ENT Pathology 4 - Septal haematoma, epistaxis, temporal/maxillary fractures, myringitis, kawasaki disease Flashcards
What pathology, caused by trauma can result in necrosis of the septal cartilage of the nose due to the ischeamia?
Septal haematoma
In a septal haemotoma, the perichondrium separates from the bone resulting in the development of the haematoma What is the treatment?
Urgent drainage is required or the nose can necrose
What deformity of the septal cartilage can a septal haematoma lead to? What is this also seen in?
Septal haematoma - can lead to saddle shaped deformity of the nose Also seen in Wegener’s granulomatosis
What is the most common point of epistaxis? What does epistaxis mean?
Little’s (keisselbach’s) Area It means a nose bleed
In a nose bleed, where is pressure applied?
External pressure and Ice - pinch lower part of nose for 20 minutes
If applying pressure fails in epistaxis, what is the next treatment option?
Clot removal e.g. suction or nose blowing Apply a cotton soaked ball - adrenaline to cause vasoconstriction and lidocaine for analgesia Cauterise using silver nitrate Rhino pack if bleeding continues
Shearing forces to the auricle can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage. As a result, there can be tearing of the perichondrial blood vessels and subsequently a hematoma formation What is this known as?
Pinna haematoma
Treatment of pinna haematoma? (aka cauliflower ear)
Aspirate and drain and then apply a pressure dressing
What are the two types of temporal bone fractures? Which is most common?
Longitudinal and transverse Longitudinal accounts for 80% of the temporal bone fractures
Does longitudinal or transverse have otic capsule involvement?
Trasnverse blows have otic capsule involvement
Describe a longitudinal temporal bone fracture?
• Lateral blows • Fracture line parallel to long axis of petrous pyramid Can see the otic caspule sparing in the longitudinal fracture
Does longitudional temporal bone fractures present with any hearing loss? Is there any nerve involvement?
Presents with conductive eharing loss as it affects the middle ear structures Also can cause facial nerve palsy in 25% of patients
Describe a transverse temporal bone fracture?
This fracture is typically due to a frontal blow at right angles to the long axis of the petrous bone
What nerve damage does transverse fracture result in?
Results in facial nerve palsy in 30% and otic capsule involvement affecting CN VIII (both cochlear and vestibular branches)
What does the otic capsule involvement in transverese temporal bone fractures result in?
Otic capsule involvement causes vertigo and sensorineural hearing loss
Which le fort fracture can affect the inferior meatus of the nose? What drains here?
Le Fort 1 fracture Nasolacrimal duct drains here
When myringitis presents with painful hemorrhagic vesislces on the tympanic membrane, what is this known as?
Myringitis bullosa (bullosa myringitis)
Myringiits bullosa is inflammation between the outer and middle layer of the tympanic membrane What are the three layers known as?
Outer epithelial layer (skin) Middle fibrous layer (lamina propria) Inner mucous layer
State what the letters are and where they are from?
AT - auricolotemporal branch of mandibular nerve (CN V3) EAM - external acoustic meatus Lesser occipital - LO Greater auricular is GA Both come from anterior rami of C2,3 spinal nerves
Describe Kawasaki’s disease? (CRASH and Burn)
Kawasaki’s disease - medium vessel vasculitis that can cause aneursyms of the coronary arteries CRASH (4 out of 5 of): * Conjunctivitis * Rash * Aneursyms / adenopathy * Strawberry tongue * Hands / feet swollen Burn - fever 5 days or more
