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

2. 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

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

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

5. 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

6. 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

7. 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

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

9. Results
30 responses received
All 30 packed
Average 2.6 weeks

10. Topical Antibiotic and Steroid
Routinely used by 24

11. Exposed Bone

12. Granulations

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

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

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

16. Recommendations
Split skin grafts
Gelfoam
Silastic