Nasal Septal Hematoma le Auricular Hematoma: Ho Thibela Lefufuru Necrosis Ka mor'a Tlokotsi¶

Ha motho a utloa bohloko nkong kapa tsebeng e ka ntle nakong ea papali ea papali, ho oa, ho thula koloi, kapa ho qabana 'meleng, ho tsoa mali ho bonahalang kapa matetetso hangata ho pata boemo ba tšohanyetso bo boholo ka tlas'a metsi. Bobeli septum ea nasal le tsebe e ka ntle (auricle kapa pinna) li itšetlehile ka avascular hyaline le lefufuru la elastic le se nang methapo ea mali e ka hare ea eona. Ho e-na le hoo, lefufuru lena le phela ka ho feletseng ka ho monya oksijene le limatlafatsi ka ho hasana ho tsoa lesela le tiileng la letlalo le bitsoang perichondrium. Ha matla a ho kuta a ebola perichondrium hole lefufuru 'me a tlatsa pokotho e hlahisoang ka letamo la mali, lefufuru le bolaoa ke tlala hang-hang. Ntle le ho potlaka ha opereishene, drainage, le bolster compression, Ischemic cartilage necrosis e sa fetoheng e qala nakong ea lihora tse 24 ho isa ho tse 48 mme e ka baka ho putlama ha sebopeho ka nako ea lihora tse 72. Haeba motho a e-na le leqeba le lebe sefahlehong, a e-na le maikutlo a fetohileng, kapa a tsoa mali a sa laoleheng, letsetsa sebakeng sa heno. dinomoro tsa tshohanyetso hang-hang 'me u hlahlobe batataisi ba rona ho mali a nko, likotsi tsa hlooho, le orbital cellulitis le cavernous sinus thrombosis.

Etsa sena hona joale¶

1. Skrine bakeng sa tsietsi ea hlooho, molala le moea o behang bophelo kotsing pele: Leqeba leha e le lefe le matla hoo le ka robehang nko kapa ho kuta lefufuru la tsebe le ka boela la baka lets'ollo, ho robeha ha lehata, kapa leqeba la mokokotlo oa molomo oa popelo. Haeba mokuli a e-na le metsi a hlakileng a phallang ho tloha nko kapa tsebe (cerebrospinal fluid rhinorrhea kapa otorrhea), pono e habeli, ho hlatsa, pherekano, kapa bohloko ba molala, letsetsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno (911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom) 'me u boloke hlooho le molala li sa sebetse.
2. Hlahloba ka har'a linko ka bobeli ka khanya e khanyang ka mor'a kotsi e 'ngoe le e 'ngoe ea nko: Ka bonolo phahamisa ntlha ea nko 'me u khantše lebone la pene kapa lebone la smartphone liropeng tse peli tsa nko. Sheba ka ho khetheha leboteng le arohaneng le bohareng (septum ea nasal). Septum e phetseng hantle e tiile, e pinki ebile e tšesaane. Nasal septal hematoma e bonahala e le lerootho le bonolo, le phunya, le bokhubelu ba cheri, boputsoa kapa bo perese bo kang ba morara bo thibelang nko e le 'ngoe kapa ka bobeli.
3. Etsa tlhahlobo ea palpation ea kopo e nang le ntlha ea k'hothone (hafeela e koetlisitsoe kapa e laetsoe): Ho fapana le li-turbinate tsa nko tse ruruhileng tse honyehang ka mor'a ho fafatsa sekoboli 'me li ikutloa li tiile leboteng le kantle la nko, septal hematoma e hlaha ka ntle ho tloha bohareng 'me e ikutloa e le bonolo, e boreleli, 'me e thella joalo ka metsi a hloekileng. swab.
4. **Batla metsi a tšohanyetso ka mor'a lihora tse seng kae bakeng sa seo ho nahanoang hore ho na le ho ruruha ha septal **: Le ka mohla u se ke ua emela matsatsi a seng makae hore ho ruruha ha sefahleho ho theohele pele ngaka e hlahloba bokahare ba nko e lemetseng, haholo-holo ngwaneng. A nasal septal hematoma ke boemo ba lefapha la tšohanyetso la letsatsi le le leng le hlokang ho phunya le ho ntša metsi ka ho paka ka pele ho nko.
5. Hatsa tsebe e ka ntle e ruruhileng (auricular hematoma): Haeba tsebe e ka ntle e hlaha leqhubu le tsitsinyehang, le bonolo, le bofubelu bo bofubelu le senya mameno a lona a tlhaho ka mor'a ho betana, rugby, martial arts, kapa ho sithabela maikutlo, koahela pakete ea leqhoa ka har'a lesela le boreleli le boreleli. Metsotso e 15 ho isa ho e 20 ho liehisa mali a tsoang ka hare ha o ntse o hlophisa tlhahlobo e potlakileng nakong ea lihora tse 24.
6. **Le ka mohla u se ke ua leka ho lla, ho phunya, kapa ho phunya hematoma ea nko kapa ea tsebe lapeng ka linale tse sa hloekang **: Ho phunya pokello ea mali ea perichondrial ntle le antisepsis e matla ea ho buoa le tloaelo ea khatello ea maikutlo e hlahisa Staphylococcus aureus kapa *Pseudomonas aeruginosa ho fetola lefu la asterile vascular ka ho toba khahlanong le lefu la asterile vascular. seso se senyang.

Sefate sa ho etsa qeto: Triage ea maqeba a nko le auricular¶

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    Trauma["Tlhekefetso e Blunt ho Nko kapa tsebe e kantle"] --> NeuroCheck{"Matshwao a Ho robeha ha Lehata, Leak ya CSF, Pherekano, kapa Ho Tswa madi ho Hoholo ha Sefofane?"}
    NeuroCheck -->|"Ee"| Call911["Letsetsa 911 / 112 / 999 Hang-hang; Tsitsisa Molala le Sefofane"]
    NeuroCheck -->|"Che"| Site{"Ke Sebopeho Sefe se Lemetseng?"}
    Site -->|"Nko / Sefahleho se Bohareng"| LightCheck["Phatsisa Leseli le Khanyang ka Hare Linkong Ka Bobeli 'me U Lekola Phallo ea Moea"]
    LightCheck --> SeptumLook{"Leqhubu la Morara o Bopherese/Bokhubelu Leboteng le Bohareng KAPA le Thibelo e Felletseng ea Linko tse peli?"}
    SeptumLook -->|"Ee"| SeptalER["LEFAPHA LA TŠOHANELO LE Etela HONA HONA JOALE: Ho Seha, Ho Phalla metsi, le Bolster ho Hlokahala ka Lihora Tse Tlang."]
    SeptumLook -->|"Che, Hlakola Septum"| FeverCheck{"Feberu, Mahlaba a Throbbing, Kapa Tšitiso e Eketsehileng Matsatsing a 2 ho isa ho a 5 hamorao?"}
    FeverCheck -->|"Ee"| AbscessER["IMMEDIATE ER TRANSFER: Ho belaelloang hore Septal Abscess le Kotsi-Triangle Intracranial Risk"]
    FeverCheck -->|"Che"| FractureCheck["Laola Epistaxis e Bonolo; Tlhahlobo ea Ho robeha ha ENT nakong ea matsatsi a 3 ho isa ho a 5"]
    Site -->|"Outer Ear (Pinna / Auricle)"| EarCheck{"Ho Tepella, Ho Ruruhile ho Fetohang ho Hlakola Mameno a Tloaelehileng a Lefufuru la Litsebe?"}
    EarCheck -->|"Ee"| EarDrain["Etsa kopo Cold Molded Compression; Emergency Drainage le Bolster nakong ea lihora tse 24 ho isa ho tse 48."]
    EarCheck -->|"Che, Laceration e pepesa Lefufuru"| EarLac["Koahela ka Gauze ea Mongobo e Hlakang; Tšireletso e Potlakileng ea ho Suturing le Lefufuru le Kenang ka Lefufuru"]

Pathophysiology: Hobaneng ha lefufuru la nko le tsebe le shoa ha le robehile¶

E le hore u utloisise hore na ke hobane'ng ha leqeba le ka har'a nko kapa molomong oa tsebe le hloka ho ntša metsi ka ho buuoa ha leqeba letsohong kapa leoto le fola ka boeona, ho hlokahala hore u hlahlobe sebōpeho sa microvascular ea lefufuru la sefahleho.

Phepo ea Avascular ka phallo ea perichondrial¶

Leha e le lefufuru la quadrangular hyaline lefufuru la nasal septum kapa lefufuru le rarahaneng le tenang la auricle ha le na li-capillaries, arterioles, kapa lymphatic channels. Ho e-na le hoo, letlapa le leng le le leng la lefufuru le khomaretsoe ka thata pakeng tsa likarolo tse peli tsa lesela le teteaneng, le nang le methapo ea methapo e bitsoang **perichondrium ** (haholo-holo ** mucoperichondrium ** ka har'a nko, moo mucous membrane le perichondrium li kopanang ka lera le le leng le thata).

• Boemo bo tloaelehileng: Oksijene, tsoekere, le li-amino acid li hasana ho pholletsa le sebaka se sa bonahaleng se ka tlase ho limilimithara tse 0.5 (0.02 inches) ho tloha ho capillary plexus ka har'a perichondrium ka kotloloho ho li-chondrocyte (lisele tsa lefufuru) tse kentsoeng ka har'a matrix.
• Ho lemala le ho kuta: Ha feisi, setsoe, mokotla oa moea, kapa 'mete oa wrestling e otla nko kapa tsebe, lefufuru le tenyetsehang le kobeha haholo ebe le khutlela morao. Lefu lena la tšohanyetso le kuta methapo ea mali ea subperichondrial 'me e rusolla perichondrium ho tloha ka tlas'a lefufuru matrix, ha e ntse e siea letlalo le ka ntle kapa bokaholimo ba mucosal bo sa sisinyeha.
• Lepheko la ho hasana: Mali a methapo le a venous a tšolohela sebakeng sena se sa tsoa thehoa sa subperichondrial, a kenya pokotho e tsitsitsoeng, e nang le khatello pakeng tsa perichondrium le lefufuru le se nang letho. Ka septum ea nasal, lefufuru le atisa ho phunyeha nakong ea ts'usumetso, ho lumella mali hore a phunyeletse moleng oa ho robeha ebe o hlobola mucoperichondrium ** mahlakoreng ka bobeli ** a septum ka nako e le 'ngoe (* ** bilateral septal hematoma **).
• **Lefu la Chondrocyte le liquefaction ea enzymatic **: Ho aroloa ho tloha kobong ea methapo ea mali ka limilimithara tse 'maloa tsa mali a sa tsitsang, a se nang oxygen, li-chondrocyte li qala ho shoa ke ischemia nakong ea **12 ho lihora tse 24 **. Ka lihora tse 48 ho isa ho tse 72, lisele tse tšoeu tsa mali tse thekeselang le libaktheria li lokolla collagenase le li-enzyme tsa protease tse qhalang matrix a proteoglycan, a qhibilisang lebota le tiileng la lefufuru hore e be boladu le maloanlahla a necrotic.

Mehloli ea vascular le ho tsoa mali¶

Understanding which blood vessels rupture inside the nose and ear explains why these hematomas expand rapidly under arterial pressure:

• Nasal septal vasculature (Kiesselbach's plexus / Little's area): The anterior nasal septum is supplied by an anastomotic network where four arterial systems converge: the anterior and posterior ethmoidal arteries, the sphenopalatine artery, the greater palatine artery, and the septal branch of the superior labial artery. When trauma shears the mucoperichondrium, branches of this arterial plexus bleed directly into the closed subperichondrial pocket rather than dripping out of the nostril.
• Auricular vasculature: The anterior surface of the pinna receives its blood supply from perforating branches of the posterior auricular artery and the superficial temporal artery that pierce through tiny foramina in the cartilage to feed the anterior perichondrium. Tangential friction shears these perforating vessels right where they exit the cartilage surface.

Recognizing a nasal septal hematoma at the scene¶

The single greatest danger of a nasal septal hematoma is that emergency responders, athletic trainers, parents, and even hurried clinicians focus exclusively on stopping the initial nosebleed or checking whether the upper nasal bones look crooked, overlooking the anterior nasal cavity.

Step-by-step visual and physical examination¶

Once active anterior epistaxis has slowed enough to see inside the nose, perform a systematic inspection using a bright focal light source:

1. Position the patient sitting upright: Have the person sit upright and tilt the chin slightly upward by 15 degrees so you have a clear line of sight along the floor of the nose.
2. Elevate the nasal tip ("Pig-Nose" view): Place a clean thumb gently on the tip of the nose and push upward to widen the nostrils (nares). Never insert sharp metal instruments or forceps into the nose outside a hospital setting.
3. Compare both sides of the central wall: Look at the medial wall (the central partition dividing the left and right nostrils):
4. Normal septum: The central partition is flat, vertical (or mildly deviated in a crisp, hard line), and covered in pale pink to light red mucosa with a generous open airway gap between the septum and the side walls.
5. Septal hematoma: One or both sides of the central partition bulge outward like a smooth, rounded, cherry-red, dark blue, or violaceous plum filling the nostril and touching the lateral nasal wall.
6. Distinguish a septal hematoma from a swollen inferior turbinate or simple deviated septum:
7. Location: Inferior turbinates project inward from the outer (lateral) wall of the nostril; a septal hematoma projects outward from the center (medial) wall.
8. Compressibility: A simple deviated or fractured cartilage septum feels rigid and hard like bone or stiff plastic when touched gently with a moistened cotton swab. A septal hematoma feels soft, spongy, and boggy: pressing it gently with a cotton swab indents the surface, which immediately rebounds when pressure is released.
9. Failure to shrink with vasoconstrictors: In the clinic or emergency department, spraying oxymetazoline (0.05%) or phenylephrine into the nose causes swollen mucosal turbinates to shrink dramatically within 3 minutes, whereas a subperichondrial hematoma remains the exact same size.

Red-flag symptoms demanding immediate emergency room transfer¶

Even if you do not have a bright flashlight to see clearly inside the nose, take the patient to an emergency department immediately if any of the following symptoms appear after nasal trauma:

• **Ho se khone ho phefumoloha ka ho feletseng ka nko e le 'ngoe kapa ka bobeli ** e qalang hang-hang kapa ka mor'a lihora tse 24 ka mor'a ho otla nko 'me e sa hlake ka mor'a hore e butsoe ka bonolo maqeba a mali a hlephileng.
• **Khatello e phehellang, e lerootho, e otlang kapa maikutlo a atolohang ho pholletsa le borokho le ntlha ea nko ** e mpefalang nakong ea lihora tse 24 ho isa ho tse 72 ho e-na le ho ntlafatsa.
• Lifolakha tse khubelu tsa bana: Lesea, ngoana e monyenyane, kapa ngoana ea hanang ho anyesa kapa ho noa ka botlolo hobane linko tsa hae li thibane, o luma haholo ka lekhetlo la pele ka mor'a ho oa, kapa a na le molomo o ka holimo o butsoeng, o ikhohomosang le mokokotlo oa nko (columella).
• Matšoao a ho tsoela pele ho ba lekhopho la nko (Matsatsi a 2 ho isa ho a 5): Ho phahama ha mocheso oa 'mele ho feta likhato tse 38.0 tsa Celsius (100.4 degrees Fahrenheit), hlooho e otlang haholo, erythema le ho ruruha ho hasana letlalong la nko le marameng, kapa liphetoho tse bonahalang.

Tsamaiso ea bongaka ea nasal septal hematoma le abscess¶

Ho utloisisa se etsahalang lefapheng la ts'ohanyetso kapa otolaryngology (ENT) surgical suite e thusa bakuli le batsoali ho tseba hore na ke phekolo efe eo ba ka e lebellang le hore na ke hobane'ng ha takatso ea nale e le 'ngoe e sa lekana.

1. Sekhao se tiileng sa ho buoa le ho ntša metsi¶

Tlas'a topical vasoconstrictive anesthesia ho batho ba baholo ba sebelisanang, kapa mokhoa o khuts'oane oa sedation ho bana ba banyenyane:

• Ho cheka mucoperichondrial incision: Ho sebelisa nasal speculum le lebone le khanyang la hlooho, ngaka e etsa sehalo se tšekaletseng (Killian kapa hemitransfixion incision) ho pholletsa le leqhubu le tlaase ka ho fetisisa le le ka pele la hematoma ka mucoperichondrium, le lula le bapile le mokatong oa nko ho qoba ho khaola lefufuru le ka tlaase.
• **Ho tsoa ka mahlakoreng a mabeli ntle le ho phunyeletsana **: Haeba hematoma e le mahlakore ka bobeli, ho ntša metsi ka lehlakoreng le le leng hangata ho ntša mahlakoreng ka bobeli haeba lefufuru le robehile. Haeba ho hlokahala hore ho be le sekheo sa bobeli ka lehlakoreng le leng, ngaka e buoang e thekesela likheo ka mekhahlelo e fapaneng e emeng ho thibela septal perforation e sa feleng.
• Ho huloa, ho nosetsa, le ho kenya metsi: Mali a lefifi a koetsoeng kapa boladu bo ntšoa ka ho feletseng, 'me mokotlana oa nosetsoa ka letsoai le tloaelehileng le sa hloekang. Ngaka ebe e kenya draina e nyane ea Penrose e se nang latex kapa e monyehang ka li-suture tsa quilting.4-0 chromic gut kapa Vicryl Rapide) tse rokang lipampiri tsa mucoperichondrial ka thata ka morao khahlanong le lefufuru le bohareng.

2. Bilateral anterior nasal packing le lithibela-mafu prophylaxis¶

Hang ha mali a ntšoa, perichondrium e tlameha ho ts'oaroa e tiile khahlanong le lefufuru le se nang letho e le hore ho hasana ha oksijene le limatlafatsi ho ka qalella hang-hang.

• Ho petsoha ha mahlakore a mabeli: Linko ka bobeli li pakiloe ka ho lekana ka liponche tsa joala tsa polyvinyl tse atolositsoeng (Merocel), lesela le kenngoeng ka lithibela-mafu, kapa likhoele tsa silicone tsa intranasal (Doyle splints) bakeng sa **48 ho lihora tse 72 ** kahoo septum e fokolang e tšehetsoa ka ho lekana ho tloha mahlakoreng ka bobeli.
• Ho Thibela Toxic Shock Syndrome (TSS): Mokuli e mong le e mong ea ntšitsoeng ka ho phutheloa nko o fuoa lithibela-mafu tse nooang tsa antistaphylococcal (tse kang amoxicillin-clavulanate, cephalexin, kapa clindamycin) ha liphutheloana li ntse li le teng. Bakuli ba nang le purulent **septal abscess ** ba hloka ho amoheloa sepetlele bakeng sa ho koahela lithibela-mafu ka methapo. MRSA le li-anaerobes tse ka holimo tsa phefumoloho. Hlahloba tataiso ea rona ho toxic shock syndrome e tsoang ho phuthela nko bakeng sa matšoao a folakha e khubelu.

Ho lemoha le ho etsa triaging hematoma ea auricular ("Ear ea Cauliflower").¶

Auricular hematoma e hlaha hoo e batlang e le ka holim'a ** ka pele (ka pele) ka holim'a tsebe ea ka ntle, haholo-holo ka har'a sekotlolo sa conchal, scaphoid fossa, le triangular fossa, ha e ntse e boloka tsebe ea nama (lobule, e nang le mafura le lithane tse nang le mafura ho e-na le lefufuru).

Hobaneng ha karolo e ka pele ea tsebe e ruruha le hore na tsebe ea cauliflower e etsa joang¶

• **Anterior vs. Ho khomarela letlalo ka morao **: Ka holim'a karolo e ka pele ea tsebe, letlalo le tšesaane ka pampiri le mafura a subcutaneous le zero, le khomarela ka ho toba perichondrium. Khohlano e matla ea ho betana kapa rugby e kuta perichondrium ho tloha lefufuru. Ka morao ho tsebe, mokokotlo oa mafura a subcutaneous o lumella letlalo ho thella holim'a litšusumetso ntle le ho rusolla likepe tsa subperichondrial.
• Mohato oa hang-hang (lihora tse 0 ho isa ho tse 24): Nakoana ka mor'a tšusumetso, likhohlo tse boreleli tsa sebopeho sa C le liphula tsa tsebe e kaholimo (helix, antihelix, scapha, concha) nyamela, ho nkeloa sebaka ke mokelikeli o teteaneng, o boreleli, o bofubelu bo pherese kapa oa letlalo.
• Mokhahlelo oa ho Hlophisa le oa Kalo (Matsatsi a 2 ho isa ho a 21+): Pakeng tsa Matsatsi a 2 le 7, mali a mokelikeli a hoama ho ba leqeba le teteaneng la rabara le thibang linale tse ntle. Ho fapana le septum ea nasal (e qhibilihang ha e amohuoa mali), perichondrium e koetsoeng e na le lisele tsa "chondrogenic progenitor" tse sebetsang tse qalang ho hlahisa lisele tse sa tsitsang tsa fibrous le lefufuru le lecha la ectopic hantle ka har'a lesapo la mali ka mor'a Letsatsi la 7, le kenella ka hare ** tsebe ea cauliflower** (wrestler's ear).
• Mathata a tshebetso: Li-hematoma tse sa phekoloeng ka sekotlolo sa conchal se tšesaane ho buleha ha kanale ea tsebe, ho tšoara li-erwax le metsi, ho baka tahlehelo ea kutlo, le ho thibela li-stethoscopes kapa lithuso tsa ho utloa. Ho feta moo, lithupa tsa nale tse sa hloekang li hlahisa Pseudomonas aeruginosa kapa Staphylococcus aureus, tse bakang suppurative perichondritis (ho ruruha ha tsebe e ka holimo ho bohloko habohloko, ho chesang, ho khubelu hoo ka mokhoa ** ho bolokang tsebe e seng lefufuru**).

Tlhokomelo ea tšimo ea thuso ea pele le drainage ea bongaka bakeng sa auricular hematomas¶

Liketso tsa hang-hang tsa lebaleng le kamoreng ea ho locker¶

1. Emisa ho nka karolo hang-hang: Ho tsoela pele ho kampana kapa ho pompa mali ka pokothong, ho ebola karolo e setseng ea perichondrium ho pholletsa le pinna kaofela.
2. Sheba kanane ea tsebe le kutlo: Sheba ka har'a lekhalo la tsebe ka lebone. Haeba mokelikeli o hlakileng oa metsi kapa mali a khanyang a tsoa botebong ** ka hare ** kanale ea tsebe, kapa haeba motho a e-na le ho se utloe litsebeng ka tšohanyetso, vertigo, kapa matetetso holim'a lesapo la mastoid (Battle's sign), ho belaella hore o robehile lehata la basilar kapa eardrum e phatlohileng. U se ke ua** sebelisa khatello ho kanale ea tsebe; bona batataisi ba rona ho likotsi tsa hlooho le ho lahleheloa ke kutlo ka tšohanyetso le ho phatloha ha moropa oa tsebe.
3. Sebetsa sehatsetsi se batang ka metsotso e 15 ho isa ho e 20: Theha lesela le mongobo le bonolo mapheong a tsebe e ka ntle, beha pakete ea leqhoa e phuthetsoeng ka thaole holim'a lesela, 'me u hatelle ka letsoho ka letsoho metsotso e 15 ho isa ho e 20. Le ka mohla u se ke ua tlotsa leqhoa ka ho toba letlalong le se nang letho la tsebe.
4. ** Lokisetsa metsi a hloekileng a bongaka nakong ea lihora tse 24 ho isa ho tse 48 **: Etela lefapha la tšohanyetso, ngaka ea meriana ea lipapali, kapa setsebi sa ENT nakong ea lihora tsa 24 ha mali a ntse a le metsi.

Mokhoa o hlakileng oa drainage ea bongaka, li-bolster, le khetho ea lithibela-mafu¶

Tlhokomelo ea lapeng le tlhokomelo ea folakha e khubelu ka mor'a ho ntša metsi¶

Ho sa tsotellehe hore na mokuli o na le nasal septal hematoma e tšetsoeng ka intranasal packing kapa auricular hematoma e tšetsoeng ka seaparo sa sewn bolster, ho shebella ka hloko matsatsing a latelang a 5 ho isa ho a 7 ho thibela tahlehelo ea lisele tsa bobeli.

Ho hlokomela sekoahelo sa nko/ho paka¶

• Robala u phahamiselitse hlooho ka likhato tse 30 ho isa ho tse 45 holim'a mesamo e 'meli kapa setulong sa ho robala ho fokotsa tšubuhlellano ea venous le ho tsubella nkong.
• Etsetsa ka molomo o ahlame: Le ka mohla o se ke wa thibela ho ethimola ka ho penya nko kapa ho kwala molomo, kaha kgatello ya tshohanyetso ya kgatello e ka ntsha mathitho a nko kapa ya qobella baktheria ho nyolosa methapo ya Eustachian le sinus ostia.
• Se ke oa hula kapa oa poma likhoele: Hangata likhoele tsa silika tsa tšireletso li tlamelloa lerameng kapa li tlamelloa ka mose ho khoele ho thibela takatso e ka morao 'metsong. Tlohela likhoele tsohle li tiile ho fihlela ngaka e tlosa ho paka ka lihora tse 48 ho isa ho tse 72.
• **Khutlela lefapheng la tšohanyetso hang-hang haeba **:
• Madi a makgubedu a kganyang a koloba a sa kgaotse ka lesela le ka pele la ho rothela nko mme a matha ho theosa ka morao mmetso leha a dutse a otlolohile.
• Mokuli o tšoaroa ke feberu e ka holimo ho likhato tse 38.0 tsa Celsius (100.4 degrees Fahrenheit), mohatsela, ho tsekela ha maikutlo ha a eme, a hlatsa, letšollo le nang le metsi, kapa lekhopho le lefubelu le pharalletseng (matšoao a lemosang a Toxic Shock Syndrome a amanang le ho paka).
• Mokuli o ba le pono e habeli, mahlo a kobehileng, leihlo le tsoileng matsoho, hlooho e bohloko ea phatleng, kapa ho satalla molala (matšoao a lemosang a ho ata ha venous sinus intracranial).

Ho hlokomela sekoahelo sa tsebe¶

• Tlosa tsebe e omme ka ho feletseng: Se ke oa shaoara ka holim'a hlooho, ua sesa, kapa ua tlohella mofufutso hore o kolobise meqolo ea meno kapa hlobo ea samente. Bolster e metsi e senya letlalo la tsebe e tšesaane 'me e tsoala libaktheria tsa Pseudomonas.
• Bea leihlo bakeng sa bolster pressure necrosis vs. perichondritis: Hobane bolster e tiisa letlalo khahlanong le lefufuru, bolster e tlanngoeng ka thata haholo e ka bipetsa phallo ea mali letlalong ka bolona. Khutlela ho ngaka ka mor'a lihora tse latelang haeba:
• Bohloko ba tsebe ka tšohanyetso bo eketseha ho tloha ho bohloko bo lerootho ho ea ho bohloko bo boholo, bo sa khaotseng, bo tukang kapa bo otlang ka matla (letšoao la khale la necrosis ea letlalo la ischemic tlas'a bolster kapa Pseudomonas perichondritis).
• Karolo e bonahalang ea tsebe e pota-potileng bolster e fetoha bosoeu bo bosehla, boputsoa bo botšo (ischemia), kapa ea tuka, e phatlalla ka bofubelu le boladu bo tsoang masobeng a suture.
• **Apara lihlooho tse sireletsang tse thata ha u khutlela papaling **: Hang ha tsebe e se e folile ka ho feletseng (hangata 2 ho libeke tse 4 ka mor'a ho tlosoa ha bolster, ho hlakisoa ke ngaka), li-wrestlers, li-grapplers, le bapalami ba rugby ba lokela ho roala hlooho ea ho betana e kentsoeng hantle, e thata-thata ea likhoele tse 'nè (ear guards) ka likopi tse tebileng tsa tsebe tse phunyeletsang pinna ntle le ho hohla lefufuru.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

Haeba ts'oaetso ea sefahleho kapa ea boko e tsamaisana le ho tsoa mali ho matla, ho senyeha ha moea, matšoao a methapo, kapa tšoaetso e jalang, ikopanye le litšebeletso tsa bongaka tsa tšohanyetso hang-hang:

Lipotso tse botsoang khafetsa¶

Ke hobane'ng ha lingaka li re u ka ema matsatsi a 5 ho lokisa nko e robehileng, leha ho le joalo hematoma ea septal e tlameha ho ntšoa letsatsing lona leo?¶

Ha masapo a nko a robeha, bokantle ba nko bo ruruha hang-hang ka edema ea mesifa e bonolo, e leng ho etsang hore ho be thata ho ngaka ea ENT ho bona ho lumellana hantle ha masapo ho fihlela ho ruruha ha ka ntle ho kokobela ka mor'a matsatsi a 4 ho isa ho a 7. Leha ho le joalo, nasal septal hematoma ka har'a nko ke tšohanyetso e fapaneng ka ho feletseng: mali a qabeletsoeng a hlobola lesela la phepelo ea limatlafatsi lefufurung la nko 'me a qala ho bolaea lisele tsa lefufuru nakong ea lihora tse 24. Ke ka lebaka leo motho e mong le e mong ea nang le nko e robehileng kapa e robehileng a tlameha ho ba le ka hare ho linko tse peli tse hlahlobiloeng ka leseli ka Letsatsi la 1 ho tlosa septal hematoma, esita le haeba ho otloloha ha lesapo ka ntle ho lokiselitsoe bekeng e latelang.

Na ngoana a ka ba le nasal septal hematoma e kotsi le haeba nko ea hae e sa tsoa mali haholo ebile e sa shebahale e khopame?¶

E, bana ha e le hantle ba kotsing e kholo ea ho fumana li-nasal septal hematomas ho feta batho ba baholo hobane lefufuru la bana le bonolo ebile le le bonolo ho e-na le ho brittle. Ha ngoana a oela ka sefahleho, lefufuru le inama haholo 'me le khutlela sebakeng ntle le ho pshatla masapo a ka ntle a nko kapa ho tabola letlalo la ka ntle, ha le ntse le kuta methapo ea mali ka tlas'a lera le ka hare la mucosal. Haeba ngoana a sa khone ho hema ka linko tsa hae ka mor’a hore a tsoe ka sefahleho, o lokela ho hlahlobjoa ka linkong tseo ka bobeli ke ngaka letsatsing lona leo.

"Ho holofala ha nko" ke eng, hona septal hematoma e baka eng?¶

Karolo e ka tlase ho tse peli ho tse tharo tsa borokho ba nko ea motho e ts'oaroe ka botlalo ke lefufuru la quadrangular septal, joalo ka ha palo e bohareng ea tente e phahamisa tente ea seile. Haeba nasal septal hematoma kapa abscess e sa fumanehe ka lihora tse 48 ho isa ho tse 72, lefufuru le qhibiliha ka lebaka la ho hloka oksijene le ho senyeha ha enzymatic. Ntle le lebota la eona le bohareng la ts'ehetso, bokaholimo bo bohareng ba mahaha a nko ka hare 'me bo bataletse ho leba sefahlehong, ho theha setšoantšo sa khoho se bitsoang "saddle-nose deformity" se hlokang opereishene e rarahaneng ea ho lokisa likhopo-lefufuru ho lokisoa.

Hobaneng ke sa khone ho ntša tsebe ea ka ea cauliflower hae ka serinji ea insulin e tsoang k'hemisteng?¶

Taba ea pele, ho ntša mali ka serinji ho siea perichondrium e tabohileng e phaphametse ka holim'a lefufuru, kahoo pokotho e tlatsoa ka mali le mokelikeli ka mor'a lihora tse 'maloa ntle le haeba mokelikeli o tloaelehileng oa khatello kapa suture ea materase e tiisa likarolo tse bataletseng ka matsatsi a 5 ho isa ho a 7. Ea bobeli, letlalo la tsebe e ka ntle le na le libaktheria tse ngata tsa Pseudomonas aeruginosa; ho sututsa nale letlalong ntle le ho lokisa iodine ka ho buoa le lithibela-mafu tse kenang lefufuru ho ka hlahisa tšoaetso ka ho toba lefufurung la avascular, e leng se bakang suppurative perichondritis e ka qhibilihang le ho holofatsa tsebe eohle e ka ntle.

Nka khetholla joang pakeng tsa leqeba le tloaelehileng la ho ruruha ha tsebe le tšoaetso e kotsi ea auricular perichondritis?¶

Ntlha ea bohlokoa ea kliniki ke ho hlahloba lesapo la tsebe (lobule) botlaaseng ba tsebe. Kaha karolo ea tsebe e na le lisele tse mafura feela le letlalo le se nang lefufuru, 'nete ea auricular perichondritis (tšoaetso ea lefufuru) e baka bofubelu bo matla, bo tukang, bonolo bo feteletseng, le ho teteana ho pholletsa le karolo e ka holimo e thata ea tsebe ha e ntse e boloka ka ho feletseng karolo e bonolo ea tsebe e ka tlase. Haeba tsebe e ka holimo e e-ba e chesang, e khubelu e khanyang, 'me e le bohloko bo feteletseng ho ea ho e bonolo ka ho fetisisa, batla thuso ea meriana ea tšohanyetso hang-hang bakeng sa lithibela-mafu tse khahlanong le pseudomonal.

Ke nako e kae ka mor'a hore tsebe ea hematoma e hlahe na e se e le morao haholo ho e ntša ka nale kapa ho phunyeha?¶

Hematoma ea auricular e lula e le metsi bakeng sa lihora tse 24 ho isa ho tse 48, e leng fensetere e loketseng bakeng sa ho ntša metsi le ho matlafatsa. Pakeng tsa Matsatsi a 3 le a 7, mali a koaleha ho ba gel e teteaneng ea rabara e hlokang ho sehoa lemenong la tsebe le ho ntšoa ha bonolo. Ka mor'a matsatsi a 7 ho isa ho a 14, perichondrium e phahamisitsoeng e qala ho theha maqeba a tiileng a fibrous le lefufuru le lecha, ka nako eo metsi a bonolo a se a sa khonehe 'me ho betla ho buuoa ke ENT kapa ngaka e buoang ea polasetiki e hlokahalang.

Litataiso tse amanang¶

• Nosebleeds (epistaxis): ho phunya nko e bonolo le lifolakha tse khubelu tse tsoang mali ka morao
• Orbital cellulitis, cavernous sinus thrombosis, le tšoaetso ea sefahleho ea Danger Triangle
• Ho lahleheloa ke kutlo ka tšohanyetso, ho otloa ke tsebe, le ho robeha ha tlhokomelo ea moropa oa tsebe
• Toxic shock syndrome (TSS): tampon, ho paka nko, le lifolakha tse khubelu tsa maqeba a ho buuoa
• Maqeba a hlooho, lifolakha tse khubelu tsa concussion, le matšoao a ho robeha ha lehata

Mehloli le tataiso ea semmuso¶

• American Academy of Otolaryngology - Opereishene ea Hlooho le Molala (AAO-HNS, United States): *Tlhahiso ea Bongaka ka Maqheka a Acute Nasal, Nasal Septal Hematoma / Abscess Drainage, le Auricular Perichondritis *.
• ** Setsi sa Sechaba sa Bophelo bo Botle ba Bophelo le Tlhokomelo (NICE) & ENT UK (United Kingdom): ** * Tataiso ea Sechaba ea Tleliniki mabapi le Tlhekefetso e Ntle ea Nasal: Letsatsi le Tšoanang la Ho Kgelloa ha Septal Hematoma le Tsamaiso ea Pinna Haematoma *.
• American Academy of Pediatrics (AAP, United States): Pediatric Facial Trauma Evaluation: Recognition of Occult Bilateral Nasal Septal Hematoma.
• National Collegiate Athletic Association (NCAA) Sports Medicine Handbook (United States): * Tataiso mabapi le Likotsi tsa Auricular ho Wrestling and Contact Sports*.
• Royal Children's Hospital Melbourne (Australia): Taelo ya Boikwetliso ba Kliniki: Leqeba la Nasal le Septal Hematoma Drainage ho Bana.