Over the years I have been consulted on common traumatic pediatric injuries of the outer ear/earlobe, eardrum, nose, throat, lip, skin of the face and head, both in the emergency department as well as in the office. Here are some common injuries kids experience:
SOFT PALATE/THROAT INJURIES
Usually the result of running with a pen/pencil/toothbrush or anything with a sharp edge in the mouth.
Thankfully, even if there is scary bleeding that parents can see after the injury, most are not life-threatening. Piercing the soft tissue/mucosa inside our mouth/throat will heal pretty well without needing stitches. There are times when the cut is too deep or long/wide and will require stitches, and for most children, brief anesthesia will be required and the repair will be performed in the operating room setting.
Small puncture wounds heal quickly within a few days, without needing antibiotics.
Lesson: Teach children never to run with anything in their mouths!
EARDRUM INJURIES
Results from sticking something inside the ear canal! For example, a child is bumped by someone while a Q-tip is in their ear canal.
Don’t let bleeding scare you. Often parents will go to the ER, and there may be a perforation or “hole” in the ear drum. Most of the time unless the hole is huge, the eardrum will heal itself over a few days to weeks. Keep water out during showers and swimming, and see an ENT.
For older kids, when messing around and slapping someone on the side of ear, such force will cause rupture and temporary dizziness!
CUT ON THE LIP
Happens as a result of a fall. The lip is a special area, bleeds a great deal and for cosmetic reasons, definitely go to an Emergency Room.
TONGUE INJURY
Whether biting down too hard and cutting the tongue with the teeth during a fall, or being cut by something else, it's very bloody and often requires suturing.
DOG BITE
If your child gets bitten by a dog to any part of the face/cheek/lip/head ALWAYS go to the Emergency Room. Simple or complex repairs are often needed depending on the location of the injuries. There is also a higher risk of infection as dog saliva is full of bacteria.
FACIAL FRACTURES
From sports, car accidents, and any facial trauma, go to the ER—don’t wait. Depending on how severe the injuries, X-ray and CAT scans are likely needed to clearly identify the extent of bony injuries.
NASAL FRACTURES
Nasal fractures usually accompany an immediate nose bleed (which will stop) and swelling. You can go to an ER, but the ENT will ask to see your child 4-5 days after the injury to allow some of the soft tissue swelling to go down. If there is significant deviation of the nasal bony pyramid (crooked nasal bridge), then closed reduction (putting it back in place) by an ENT is likely needed.
Young children (younger than 6) are less likely to experience a true “bony” nasal fracture requiring us to set it back. That’s because most of the nose is cartilaginous, and the nasal bridge is not that tall (think of my nose as an Asian!). So when the face hits the pavement, the teeth and lip are at greater risk, the larger protruding forehead will also hit the pavement first and protect the bony nasal pyramid not yet fully formed.
EARLOBE INJURY FROM EARRINGS
This can happen when a hoop is pulled or caught and rips the earlobe in half! This requires suturing by an ENT or a plastic surgeon.
EARLOBE INFECTIONS
An infection can occur if the back of an earring gets stuck inside the earlobe. ("Mom, I lost my earring back!") This is tough—it requires injecting some numbing medicine, then I can usually “fish it out” in the clinic and the earlobe will heal itself.
TRAUMA TO THE NECK
Trauma to the neck has a high risk of airway injury. Go to an ER immediately—whether it’s a lacrosse ball hitting the Adam’s apple, or car accident, or wire line injury (high mortality) due to snowmobiling, objects striking against neck, etc. The largest blood vessels from our heart supplying blood to our brain (carotid arteries and veins) are on either side of the neck, as well as our trachea (windpipe) and esophagus (swallowing tube) behind that. Go to the ER.
TEMPORAL BONE FRACTURE
This happens when the side of the temple/head is hit by force. The force will be absorbed by the body and cause either a “longitudinal” or “horizontal” bony fracture, the former being more common and often cause bleeding from the ear canal, a possible hole in the eardrum, but less likely to cause injury to facial nerves (this is more common in a horizontal temporal bone fracture). Go to the ER—a CT scan is needed to diagnose this. It usually does not require surgery, but a horizontal fracture that injures the inner ear can cause immediate deafness as inner ear fluid leaks out.
Good luck! Annoy your children by warning them over and over what to watch out for, then let doctors take care of the rest! Ask for an ENT consultation or plastic surgery consultation when appropriate, your gut will tell you when that is.