Clinical notes (Snell's) Flashcards
True or False: Fractures of the skull are common in ADULT but much less so in the young child.
True
In the infant skull, the bones are more resilient than in the adult skull and ____________ separate them.
Fibrous sutural ligaments
True or False: In the adult, the OUTER TABLE OF THE SKULL is particularly brittle
False:
Inner table of the skull
Moreover, the ___________ begin to ossify during middle age.
Sutural ligaments
The type of fracture that occurs in the skull depends on:
- The age of the patient
- The severity of the blow
- The area of skull receiving the trauma
A severe, localized blow produces a local indentation often accompanied by _________________
Splintering of the bone
Blows to the vault often result in a series of _________, which radiate out through the thin areas of bone.
Linear fractures
The petrous parts of the __________ and the _________ strongly reinforce the base of the skull and tend to deflect linear fractures.
Temporal bones and the Occipital crests
In the young child, the skull may be likened to a table tennis ball in that a localized blow produces a depression without splintering. This common type of circumscribed lesion is referred to as a ______________.
Pond fracture
The cribriform plate of the ethmoid bone may be damaged in fractures of the ____________.
Anterior cranial fossa
This usually results in tearing of the overlying meninges and underlying mucoperiosteum.
Anterior cranial fossa fractures
The patient will have bleeding from the nose or __________ and leakage of CSF into the nose or ___________.
Epistaxis
Cerebrospinal rhinorrhea
Fractures involving the beneath the conjunctiva and into the orbital cavity, causing __________. The frontal air sinus may be involved with hemorrhage into the nose.
Exophthalmos
Fractures of the ___________ are common, because this is the weakest part of the base of the skull. This weakness is caused by the presence of NUMEROUS FORAMINA and CANALS in this region.
Middle cranial fossa
True or False: The cavities of the middle ear and the sphenoid air sinuses are particularly VULNERABLE.
True
The leakage of CSF and blood from the _________ is common.
External auditory meatus
The _____ and _____ cranial nerves may be involved as they pass through the petrous part of the temporal bone.
7th and 8th cranial nerves
The _____, _______ and ______ cranial nerves may be damaged if the lateral wall of the cavernous sinus is torn.
3rd, 4th and 6th
In fractures of the _________, blood may escape into the nape of the neck deep to the postvertebral muscles.
Posterior cranial fossa
In fractures involving the JUGULAR FORAMEN, the _____, ______ and _____ cranial nerves may be damaged.
9th
10th
11th
Are common causes of facial fractures.
- automobile accidents
- fisticuffs
- falls
Fortunately, the upper part of the skull is developed from _________ whereas the remainder is developed from _________.
Membrane
Cartilage
Signs of fractures of the facial bones include:
- Deformity
- Ocular displacement
- Abnormal movement accompanied by crepitation
- Malocclusion of the teeth
Anasthesia or parasthesia of the facial skin will follow fracture of bones through which branches of the _________ pass the skin.
Trigeminal nerve
_________ is not needed once a fracture of the maxilla has been reduced.
Prolonged fixation
However, in the case of the _______, the strong muscles of mastication can create considerable displacement requiring long periods of fixation.
Mandible
The most common facial fractures involve the ________, followed by the ________ and then the __________.
Nasal bones
Zygomatic bone
Mandible
Because of the prominence of the nose, fractures of the _______ are the most common facial fractures.
nasal bones
Because the bones are lined with ___________, the fracture is considered open; the overlying skin may also be lacerated.
Mucoperiosteum
___________ usually occur as the result of massive facial trauma.
Maxillofacial fractures
There is extensive facial swelling, midface mobility of the underlying bone on palpation, malocclusion of the teeth with anterior open bite and possibly leakage of CSF secondary to fracture of the cribriform plate of the ethmoid bone.
Maxillofacial fractures
Involvement of the __________ with anesthesia or parasthesia of the skin of the cheek and upper gum may occur in fractures of the body of the maxilla.
Infraorbital nerve
A severe blow to the orbit (as from a baseball) may cause the contents of the orbital cavity to explode _______ through the floor of the orbit into the maxillary sinus.
Downward
Damage to the _________ may occur, resulting in altered sensation in the skin of the cheek, upper lip and gum.
Infraorbital nerve
A blow to the side of the face can fracture the ZYGOMA or ZYGOMATIC ARCH. Although it can occur as an ___________, as from a blow from a clenched fist it may be associated with multiple other fractures of the face as often seen in automobile accidents.
Isolated fracture
The _________ is horseshoe shaped and forms part of a bony ring with the two temperomandibular joints and the base of the skull.
Mandible
__________ is transmitted around the ring, causing a single fracture or multiple fractures of the manidble, often far removed from the point of impact.
Traumatic impact
It is important to realize that the SKIN, the SUBCUTANEOUS TISSUE, and the EPICRANIAL APONEUROSIS are separated from the periosteum by ____________.
Loose aerolar tissue
The skin of the scalp possesses numerous ___________, the ducts of which are pone to infection and damage by repeated hair treatment. For this reason, the __________ of the scalp are common.
Sebaceous glands
Sebaceous cysts
True or False:
The scalp has a PROFUSE BLOOD SUPPLY to nourish the hair follicles.
True
It is often difficult to stop the bleeding of a scalp wound because the arterial walls are attached to ________ in the subcutaneous tissue (C layer) and are unable to contract or retract to allow blood clotting to take place.
Fibrous septa
___________ applied to the scalp is the only satisfactory method of stopping the bleeding.
Local pressure
In scalp lacerations, appropriate _________ reduces the chance of necrosis.
Vascular suturing
The tension of the epicranial aponeurosis, produced by the tone of the ____________, is important in all deep wounds of the scalp.
Occipitofrontalis muscles
True or False: All the superficial arteries supplying the scalp ascend from the face and neck.
True
Infections of the scalp tend to remain _______ and are usually painful because of the abundant FIBROUS TISSUE in the subcutaneous layer.
Localized
Ocassionally, an infection of the scalp spreads by the emissary veins which are valveless to the skull bones causing __________.
Osteomyelitis
Infected blood in the DIPLOIC VEINS may travel by the emissary veins farther into the venous sinuses and produce __________
Venous sinus thrombosis
Blood or pus may collect in the potential space deep to the _____________ (the L layer of the scalp).
Epicranial aponeurosis
______________ is limited to ONE BONE because of the attachment of the periosteum to the sutural ligaments.
Subperiosteal blood or pus
