11 CEN: Maxillofacial and Ocular Emergencies Flashcards
11 items on exam
What is a Peritonsillar abscess (PTA)?
S/S? Tx?
Peritonsillar abscess is an area of pus-filled tissue at the back of the mouth, next to one of the tonsils.
S/S: severe throat pain, DEVIATED UVULA, fever, halitosis (bad breath), pain that radiates to ear, erythematic tonsils.
TX: throat culture, IV fluids, analgesics, antibiotics, steroids, aspiration incision and drainage (I&D).
What is Ludwig’s Angina?
S/S? Tx?
Bacterial infection submandibular after a tooth abscess.
S/S: difficulty swallowing, DROOLING, swelling and redness of neck, TONGUE SWELLING.
TX: maintain airway, antibiotics.
What is the immediate intervention for an Avulsed tooth?
TX: preserve tooth by placing back IN SOCKET or between in cheek/gum or under tongue only if patient alert and ADULT.
If altered LOC, concurrent injury, or CHILD, place tooth in saline, MILK or in a CALCIUM-based solution; replant tooth within 6 hours if possible. Hold by crown, do not touch root.
What is needed for Lip lacerations?
Lip laceration - consider specialty consultation to suture if laceration is through vermillion border. First stitch prior to LIDOCAINE (xylocaine) due to swelling to approximate.
The muscle layer and oral mucosa should be repaired with 3-0 or 4-0 absorbable sutures, and skin should be repaired with 6-0 or 7-0 nylon sutures.
What are causes of anterior and posterior epistaxis?
Anterior is most common, bright red blood caused by picking nose.
Posterior is more serious, caused by HTN and coagulopathies - heaver bleeding, darker red, drips out of nares and down throat, leads to clots, monitor airway.
What is treatment for epistaxis?
TX: elevate HOB, suction available, IV fluids, pinch nostrils firmly for 10-15 minutes for anterior, progress to cauterizing with silver nitrate or electrocutery, nasal packing soaked in TXA, phenylephrine, or lidocaine with epinephrine).
Monitoring airway is most important, so may need to admit.
BP management for posterior; avoid blowing/picking nose and cool mist humidifier for anterior bleed.
What is Bell’s Palsy? S/S?
Bell’s Palsy- Unilateral facial paralysis due to cranial nerve VII (facial) inflammation.
S/S: tears, drooling, unable to blink or close affected eye, facial drooping, ipsilateral loss of taste, increased sensitivity to sound (hyperacusis).
How is Bell’s Palsy Dx and Tx?
DX: Rule out stroke and meningitis.
TX: antivirals and corticosteroids to shorten progression, analgesics, and eye lubricants.
DC teaching for Bell’s Palsy?
wear sunglasses/eye protection to help with eye irritation, moist heat from humidifier, ARTIFICIAL TEARS during wake hours, FACIAL MASSAGE can prevent permanent contractures/paralysis.
Most resolve in 3-6 months.
What is Trigeminal neuralgia (tic doloureux)?
a type of chronic pain disorder that involves sudden, severe facial pain. It affects the trigeminal nerve, or fifth cranial nerve, which provides feeling and nerve signaling to many parts of the head and face.
What are causes of Trigeminal neuralgia (tic doloureux)?
S/S? Tx?
Causes: Compression of CN V from tumor, Arteriovenous malformation, trauma, or multiple sclerosis
S/S: Sudden, unilateral, severe, stabbing pain on one or more of branches of CN V (Trigeminal); facial twitching that is provoked by brushing teeth or chewing.
TX: Tegretol (carbamazepine), phenytoin, valproic acid, gabapentin, lamotrigine, clonazepam.
What should be monitored with a Nasal Foreign Body?
most common in pediatrics, monitor for aspiration.
What are S/S of a Nasal Foreign Body?
Tx?
S/S: pain in nasal/sinus cavity, unilateral purulent nasal drainage, recurent epistaxis, fever.
TX: use least invasive means possible - decongestants or pressor agent prior to removal to decrease swollen tissue; occlude unaffected nostril and ask child to blow nose, or ask mother to blow in mouth or use BVM; wall suction, forceps as last resort.
What is one of the most dangerous foreign bodies?
Alkaline button batteries dangerous, cause saponification of tissue quickly.
An electrical current can form in the body, and hydroxide, an alkaline chemical, can cause tissue burns that can be fatal.
What are S/S of a Ear Foreign Body?
Tx?
S/S: pain, anxiety/fear (increased with live insects), bleeding, hearing loss on affected side, N/V, dizziness, purulent drainage from ear.
TX: flying insects may fly to the light. Suffocate live insect with viscous lidocaine or mineral oil, then irrigate and attach wall suction. Use alcohol base solution in irrigation of organic material (bread peas, beans).
Last resort - consider sedation, then use forceps to remove object, without pushing deeper in canal.
What is otitis externa?
S/S? Tx? DC teaching?
Infection (typically bacterial) of external auditory canal. (Swimmer’s Ear; outside tympanic membrane)
S/S: pain with movement of tragus or auricle, possible periauricular cellulitis, hearing loss, drainage from ear, swelling, erythema.
TX: analgesics, antibiotics, warm otic drops.
DC teaching: apply warm compress, keep ear dry, no objects in ear, earplugs while swimming/bathing.
What is otitis media?
S/S? Tx? DC teaching?
Infection of inner ear canal; blocked Eustachian tubes causing fluid to build up behind TM; common 6 months - 3 years old, after an URI.
S/S: sharp ear pain, pulling at ear, fever, hearing loss, sensation of fullness, bulging of TM, history of URI.
TX: analgesics, possible systemic antibiotics, antipyretics.
What is Sinusitis?
S/S? Tx? DC teaching?
Sinusitis - bacterial infection of mucosa of paranasal sinuses
S/S: pain, nasal congestion, purulent drainage, malaise, fever, facial swelling, decreased transillumination of sinuses.
DX: frontal view of maxillary sinus, orbits & nasal structures (Water’s View X-ray).
TX: oral antibiotics, analgesia, antipyretics, limited use of nasal decongestants.
DC teaching: monitor BP for HTN from antihistamines, limit nasal sprays.
What is Mastoiditis?
S/S? Tx?
Mastoiditis- Complication of otitis media that erodes mastoid and affects surrounding structures.
S/S: history of otitis media, pain & swelling in mastoid area, ear pain, fever, possible TM rupture, headache, hearing loss.
TX: prepare for admission, IV antibiotics, analgesics, surgical intervention.
What is Labyrinthitis?
S/S? Tx?
Labyrinthitis- Inflammation of inner ear (labyrinth) from recent infective process (fluid), treatable.
S/S: nystagmus, vertigo, tinnitus (ringing in ear), pain in ear (otalgia), N/V, hearing loss.
TX: corticosteroids, meclizine for motion sickness, antihistamines, fall risk.
What is Labyrinthitis?
S/S? Tx? D/C teaching?
Meniere’s Disease (acute attack)- Unknown etiology, more common in women 40-60 years old. It is a disorder caused by build of fluid in the chambers in the inner ear.
S/S: recurring episodes of nystagmus, vertigo, tinnitus, hearing loss, N/V, headache, loss of balance, and sweating.
TX: corticosteroids, meclizine (Antivert) for motion sickness, antihistamines, diuretics, anticholinergics.
DC teaching: bed rest, slow position changes to avoid falls, limit activity and sodium/sugar intake; avoid caffeine, nicotine, and alcohol.
Where is a Le Fort I fracture? S/S?
Le Fort I: “A man with a MUSTACHE”
Transverse detachment of the entire maxilla above the teeth at the level of nasal floor; Free-floating maxilla.
S/S: malocclusion, lip laceration, fractured teeth, swelling to area.
Where is a Le Fort II fracture? S/S?
Le Fort II: “goes to the PYRAMIDS”
Pyramidal shaped fracture with transverse detachment of maxilla (base of pyramid), fracture at bridge of nose (top of pyramid), fracture through lacrimal & ethmoid bones (sides of pyramid).
S/S: nasal fracture, epistaxis, malocclusion, lengthening of face.
Where is a Le Fort III fracture? S/S?
Le Fort III: “and takes off his Halloween MASK”
Free-floating segment of mid-face; craniofacial disjunction - involves maxilla, zygomatic arch, orbits, & cranial base bones.
S/S: commonly unresponsive, malocclusion, immense swelling “beach ball”, severe hemorrhage.
