ENT Trauma

Question 1

Why must a septal haematoma be excluded in a patient with nasal trauma?

Answer 1

It may cause infection and septal abscess

It can lead to ischaemia and cartilage death

Question 2

What are the complications associated with nasal fracture?

Answer 2

Epistaxis

CSF leak and meningitis

Anosmia (if cribriform plate fracture)

Question 3

Which inherited condition can cause severe epistaxis?

Answer 3

Hereditary hemorrhagic telangiectasia

Question 4

How is epistaxis treated?

Answer 4

Pinch lower bony part of nose

Lean head forward slightly

(do not put head between legs, this only increases venous pressure in the head)

Question 5

How is a severe epistaxis treated?

Answer 5

1. Resus
2. Slow blood flow (pressure, ice, topical vasoconstrictor)
3. Remove clot
4. Anterior rhinoscopy
5. Cautery

Question 6

What is a rapid rhino pack?

Answer 6

A tool to stop nose bleeding

Inserted into nose and inflated

Question 7

What is a pinna haematoma?

Answer 7

Bleeding beneath the perichondrium

May calcify and cause cauliflower ear

Question 8

How is a pinna haematoma treated?

Answer 8

1. Aspirate
2. Incision
3. Drainage
4. Pressure dressing

Question 9

What is Battle’s sign?

Answer 9

Indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma

It involves injury to mastoid process leading to bruising

Question 10

How can temporal bone fractures be classified?

what is a classical history of temporal bone fracture?

Answer 10

1. Longitudinal or transverse
2. Otic capsule sparing or involved

Injury mechanism

Hearing loss

Facial palsy

Vertigo

CSF leak

Associated injuries

Question 11

What is the most common type of temporal bone fracture?

Answer 11

Longitudinal (80%)

(fracture line parallels the long axis of the petrous pyramid)

Question 12

What is Haemotympanum?

Answer 12

Blood in the middle ear space

(a cause of conductive deafness)

Question 13

Why is a transverse temporal bone fracture more likely to damage the auditory and facial nerves versus a longitudinal fracture?

Answer 13

The fracture line is at right angles to the petrous pyramid and may cross the internal acoustic meatus

Question 14

Which type of hearing loss may occur with a transverse temporal bone fracture?

Answer 14

Sensorineural (damage to CN VIII)

Question 15

Which type of temporal bone fracture is most affected by vertigo?

Answer 15

Transverse

Question 16

What are the four types of hearing loss?

Answer 16

1. Conductive
2. Sensorineural
3. Mixed
4. Central

Question 17

What may cause conductive hearing loss?

Answer 17

1. Fluid e.g. effusion, blood, CSF
2. Tympanic membrane perforation
3. Ossicular issues
4. Otosclerosis

Question 18

What is Otosclerosis?

Answer 18

A bony growth in the middle ear usually affecting the stapes

Question 19

What may cause sensorineural hearing loss?

Answer 19

Cochlear damage

Neura (CN VIII) damage

Question 20

How are most CSF leaks into the ear managed?

Answer 20

Most are self limiting (10 days)

Repair may be indicated

Question 21

What are the 3 zones of the neck which can be affeted by trauma?

Answer 21

Zone 1 - Lower aspect (root)

Zone 2 - Larynx to carotid arteries

Zone 3 - Upwards from larynx and pharynx

Question 22

What is the classical sign for an orbital fracture on CT?

Answer 22

Tear drop sign

(in a blow-out fracture)

Question 23

When will repair be attempted in a blow out fracture?

Answer 23

1. Entrapment
2. Large defects
3. Significant enophthalmos

Question 24

What is the most important foreign body that needs to be removed?

Answer 24

Batteries!!!!

Question 25

Describe what the different types of lefort fractures are

Answer 25

1 Horizontal. Passes horizontally above teeth apices.

2 Pyramidal. Nasal bridge, through frontal processes of maxilla, through lacrimal bone and inferior orbital floor, then through under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.

3 Transverse. Craniofacial dysjunctions. In reality, the Le Fort classification is an oversimplification of maxillary fractures. The amount of force impacted during a motor vehicle accident is much greater than Le Fort took into consideration during his work in the late 19th century. In most instances, maxillary fractures are a combination of the various Le Fort types.