwe48 kusvika kumaawa 72 saka iyo isina simba septum inotsigirwa zvakaenzana kubva kumativi ese.
• Kudzivirira Toxic Shock Syndrome (TSS): Murwere wose anenge abudiswa mumhino akaiswa mumhino anonyorerwa mishonga inorwisa mabhakitiriya yemukanwa (yakadai seamoxicillin-clavulanate, cephalexin, kana clindamycin) apo mapepa acho anoramba aripo. Varwere vane purulent **septal abscess ** vanoda kuendeswa kuchipatara kune intravenous antibiotics inovhara. MRSA uye pamusoro pekufema anaerobes. Wongorora gwara redu pa toxic shock syndrome kubva mumhino kurongedza kune red-flag zviratidzo.

Kuziva uye triaging auricular hematoma ( "Cauliflower Nzeve")¶

Auricular hematoma inoitika chete pa ** anterior (yakatarisana) pamusoro ** yekunze kwenzeve, kunyanya mukati me conchal mbiya, scaphoid fossa, uye triangular fossa, uku ichichengetedza nyama yenzeve (lobule, ine mafuta uye fibrous tishu kwete cartilage).

Sei pamberi penzeve ichizvimba uye kuti nzeve ye cauliflower inoumbwa sei¶

• Anterior vs. posterior skin adherence: Pamberi pe concave pamusoro penzeve, ganda rine bepa rakatetepa ne zero subcutaneous mafuta, rinonamatira zvakananga ku perichondrium. Tangential friction mu wrestling kana rugby shears the perichondrium kubva pa cartilage. Kuseri kwenzeve, cushion ye subcutaneous fat inobvumira ganda kutsvedza pamusoro pezvinokanganisa pasina kubvarura subperichondrial midziyo.
• Immediate Phase (0 kusvika maawa makumi maviri nemana): Nguva pfupi mushure mekukanganisa, mitsetse yakasviba yakaita C-mipata uye mipata yekumusoro kwenzeve (helix, antihelix, scapha, concha) kunyangarika, kunotsiviwa nemvura yakagadzikana, yakatsetseka, yakatsvuka-tsvuku kana kuti yeganda.
• Kuronga uye Kuverengera Phase (Mazuva 2 kusvika 21+): Pakati peMazuva 2 ne7, ropa remvura rinogwamba kuita jira rakasimba rerubha rinovhara tsono. Kusiyana nenasal septum (iyo inonyunguduka kana yabviswa ropa), iyo yakavharwa auricular perichondrium ine inoshanda ** chondrogenic progenitor masero ** inotanga kugadzira isina kurongeka fibrous tissue uye ectopic new cartilage mukati megomba reropa mushure meZuva 7, calcifying kupinda zvachose ** cauliflower nzeve ** (wrestler's ear)
• Matambudziko Anoshanda: Mahematoma asina kurapwa mundiro yeconchal anopinza buri renzeve, kuteya wakisi yenzeve nemvura, zvichikonzera kurasikirwa kwekunzwa, uye kuvhara stethoscopes kana zvinoyamura kunzwa. Uyezve, tsono dzisina kuberekwa dzinounza Pseudomonas aeruginosa kana kuti Staphylococcus aureus, zvichikonzera suppurative perichondritis (kuzvimba kunorwadza zvikuru, kupisa, kutsvuka kwepamusoro kwenzeve izvo zvinoratidzira ** zvinodzivirira nzeve isiri-cartilaginous*).

Chekutanga-rubatsiro rwemumunda kutarisirwa uye mvura yekurapa yeauricular hematomas¶

Pakarepo munda uye locker-room zviito¶

1. Misa kutora chikamu nekukasika: Kuramba uchiita mutsimba kana kuti spar pombi yekuwedzera ropa muhomwe, uchibvisa perichondrium yasara papina yese.
2. Tarisa nzeve nekunzwa: Tarisa mukati mekaburi renzeve nechiedza. Kana mvura yakachena yemvura kana ropa rakajeka richidurura kubva pakadzika ** mukati ** mugero renzeve, kana kana munhu wacho akangoerekana anzwa matsi, vertigo, kana mavanga pamusoro pemastoid bone (Battle's sign), fungidzira kutyoka kwedehenya remusoro kana kutsemuka nzeve. Ita ** kwete ** shandisa kudzvinyirira kune nzeve yenzeve; ona vatungamiriri vedu pa kukuvara mumusoro uye kutadza kunzwa kamwe kamwe uye kuputika kweeardrum.
3. Isa contoured cold compression for 15 kusvika 20 maminetsi: Gadzira jira rakanyorova rakanyorova mukati mekunze kwenzeve, isa tauro-rakaputirwa rakapwanyika-aizi paki pamusoro pejira, uye bata zvinyoronyoro zvinyoronyoro kwemaminetsi gumi nemashanu kusvika makumi maviri. Usambofa wakaisa chando zvakananga paganda renzeve risina chinhu.
4. Ronga mvura yekurapa isina utachiona mukati meawa makumi maviri nemana kusvika makumi mana nemasere: Shanyira dhipatimendi rekukurumidzira, chiremba wemishonga yemitambo, kana nyanzvi yeENT mukati meawa makumi maviri nemana ropa richiri mvura.

Definitive medical drainage, bolsters, uye antibiotic kusarudzwa¶

Kuchengeta pamba uye tsvuku-mureza yekutarisa mushure memvura¶

Zvingave murwere ane nasal septal hematoma yakanyungudutswa ne intranasal packing kana kuti auricular hematoma yakanyungudutswa ine sewn bolster dressing, kunyatsotarisa pamusoro pemazuva mashanu kusvika ku7 anotevera kunodzivirira kurasikirwa kwechipiri kwenyama.

Kuchengeta simbi yemhino/kurongedza¶

• Rara wakasimudza musoro pa30 kusvika 45 madhigirii pamapiro maviri kana mureliner kuti uderedze kusangana kwetsinga uye kupuruzira mumhino.
• Hotsira wakashama muromo wakashama: Usambofa wakadzvanya kuhotsira nekudzvanya mhino kana kuvhara muromo, sezvo mhepo inoerekana yavepo ichigona kuburitsa tsinga dzemhino kana kumanikidza utachiona kukwira machubhu eEustachian uye sinus ostia.
• Usadhonze kana kudimburira tambo: Mapaketi emhino anowanzova neshinda dzesiririka dzekuchengetedza dzakanamirwa padama kana kusungirirwa nepakati pecolumella kudzivirira kuchiva kwemashure muhuro. Siya tambo dzese dzakasimba kusvika chiremba abvisa kurongedza pa48-to-72-awa recheck.
• **Dzokera kudhipatimendi rekukurumidzira nekukurumidza kana **:
• Ropa dzvuku rakajeka rinogara richinyura nepakati pemhino yedrip pad uye rinomhanya richidzika nekuseri kwehuro zvisinei kuti rakati twasu.
• Murwere anoita fivha inodarika 38.0 degrees Celsius (100.4 degrees Fahrenheit), kupindwa nechando, kuita dzungu paanomira, kurutsira, manyoka ane mvura, kana tumapundu tutsvuku twakapararira (zviratidzo zvinonyevera zvepacking-zvinechekuita Toxic Shock Syndrome).
• Murwere anotanga kuona kaviri, maziso akarembera, ziso rinoputika, musoro wakakomba wehuma, kana kuoma kwemutsipa (zviratidzo zvinonyevera zve intracranial venous sinus spread).

Kutarisira kupfeka kwesimbi¶

• ** Chengetedza simbi yenzeve yakaoma zvachose **: Usageze pamusoro pemusoro, kushambira, kana kurega dikita richinyudza mazino emazino kana plaster mold. Bolster inonyorova inobata ganda rakatetepa nzeve uye inobereka Pseudomonas bhakitiriya.
• Monitor for bolster pressure necrosis vs. perichondritis: Nekuti bolster inosunga ganda pa cartilage, bolster yakasungirirwa zvakanyanya inogona kuvhunga kuyerera kwearteri kuganda pacharo. Dzokera kuna chiremba mukati memaawa kana:
• Marwadzo munzeve anongoerekana awedzera kubva pakurwadza kwakadzikama kusvika pakurwadziwa kwakanyanya, kusingaregi, kupisa kana kurova (chiratidzo chekare cheischemic skin necrosis pasi pe bolster kana acute Pseudomonas perichondritis).
• Mupendero wenzeve unooneka wakatenderedza simbi unoshanduka kucheneruka, dusky grey-black (ischemia), kana moto, richipararira dzvuku nehupa hunobuda kubva mumaburi esuture.
• ** Pfeka chidzitiro chakasimba chekudzivirira paunodzokera kumutambo **: Kana nzeve yapora zvachose (kazhinji 2 kusvika kumavhiki e4 mushure mekubviswa kwebolster, kucheneswa nachiremba), wrestlers, grapplers, uye rugby mberi vanofanira kupfeka zvakagadzirirwa zvakakodzera, zvakaoma-shell-strap wrestling headgear (ear guards) ine makomichi enzeve akadzika anovharika pamusoro pepina pasina kukwiza pashwashwa.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

Kana kurwadziswa kwechiso kana kwemugotsi kuchiperekedzwa nekubuda ropa kwakanyanya, kukanganiswa kwemhepo, zviratidzo zvetsinga, kana hutachiona hwekuparadzira, taura neve emergency emergency service nekukurumidza:

Mibvunzo inowanzo bvunzwa¶

Sei vanachiremba vachiti iwe unogona kumirira mazuva mashanu kuti ugadzirise mhino yakaputsika, asi septal hematoma inofanira kudirwa zuva rimwe chete?¶

Kana mapfupa emhino achitsemuka, kunze kwemhino kunobva kwazvimba nesoft-tissue edema, zvichiita kuti zviomere chiremba weENT kuti aone kunyatsorongeka kwemapfupa kusvikira kuzvimba uku kwekunze kwapera mushure memazuva mana kusvika ku7. Zvakadaro, nasal septal hematoma mukati memhino injodzi yakasiyana zvachose: ropa rakavharirwa rinobvisa chikafu chinopa chikafu kubva mumhino shwashwa uye rinotanga kuuraya masero ecartilage mukati memaawa makumi maviri nemana. Ndicho chikonzero munhu wese ane mhino yakapwanyika kana yakaputsika anofanirwa kunge ane mukati memhino mbiri yakatariswa nechiedza paZuva 1 kuti abvise septal hematoma, kunyange kana kunze kwefupa kururamisa kwakarongerwa vhiki inotevera.

Mwana angave ane ngozi nasal septal hematoma kunyange kana mhino yake isina kubuda ropa rakawanda uye isingataridzi yakakombama?¶

Hongu, vana vari panjodzi huru yekunyarara nasal septal hematomas kupfuura vanhu vakuru nekuti septal cartilage yevana yakapfava uye yakanyungudika pane brittle. Kana mwana mudiki akadonha nechiso, shwashwa rinokotama zvine simba rodzokera panzvimbo risingatyoki mapfupa epamhuno ekunze kana kubvarura ganda rekunze, uku achiveura tsinga dzeropa chinyararire pasi pemukati memucosal lining. Kana mwana asingakwanisi kufema nemumhino mushure mekuputika kwechiso, anofanira kuongororwa mukati memhino dzose nachiremba zuva iroro.

Chii chinonzi "saddle-nose deformity" uye septal hematoma inokonzera sei?¶

Zvikamu zviviri muzvitatu zvebhiriji remhuno yemunhu zvakasimudzwa zvachose nequadrangular septal cartilage, senge bango retende repakati rinosimudza tende recanvas. Kana nasal septal hematoma kana abscess ikasaonekwa kwemaawa makumi mana nemasere kusvika makumi manomwe nemaviri, shwashwa rinonyungudika nekushaikwa kweokisijeni uye kuparara kwe enzymatic. Pasina rusvingo rwayo rwepakati rwerutsigiro, chivharo chepakati chemhino mapako nechomukati uye chinotsvedza chakananga kuchiso, chichigadzira scooped-out concave profile inozivikanwa sesaddle-nose deformity inoda yakaoma rib-cartilage reconstructive operation kugadzirisa.

Sei ndisingagone kudonhedza nzeve yangu yecauliflower kumba nesirinji ye insulin kubva kuchitoro chemishonga?¶

Chekutanga, kubudisa ropa nejekiseni kunosiya perichondrium yakabvaruka ichiyangarara yakasununguka pamusoro peshwashwa, saka homwe inongozadza neropa uye mvura mukati memaawa mashoma kunze kwekunge tsika yekumanikidza simbi kana metiresi suture inosunga matinji pamwe chete kwemazuva mashanu kusvika manomwe. Chechipiri, ganda renzeve yekunze rinonyanya kuvharwa nePseudomonas aeruginosa bacteria; Kusunda tsono paganda pasina kuvhiya ayodhini kugadzirira uye cartilage-inopinza mishonga inorwisa mabhakitiriya inogona kupinza utachiona zvakananga muavascular shwashwa, zvichikonzera suppurative perichondritis inogona kunyunguduka nekukanganisa nzeve yese yekunze.

Ndingaziva sei mutsauko pakati pekuzvimba kwenzeve yakajairwa uye ine ngozi yeauricular perichondritis infection?¶

Chinhu chakakosha chekiriniki chekuongorora nzeve (lobule) pazasi penzeve. Nekuda kwekuti rukuvhute rwenzeve rune mafuta chete uye ganda risina cartilage, chokwadi auricular perichondritis (kutapukirwa kwecartilage lining) kunokonzera kutsvuka kwakanyanya, kunotyisa, kupfava kwakanyanya, uye kukora nechepamusoro kwakaomarara chikamu chenzeve ichidzivirira zvachose nyoro pasi. Kana nzeve yepamusoro ikapisa, yakatsvuka, uye inorwadza zvisingaite kusvika pakubata kwakareruka, tsvaga rubatsiro rwechimbichimbi nekukasika kune anti-pseudomonal antibiotics.

Inguva yakareba sei mushure mokunge hematoma yenzeve yaitika, inguva yakareba sei kuidhonza netsono kana kuchekwa?¶

Auricular hematoma inogara iri mvura kwemaawa makumi maviri nemana kusvika makumi mana nemasere ekutanga, rinova iro hwindo rakakodzera remvura yekuvhiya uye kusimbisa. Pakati peMazuva 3 ne7, ropa rinogwamba kuita gel gobvu, rerubha refibrin rinoda kuvhiyiwa kuchekwa pamwe nekupetwa kwenzeve uye kubviswa zvinyoro-nyoro. Mushure memazuva manomwe kusvika gumi nemana, iyo perichondrium yakasimudzwa inotanga kuumba yakasimba fibrous scar tissue uye calcified cartilage itsva, panguva iyo mvura yakapfava haichagoneki uye kuvhiya kuvezwa neENT kana chiremba anovhiya epurasitiki zvinodiwa.

Mazano anoenderana¶

• Nosebleeds (epistaxis): kudzvanya mhino yakapfava uye mushure mekubuda ropa mireza matsvuku
• Orbital cellulitis, cavernous sinus thrombosis, uye Danger Triangle kutapukira kumeso
• Kamwe kamwe kunzwa kurasikirwa kwekunzwa, kurova nzeve, uye kuputika kwekuchengetedza eardrum
• Toxic shock syndrome (TSS): tampon, kurongedza kwemhino, uye maronda ekuvhiya mabhegi matsvuku
• Kukuvara mumusoro, mireza yakatsvuka, uye zviratidzo zvekutyoka dehenya

Nzvimbo uye nhungamiro yepamutemo¶

• American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS, United States): Clinical Consensus pamusoro peAcute Nasal Fractures, Nasal Septal Hematoma/Abscess Drainage, uye Auricular Perichondritis.
• ** National Institute for Health and Care Excellence (NICE) & ENT UK (United Kingdom): ** * National Clinical Guideline pamusoro peAcute Nasal Trauma: Same-Day Exclusion of Septal Hematoma uye Management yePinna Haematoma *.
• American Academy of Pediatrics (AAP, United States): Pediatric Facial Trauma Evaluation: Kuzivikanwa kweOccult Bilateral Nasal Septal Hematoma.
• National Collegiate Athletic Association (NCAA) Sports Medicine Handbook (United States): Nhungamiro pamusoro peAuricular Injuries muWrestling uye Contact Sports.
• Royal Vana Chipatara Melbourne (Australia): Chiremba Chekuita Nhungamiro: Nasal Trauma uye Septal Hematoma Drainage muVana.