Cranio-Orbital Trauma Flashcards
What is cranio-orbital trauma?
A heterogenous group of injuries involving the frontal bone, orbits, ethmoids and upper midface
Can be isolated or part of midface injury, panfacial injury and beyond
Are distinct due to their proximity to the intracranial space, necessitating a cautious approach and neurosurgical involvement in selected cases
Where does the frontal sinus drain into?
Middle meatus through the fronto-nasal duct by ethmoid air cells
What does an examination of cranio-orbital trauma include?
ATLS (advanced trauma life support system)
Airway and C spine first
Dents in forehead or any of their face
Numbness of scalp
Diplopia
Scars/wound overlying/open fracture?
NOE fractures
CSF leak- clear fluid running out of nose or ears
What is the aims of treatment of cranio-orbital trauma?
Create a ‘safe sinus’- one that drains and doesn’t collect mucous and infection
Restore appearance
Minimally displaced anterior and/or posterior fractures can be managed expectantly
Observe for signs of sinusitis
Consider CT scan for signs of sinus disease
What are the indications for cranio-orbital trauma surgery?
Anterior table displacement with significant forehead deformity
Frontonasal duct involvement/obstruction
Displacement of posterior table with underlying neurological injury
What are the classifications of nasoorbitoethmoidal fractures (NOE)?
Type 1: big piece, medial canthus (eye attachment) attached to bone
Type 2: comminutes, medial canthus attached to bone
Type 3: comminuted, medial canthus not attached to anything
What clinical signs aid diagnosis of a ZOE fracture?
Blow to bridge of the nose
Nasal bridge pushed in
Nose tipped up
Increased nasio-labial angle
Assess for telecanthus (lateral displacement of medial canthi, eyes drifted too far apart)
Why treat cranio-orbital trauma?
Aesthetics
Wound infection
Chronic sinusitis (up to 60%)
Meningitis (6% per year)- build up of snot due to sinuses not functioning
Mucocele/mucopyocele
Cavernous sinus thrombosis
Encephalitis
Brain abscess
