Post-operative care of Exostoses Surgery Gary Kroukamp Kingsbury and Claremont Hospitals & Tygerberg Hospital

A New Method! - Keyhole surgery via the ear canal   - Keyhole surgery via the ear canal - NO external incisions - Faster healing time - Less complications - Minimises drilling - Faster return to surfing

Background “The most common bony abnormality of the EAM” Van Gilse(1938) – cold water swimmers

Surgery Endaural or Post –auricular approach Meatal flaps lifted Tympanic membrane protected Exostoses drilled away Eggshell removed with House curettes Skin grafts Packing

Post-operative care Literature Operative Otorhinolaryngology (Bleach, Milford, Van Hasselt – eds Feely Canal dressing x 7 days Filled with antibiotic cream Complete healing in 4-6 weeks

Post-operative care Literature Surgery of the Ear – Nadol and Schuknecht eds Rauch All denuded bone split thickness skin graft Healing by secondary intent = granulations Granulation = thicker scar and slower healing Rosebud pack/gelatin pack Healing in 4-6 weeks Granulations – curetted and cauterised

Objective To find out how exostoses are managed post-operatively in the W and E Cape Packing Local treatment Exposed bone? Granulations? Time to healing

Design and Methods Questionaire sent to ENTs Method of packing What local treatment used Incidence of exposed bone and granulations Time taken to healing

Results 30 responses received All 30 packed Average 2.6 weeks

Topical Antibiotic and Steroid Routinely used by 24

Exposed Bone

Granulations

Treatment of Granulations Steroid/antibiotic ointment – 18 Drops – 1 Chemical cautery – 9 Removal with cups – 6

Time to complete healing BIPP – 6.15 weeks (4 – 12) Gelfoam – 6.08 weeks (3 – 12)

Conclusion Canals always packed Gelfoam = less exposed bone Granulation incidence – similar Time to healing – similar

Recommendations Split skin grafts Gelfoam Silastic