Ch.28 Faceandneck Injuries

Question 1

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart

Answer 1

Air embolism

Question 2

A mass of blood that has collected within damaged tissue beneath the skin or in a body cavity

Answer 2

Hematoma

Question 3

The head is divided into two parts: the___ and the face. The__, or skull, contains the brain, which connects to the spinal cord through the foramen magnum, a large opening at the base of the skull. The most posterior portion of the___ is called the occiput. On each side of the cranium, the lateral portions are called the temples or temporal regions. Between the temporal regions and the occiput lie the parietal regions. The forehead is called the frontal region. Just anterior to the ear, in the temporal region, you can feel the pulse of the superficial temporal artery.

Answer 3

cranium

Question 4

The face is composed of the eyes, ears, nose, mouth, and cheeks. Six bones-_____are the major bones of the face

Answer 4

the nasal bone, the two maxillae (upper jaw bones), the two zygomas (cheek bones), and the mandible (jaw bone) —

Question 5

The____ of the eye is composed of the lower edge of the frontal bone of the skull, the zygoma, the maxilla, and the nasal bone. The bony___ protects the eye from injury. By viewing the face from the side, you can see the eyeball recessed in the orbit.

Answer 5

orbit

Question 6

Only the proximal third of the nose-___is formed by bone. The remaining two-thirds are composed of cartilage.

Answer 6

the bridge

Question 7

The exposed portion of the ear is composed entirely of cartilage that is covered by skin. The external, visible part of the ear is called the__

Answer 7

pinna

Question 8

The___ is a small, rounded, fleshy bulge immediately anterior to the ear canal. The superficial temporal artery can be palpated just anterior to the__.

Answer 8

tragus

Question 9

About 1 inch (2.5 cm) posterior to the external opening of the ear is a prominent bony mass at the base of the skull called the__

Answer 9

mastoid process.

Question 10

The joint formed where the mandible and cranium meet, just in front of the ear

Answer 10

Temporimandibular joint

Question 11

The mandible forms the jaw and chin. The jaw is the lower border of the mouth, where the tongue and 32 teeth are located. Motion of the mandible occurs at the___, which lies just in front of the ear on either side of the face. Below the ear and anterior to the mastoid process, the angle of the mandible is easily palpated.

Answer 11

temporomandibular joint

Question 12

The neck also contains many important structures. It is supported by the cervical spine, or the_. The spinal cord exits from the foramen magnum and lies within the spinal canal formed by the vertebrae. The upper part of the esophagus and the trachea lie in the midline of the neck. The carotid arteries are found on either side of the trachea, along with the jugular veins and several nerves

Answer 12

first seven vertebrae in the spinal column (C1 through C7)

Question 13

Several useful landmarks can be palpated and seen in the neck (FIGURE 28-3). The most obvious is the firm prominence in the center of the anterior surface, commonly known as the Adam’s apple. Specifically, this prominence is the upper part of the larynx, formed by the__. It is more prominent in men than in women.

Answer 13

thyroid cartilage

Question 14

The other portion of the larynx is the__, a firm ridge of cartilage (the only complete circular cartilage structure of the trachea) below the thyroid cartilage, which is somewhat more difficult to palpate. Between the thyroid cartilage and the___ in the midline of the neck is a soft depression, the cricothyroid membrane. This is a thin sheet of connective tissue (fascia) that joins the two cartilages (FIGURE 28-4). The cricothyroid membrane is covered at this point only by skin.

Answer 14

cricoid cartilage

Question 15

A thin sheet of fascia that connects the thyroid and cricoid cartilages that makes sense up the larynx

Answer 15

Crickthyroid membrane

Question 16

Below the larynx, several additional firm ridges are palpable in the anterior midline. These ridges are the cartilage rings of the___. The____ connects the oropharynx and the larynx with the main air passages of the lungs (the bronchi).
On either side of the lower larynx and the upper trachea lies the thyroid gland. Unless it is enlarged, this gland is usually not palpable.

Answer 16

trachea

Question 17

Pulsations of the carotid arteries are easily palpable in a groove approximately 0.5 inch (13 mm) lateral to the larynx.
Lying immediately adjacent to these arteries, but not palpable, are the internal jugular veins and several important nerves.
Lateral to these vessels and nerves lie the___. These muscles originate from the mastoid process of the cranium and insert into the medial border of each collarbone and the sternum at the base of the neck. They allow movement of the head

Answer 17

sternocleidomastoid muscles

Question 18

A series of bony prominences lie posteriorly, in the midline of the neck. They are the spines of the cervical vertebrae. The lower___ are more prominent than the upper ones. They are more easily palpable when the neck is in flexion. At the base of the neck posteriorly, the most prominent spine is the seventh cervical vertebra.

Answer 18

cervical spines

Question 19

At the base of the neck posteriorly, the most prominent spine is the__.

Answer 19

seventh cervical vertebra

Question 20

The___ is globe-shaped, approximately 1 inch (2.5 cm) in diameter, and located within a bony socket in the skull called the orbit FIGURE 28-5. The orbit is composed of the adjacent bones of the face and skull; the orbit forms the base of the floor of the cranial cavity, and directly above it are the frontal lobes of the brain. In the adult, more than 80% of the eyeball is protected within this bony orbit. Between and below the orbits are the nasal bone and the sinuses, respectively. Therefore, any severe injury to the face or head can potentially damage the eyeball or the muscles attached to the eyeball that cause the eye to move.

Answer 20

eye

Question 21

Globe

Answer 21

The eyeball.

Question 22

The eyeball, or globe, keeps its global shape as a result of the pressure of the fluid contained within its two chambers.
The clear, jellylike fluid near the back of the eye is called the vitreous humor. In front of the lens is a clear fluid called the___, named for its watery appearance; in Latin, aqua means water. In penetrating injuries of the eye, aqueous humor can leak out, but with time and appropriate medical treatment, the body can make more.

Answer 22

aqueous humor

Question 23

The inner surface of the eyelids and the exposed surface of the eye itself, which are covered by a delicate membrane, the conjunctiva, are kept moist by fluid produced by the__, often called tear glands (FIGURE 28-6). Humans blink unconsciously many times per minute. This action sweeps fluid from the lacrimal glands over the surface of the eye, cleaning it. The tears drain on the inner side of the eye through two lacrimal (tear) ducts into the nasal cavity. This is why people sometimes need to blow their nose when they cry.

Answer 23

lacrimal glands

Question 24

The white of the eye, called the___, extends over the surface of the globe. This extremely tough, fibrous tissue helps maintain the eye’s globular shape and protects the more delicate inner structures.

Answer 24

sclera

Question 25

On the front of the eye, the sclera is replaced by a clear, transparent membrane called the__, which allows light to enter the eye. A circular muscle lies behind the cornea with an opening in its center. Like the shutter in a camera, this muscle adjusts the size of the opening to regulate the amount of light that enters the eye. This circular muscle and surrounding tissue are called the iris. The iris is pigmented, giving the eye its characteristic brown, green, or blue color. The opening in the center of the iris, which allows light to move to the back of the eye, is called the pupil. Normally, the pupil appears black. Like the opening in a camera, the pupil becomes smaller in bright light and larger in dim light. The pupil also becomes smaller and larger when the person is looking at objects near at hand and farther away; these adjustments occur almost instantaneously. Normally, the pupils in both eyes are equal in size. Some people are born with pupils that are not equal (anisocoria); however, particularly in unconscious patients, unequal pupil size may indicate serious injury or illness of the brain or eye.

Answer 25

cornea

Question 26

The opening in the center of the iris, which allows light to move to the back of the eye, is called the__. Normally, the___ appears black. Like the opening in a camera, the____ becomes smaller in bright light and larger in dim light. The___ also becomes smaller and larger when the person is looking at objects near at hand and farther away; these adjustments occur almost instantaneously. Normally, the pupils in both eyes are equal in size. Some people are born with pupils that are not equal (anisocoria); however, particularly in unconscious patients, unequal pupil size may indicate serious injury or illness of the brain or eye.

Answer 26

pupil

Question 27

Behind the iris is the lens. Like the lens of a camera, this lens focuses images on the light-sensitive area at the back of the globe, called the__. Within the__ are numerous nerve endings that respond to light by transmitting nerve impulses through the optic nerve to the brain. In the brain, the impulses are interpreted as vision.

Answer 27

retina

Question 28

The retina is nourished by a layer of blood vessels between it and the sclera at the back of the globe. This layer is called the choroid. If, as sometimes happens, the retina detaches from the underlying choroid and sclera, the nerve endings are not nourished, and the patient experiences blindness. This may be partial blindness, depending on how much of the retina is separated. This condition is called___.

Question 29

A cranial nerve that transmits visual information to the brain

Answer 29

Optic nerve

Question 30

The light-sensitive area of the eye where images are projected; a layer of cells at the back of the eye that changes the light image into electric impulses, which are carried by the optic nerve to the brain

Answer 30

Retina

Question 31

The transparent part of the eye through which images are focused on the retina

Answer 31

Lens

Question 32

Soft-tissue injuries of the face and neck are common. Because the face and neck are extremely vascular, swelling from soft-tissue injuries in this area may be more severe than in other injured parts of the body. The skin and underlying tissues in these areas have a rich blood supply, so bleeding from penetrating injuries may be heavy. Even minor soft-tissue wounds of the face and neck may bleed profusely. A blunt injury that does not break the skin may cause a break in a blood vessel wall, causing blood to collect under the skin; this is called a___ (FIGURE 28-7). In some situations, a flap of skin is peeled back, or avulsed, from the underlying muscle and fascia

Answer 32

hematoma

Question 33

A major___ injury is characterized by a large flap of skin that is peeled back from the underlying muscle and tissue.

Answer 33

avulsion

Question 34

Often, physicians will be able to graft a piece of avulsed skin back into the appropriate position. For this reason, if you find portions of avulsed skin that have become separated, wrap them in a sterile dressing, place them__. Never place tissue directly on ice because freezing will cause further injury to the tissue and make it unusable. Deliver the bag labeled with the patient's name to the emergency department along with the patient. In many avulsion injuries, the skin will still be attached in a loose flap (FIGURE 28-11). Place the flap in a position that is as close to normal as possible, and hold it in place with a dry, sterile dressing. These steps will help to increase the patient's chances of having his or her normal appearance restored.

Answer 34

in a plastic bag, and keep them cool

Question 35

Large objects are prevented from penetrating the eye by the protective orbit that surrounds it. However, moderately sized and smaller foreign objects of many different types can enter the eye and cause significant damage. Even a tiny foreign object, such as a grain of sand lying on the surface of the conjunctiva, may produce severe irritation (FIGURE 28- 14). The conjunctiva becomes inflamed and red— a condition known as____ — almost immediately, and the eye begins to produce tears to flush out the object. Irritation of the cornea or conjunctiva causes intense pain. The patient may have difficulty keeping the eyelids open, because the irritation is further aggravated by bright light.

Answer 35

conjunctivitis