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Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions > 25 Trauma and Foreign Bodies > Flashcards

25 Trauma and Foreign Bodies Flashcards

1
Q

T/F: In kids, the incidence of FB aspiration is equal b/w right and left bronchus

A

True (left bronchus not as obliquely angled in kids as in adults)

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2
Q

T/F: Airway FB are more common than esophageal

A

False

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3
Q

M/c esoph FB in kids < 5 yo

A

coins

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4
Q

M/c dx inappropriately given to a child with an airway FB

A

Asthma

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5
Q

What are the 2 types of nontraumatic CSF leaks

A

High pressure and nl pressure

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6
Q

M/c cause of CSF leak

A

nonsurgical trauma

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7
Q

What percent of CSF leaks are from nontraumatic causes

A

3-4%

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8
Q

What percent of basilar skull fx result in CSF leak

A

10-30%

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9
Q

What percent of pts with CSF leak 2/2 nonsurg trauma will get meningitis

A

10-25%

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10
Q

What is mortality rate of pts who develop meningitis w/ traumatic CSF leak

A

10%

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11
Q

What percent of CSF leaks are cranionasal?

A

80%

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12
Q

T/F: cranio-aural CSF leaks are more likely to spontaneously close than cranionasal CSF leaks

A

True

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13
Q

What is medical MAN of CSF leaks

A 
Elevate HOB
Antitussives
Laxatives
Anti-hypertensives
Analgesics
Bed rest
Lumbar drain
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14
Q

What is a serious complication of lumbar drainage?

A

Tension pneumocephalus

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15
Q

What percent of skull fx involve t bone

A

20%

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16
Q

What is m/c mechanism of CHL in longitudinal t bone fx

A

IS joint dislocation

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17
Q

Incidence of facial nerve injury after transverse t bone fx

A

40-50%

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18
Q

What type of t bone fx accounts for majority of facial nerve injuries

A

Longitudinal, just bc it is so much more common

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19
Q

Incidence of FN paralysis in pts with longitudinal t bone fx

A

20-25%

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20
Q

M/c etiologies of nerve dysfunction after longitudinal t bone fx

A

Edema and intraneural hemorrhage

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21
Q

M/c area of FN injury following trauma

A

Perigeniculate area

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22
Q

Strongest predictor of poor recovery of FN fnc following t bone trauma

A

Immediate onset of paralysis in pt w/ closed head injury

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23
Q

What type of t bone fx most likely if the blow is to the occiput

A

transverse

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24
Q

Typical course of fx line in transverse t bone fx

A

foramen magnum across petrous apex across IAC and otic capsule to foramen spinosum or lacerum

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25
Q

Where are the laceration and bony disruption in EAC most often found after longitudinal fx

A

tympanosquamous suture line (posterior and superior)

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26
Q

Where does longitudinal fx line course in relation to otic capsule

A

anterior

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27
Q

M/c etiology of dizziness after longitudinal t bone fx

A

BPPV

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28
Q

When should middle ear exploration and ossicular reconstruction be performed after t bone fx

A

at least 3 mo after injury

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29
Q

M/c type of t bone fx in kids

A

Obliquely oriented fx

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30
Q

Which LeFort involves infra-orbital rim

A

LeFort II

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31
Q

Sequelae of untreated maxillary fx

A

Midface retrusion, facial elongation, anterior open bite deformity

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32
Q

Sequelae of untreated lateral zygomatic arch fx

A

Inc midfacial width and malar flattening

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33
Q

What is a type I NOE

A

Single, noncomminuted central segment fx

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34
Q

What is a type II NOE

A

comminuted, but identifiable, central fragment

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35
Q

What is a type III NOE

A

Severely comminuted fx with disruption of medial canthal tendon or too small a central fragment to be repaired directly

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36
Q

How do type I, II, III NOE fx differ in terms of MAN

A

I: Microplates
II: transnasal wires in addition to plate fixation
III: at least two sets of transnasal wires and may require bone graftin

37
Q

What are the different types of ZMC fx

A

Type A: isolated to one component of the tetrapod (arch, lateral orbit, or inferior orbital rim) – least common
B: injury to all 4
C: Complex fx with comminution of zygomatic bone

38
Q

What are the different classes of mandible fx

A

Class I: b/w 2 teeth
II: teeth are present on only one side of the fx
III: Edentulous area

39
Q

Which parts of the mandible are most commonly fx

A

Condyle (36%)
Body (21%)
Angle (20%)

40
Q

Mechanism for b/l condylar fx

A

anterior blow to chin

41
Q

What percent of mandible fx are a/w other injuries

A

40-60%

42
Q

Optimal tx for nondisplaced condylar fx

A

Nl occlusion: soft diet and close obs

B/l or u/l with malocclusion: MMF 3 wks then elastics for 2 wks

43
Q

Absolute indications for open reduction of condylar fx

A
  • Displacement of fractured fragments into middle cranial fossa
  • inadequate reduction with MMF
  • lateral extracapsular displacement of condyle
  • foreign body (bullet) embedded in joint
44
Q

Relative indicatinos for open reduction condylar fx

A
  • B/l condylar fx in edentulous pt when MMF not possible
  • Condylar fx when MMF is not recommended for medical reasons
  • B/l condylar fx a/w midface fx
45
Q

Appropriate MAN for deep puncture wound from dog or cat bite

A

Postexposure rabies ppx should be considered for all bites. If animal is healthy, should be quarantined for 10 days to exclude rabies. If animal unavailable or suspected rapid, immediate vaccination and Ig therapy.

Also antibiotic coverage for pasteurella multocida

46
Q

What type of neurologic sequelae usu results from isolated u/l vertebral artery injury

A

none

47
Q

After carotid artery injury, when is it too late to attempt revascularization

A

when coma has occurred beyond 3 hours, if an anemic infarction has occurred, or if no vascular back flow is present

48
Q

Strongest predictor of negative outcome in trauma pt

A

Arterial hypoTN < 90 mmHg

49
Q

Transcatheter arterial embolization is most useful in MAN of what neck injury

A

Gunshot to zone III

50
Q

What is major advantage of immediate aggressive recon to face after high energy gunshot wound

A

less soft tissue scarring and contracture

51
Q

What are the m/c injuries a/w facial trauma in kids

A

dental injuries

52
Q

M/c mandible fx in kids

A

condyle

53
Q

What are 3 types of condylar fx

A
  • Intracapsular crush fx of condylar head
  • High condylar fx through neck above sigmoid notch
  • Low subcondylar fx (m/c)
54
Q

Usual tx for condylar fx in kids

A

soft diet

55
Q

Indications for open reduction of condylar fx in kids

A

When fractured condyle directly interferes with jaw mvmt; when fx reduces the height of ramus and results in open-bite deformity; when condyle is dislocated into MCF

56
Q

T/F: A mandible fx in a child is much more likely to be a/w other injuries than in an adult

A

True

57
Q

Among kids, which mandible fx results in highest incidence of dentofacial abnlities

A

Intracapsular crush fx of condyle

58
Q

What is difference in tooth viability when comparing plates vs wires for fixation of mandible fx

A

Significant increase in nonviability of teeth in line and adjacent to fx of the mandible treated by plates compared with those treated with wires

59
Q

What is best way to treat mandible fx in infants < 2 yo

A

Acrylic splints x 2-3 wks

60
Q

What are tx options for mandible fx in kids b/w 2-5 yo

A

Interdental eyelet wiring, arch bars, cap splints, or soft diet

61
Q

Which teeth can be used in kids b/w 5-8 for immobilization

A

deciduous molars

62
Q

Which teeth can be used in kids b/w 7-11 for immobilization

A

Primary molars and incisors

63
Q

How long should immobilization be maintained in kids

A

2-3 wks

64
Q

In a child, what is the tx for an incomplete monocortical crack of the mandibular body with nl occlusion and mvmt

A

soft diet

65
Q

when can bicortical plates be used in kids

A

when permanent dentition is present

66
Q

what structure is most likely to be fractured after blunt trauma to the anterior neck

A

thyroid cartilage

67
Q

which types of laryngeal injuries are best managed medically

A

edema; small hematoma with intact mucosa; small glottic or supraglottic lacerations not involving the free margin of the VF or the anterior commissure and w/o cartilage exposure; single nondisplaced thyroid cartilage fx

68
Q

What does medical MAN of laryngeal fx consist of

A

24 hrs or more of airway obs, voice rest, elevation of head, humidified air, H2 blockers, steroids, abx if lacerations are present

69
Q

Which types of layrngeal injuries require open exploration and repair

A

Lacerations involving the free margin of the vocal cord or anterior commissure; large mucosal lacerations with exposed cartilage; multiple displaced cartilage fractures; avulsed or dislocated arytenoids; vocal cord immobility.

70
Q

When should open laryngeal exploration be performed after injury

A

w/in 24 hrs

71
Q

What injuries are more commonly associated with laryngotracheal separation than with other laryngeal injuries?

A

Subglottic stenosis and b/l RLN injury

72
Q

Which types of laryngeal injuries are more common in kids than in adults

A

Soft tissue injury with edema, arytenoid dislocation, and recurrent laryngeal nerve injury; telescoping injuries where the cricoid becomes displaced under the thyroid.

73
Q

In what age is caustic ingestion m/c

A

18-24 months and 20-30 yo

74
Q

What are the 3 stages of injury after caustic ingestion

A
  1. necrosis, bacterial invasion, sloughing of mucosa
  2. granulation tissue and reepithelialization (day 5- several wks)
  3. Scar formation and contraction
75
Q

How does injury differ after ingestion of acidic substances v basic

A

Acid - coagulation necrosis (the eschar limits the depth of injury)

Base - liquefactive necrosis and deeper injury

76
Q

Where is most likely site of injury after ingestion of acid

A

stomach

77
Q

“After caustic ingestion, what sign is most likely to signal the development of a complication?

A

drooling

78
Q

What is most likely consequence of ingesting hair relaxer

A

no long term sequelae

79
Q

What percent of pts w/o OP burn will have evidence of esoph burn

A

8-20%

80
Q

Onces ABCs have been stabilized what is acute MAN of caustic injury

A

“Prevent ongoing injury with irrigation of eyes, skin, and mouth, +/− flushing of the esophagus and stomach with water or milk <15 mL/kg (nasogastric tube placement is controversial). Surgical exploration is indicated for perforation, mediastinitis, or peritonitis.

81
Q

What should be done for pt who has ingested a battery

A

If battery in esoph – immediate esophagoscopy

If in stomach – allow it to pass

82
Q

True/False: Inducing emesis and activated charcoal are contraindicated in the management of caustic ingestion.

A

True

83
Q

MAN of pts w/ evidence of grade 1 caustic injury (superficial) on endoscopic exam

A

no intervention; schedule for esophagogram in 3 wks

84
Q

MAN of pts w/ evidence of grade 2 or 3 caustic injury (transmucosal or transmural) on endoscopic exam

A

Esophageal rest (NPO), reflux precautions, +/− steroids, +/− antibiotics, +/− lathyrogens, +/− subcutaneous heparin, +/− nasogastric tube, +/− prophylactic bougienage.

85
Q

What are the CI to steroid use in caustic injury

A

Grade 3 burns, esophageal or gastric perforation

86
Q

What percent of kids with esophageal burns will develop esophageal stricture

A

7-15%

87
Q

Why should all pts w/ h/o caustic ingestion be followed for life with repeated esophagograms and endoscopy?

A

Risk of SCCa of the esophagus is 1000 times that of the general population

88
Q

What percent of pts with esophageal stricture will develop esoph CA

A

1-4%

89
Q

What are the typical features of esoph CA occurring after esoph stricture from burn injury

A

Usu SCCa, w/ onset 25-70 yrs postinjury occurring w/in scar tissue with a lower incidence of distant mets and higher chance of cure with surgical resection

Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions (14 decks)

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