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or trachea for injury, and to identify subcutaneous air from related injuries. CT
scans provide more details regarding the laryngeal structures in the setting of
trauma. Penetrating trauma may require MRA/MRV to evaluate the vasculature of
the neck. Surgical exploration should be considered for patients with penetrating
injuries to zone 2 of the neck, even if clinically stable. Any patients with distress
or penetrating injury should be admitted either directly to the operating room for
airway management and exploration, or after complete work up in consultation
with appropriate surgical specialists. Mildly symptomatic children with blunt
trauma but who are otherwise stable and are determined not to have clinically
significant injury by history and examination, and possibly with additional
imaging and/or surgical specialty consultation, may be observed in the ED and
discharged home if there is no worsening of symptoms over time.
Suggested Readings and Key References
Ear
Greywoode JD, Pribitkin EA, Krein H. Management of auricular hematoma and
the cauliflower ear. Facial Plast Surg 2010;26:451–455.
Karimnejad K, Nelson EJ, Rohde RL, et al. External auditory canal foreign body
extraction outcomes. Ann Otol Rhinol Laryngol 2017;126(11):755–761.
Olson MD, Saw J, Visscher SL, et al. Cost comparison and safety of emergency
department conscious sedation for the removal of ear foreign bodies. Int J
Pediatr Otorhinolaryngol 2018;110:140–143.
Schuldt T, Großmann W, Weiss NM, et al. Aural and nasal foreign bodies in
children—Epidemiology and correlation with hyperkinetic disorders,
developmental disorders and congenital malformations. Int J Pediatr
Otorhinolaryngol 2019;118:165–169.
Svider PF, Vong A, Sheyn A, et al. What are we putting in our ears? A consumer
product analysis of foreign bodies. Laryngoscope 2015;125(3):709–714.
Nose and Sinuses
Cakabay T, Ustun Bezgin S. Pediatric nasal traumas: contribution of
epidemiological features to detect the distinction between nasal fractures and
nasal soft tissue injuries. J Craniofac Surg 2018;29(5):1334–1337.

Hwang K, Yeom SH, Hwang SH. Complications of nasal bone fractures. J
Craniofac Surg 2017;28(3):803–805.
Perkins V, Vijendren A, Egan M, et al. Optimal timing for nasal fracture
manipulation—Is a 2-week target really necessary? A single-centre