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Year 2 Clinical > ENT Trauma > Flashcards

ENT Trauma Flashcards

1
Q

Mechanisms of injury with nasal trauma?

A

Fight, sports and falls

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2
Q

Important Hx questions with nasal trauma?

A

When did it occur?

Was there a loss of consciousness? - suggests head injury

Epistaxis?

Breathing issues?

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3
Q

Symptoms and signs of nasal trauma?

A

Bruising, swelling and tenderness

Deviation

Epistaxis - if this is recurrent, it suggests an arterial injury

Facial tenderness

Check infraorbital sensation and CN functions

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4
Q

What is a nasal septal haematoma?

A

Assoc. with nasal septal trauma; blood separates the septal cartilage and the perichondrium (which provides nutrition to the cartilage)

Although septal hematomas are rare, early diagnosis and treatment is important to prevent abscess formation, septal perforation, saddle-nose deformity, and potentially permanent complications

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5
Q

Why must septal haematomas be excluded and treated early?

A

If not treated:
• Abscess formation
• Intracranial infection
• Septal perforation and saddle-nose deformity

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6
Q

Examination of a septal haematoma?

A

If boggy when prodded, it may be a septal haematoma

If solid, it is likely to be a deviated septum

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7
Q

Examination of a nasal fracture?

A

Clinical diagnosis that is based on deviation/cosmesis and breathing issues

Review at 5-7 days post-injury (once swelling has settled)

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8
Q

Management of nasal fracture?

A

Various options:
• No intervention
• Manipulation under anaesthetic (MUA) - local or general

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9
Q

Complications of nasal fracture?

A

Epistaxis (part. if the anterior ethmoid artery has been injured)

CSF leak (risk of ascending infection leading to meningitis)

Fracture of the cribriform plate can cause anosmia

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10
Q

Treatment of CSF leak due to nasal fracture?

A

Tends to resolve spontaneously (dura heals itself); if not healed within 10 days, repair

Prophylactic antibiotics are not given as risk of infection is low; antibiotics are only given if symptoms of meningitis develop

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11
Q

Vasculature of the nose?

A

Just underneath the mucosa and arteries include:
• Anterior and posterior ethmoid arteries
• Sphenopalatine artery
• Greater palatine artery

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12
Q

Mx of epistaxis in relation to stopping bleeding?

A

If necessary, resuscitate

Arrest/slow blood flow with:
• Pressure
• Ice
• Topical vasoconstrictor +/- LA (lignocaine + adrenaline, co-phenylcaine)

Remove clot:
• Suction
• Nose-blowing

Cautery/pack (AKA nasal tampon)

Rigid nasendoscopy can be used

Cauterise vessel:
• Silver nitrate (if there is no active bleeding to stop the chemical sliding off)
• Diathermy

Consider arterial ligation

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13
Q

Ix for epistaxis?

A

FBC (assess haemorrhage)

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14
Q

Cautions with epistaxis and risk of aspiration of blood?

A

Do not sedate the patient

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15
Q

How does a pinna haematoma form?

A

AKA sub-perichondrial haematoma

Trauma, e.g: boxing, can lead to separation of the anterior auricular perichondrium from the underlying cartilage; there can be tearing of the perichondrial blood vessels and haematoma formation

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16
Q

Treatment of a sub-perichondrial haematoma?

A

Various techniques:
• Aspiration
• Incision and drainage
• Pressure dressing

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17
Q

Causes of lacerations pinna?

A

Blunt trauma, avulsion, dog bites, etc

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18
Q

Mx of lacerations to the pinna?

A

Debridement and closure:
• Primary OR reconstruction
Pinna has a very good blood supply so can heal if reattached

Usually, LA is given and antibiotics (prevent cartilage infection)

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19
Q

Hx questions in a temporal bone fracture?

A

Injury mechanisms and assoc. injuries

Other symptoms:
• Hearing loss
• Facial palsy
• Vertigo
• CSF leak
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20
Q

Examination of temporal bone fracture reveals?

A

Occasionally, a battle sign (bruising behind the ear) can be seen

Check condition of the TM and ear canal; check function of CN VII

Do a hearing test

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21
Q

Classifications of temporal bone fractures?

A

Longitudinal (80%) VS transverse fractures (20%)

Otic capsule involved VS otic capsule spared

22
Q

Describe longitudinal temporal bone fractures?

A

Typically caused by lateral blows, resulting in a fracture line that parallels the long axis of the petrous pyramid

23
Q

Symptoms and signs of longitudinal fractures of the temporal bone?

A

Bleeding from external canal (laceration of skin and ear drum)

Haemotympanum and ossicular chain deafness (causes conductive deafness)

Facial palsy may occur

Otorrhoea of CSF

24
Q

Describe transverse fractures of the temporal bone

A

Typically caused by frontal blows, resulting in a fracture at right angles to the long axis of the petrous pyramid

25
Q

Symptoms and signs of transverse fracture?

A

Fracture can cross internal acoustic meatus and damage the auditory and facial nerves

Sensorineural hearing loss (damage of CN VIII)

Facial nerve palsy (half of patients)

Vertigo

26
Q

4 types of hearing loss?

A
  1. Conductive
  2. Sensorineural
  3. Mixed
  4. Central
27
Q

Causes of conductive hearing loss?

A

Fluid
• Blood (looks blue)
• Effusion (golden)
• CSF leak

TM perforation

Ossicular problem

Stapes fixation (AKA otosclerosis) - stapes is fixed in the oval window and so cannot vibrate

28
Q

Causes of sensorineural hearing loss?

A

Sensory (cochlea)

Neural (CN VIII)

29
Q

Mx of temporal bone fractures?

A

Often delayed due to polytrauma

May require:
• Facial nerve decompression (if they have no recovery and EMG studies are +ve, as these suggest a laceration rather than compression)
• Management of CSF leak
• Hearing restoration (hearing aid or ossiculoplasty)

30
Q

How to differentiate the severity of nerve injuries?

A

If nerve injury occurred at the time of injury and symptoms started then, likely that the nerve was lacerated

If nerve injury occurred a few days later with symptoms developing at this time, likely that allowing the nerve to decompress will resolve symptoms

31
Q

Causes of neck trauma?

A

Penetrating (knife, gunshot, RTA, industrial/household accidents)

Blunt (RTA, sports injuries)

32
Q

Occurrence of neck trauma?

A

More common in males, adolescents/young adults

Depends on city

33
Q

What does a zone 1 neck injury involve?

A 
Zone 1: - involves:
• Trachea and oesophagus
• Thoracic duct
• Brachiocephalic, subclavian, common carotid and thyrocervical vessels
• Spinal cord
34
Q

What does a zone 2 neck injury involve?

A 
Zone 2 - involves:
• Larynx and hypolarynx
• CN X, XI, XII
• Carotid and internal jugular vessels
• Spinal cord
35
Q

What does a zone 3 neck injury involve?

A 
Zone 3 - involves:
• Pharynx
• CNs
• Carotid, internal jugular and vertebral vessels
• Spinal cord
36
Q

Hx questions with a neck injury?

A

Mechanism?

Pain (SOCRATES)?

Aerodigestive tract symptoms:
• Dyspnoea, hoarseness, dysphonia, haemoptysis
• Dysphagia

CNS issues (paraesthesia and weakness)?

37
Q

Examination of neck injury?

A

ABCDE

Secondary survey

38
Q

What does the secondary survery involve?

A

Inspect the injury:
• If injury has not gone through the platysma, it can be cleaned and closed
• If through platysma, must explore and deal with it as a true penetrating wound

Zone of neck

Bleeding/haematoma

Aerodigestive injuries

Neurological assessment

39
Q

What is the platysma?

A

Superficial muscle that overlaps the sternocleidomastoid

40
Q

Ix of neck injuries?

A

FBC, G

CXR (may show haemothorax or emphysema)

CT angiogram

MRA

41
Q

Complications of neck injuries?

A

Expanding haematoma

Hypovolaemic shock

Airway obstruction

Blood in aerodigestive tract

42
Q

What is the maxilla?

A

Bridge between the cranial base and dental occlusal plane (functionally and cosmetically important)

43
Q

Cause of maxillary fracture?

A

High-energy blunt force injury to the facial skeleton; potentially life-threatening and disfiguring

44
Q

Sign of maxillary fracture?

A

“Bite” (dental occlusion) feeling abnormal

45
Q

Occurrence of orbital floor fractures?

A

2nd most common mid-facial fracture

46
Q

Main area in which orbital floor fracture occur?

A

Infraorbital groove

47
Q

Signs of orbital floor fracture?

A

Pain

Decreased visual acuity and diplopia

Hypoaesthesia in infraorbital region

Periorbital ecchymosis (racoon eyes) and oedema

Enophthalmos

Restriction of ocular movement

Bony step of orbital rim

48
Q

Ix for orbital floor fracture?

A

CT sinuses shows “tear drop” sign

49
Q

What is an orbital blowout fracture?

A

Affects the medial wall and floor

50
Q

Mx of orbital floor fractures?

A

Conservative

Surgical repair of bony walls if:
• Entrapment
• Large defect
• Significant enophthalmos

51
Q

Le fort classification of fractures?

A

Le fort I - horizontal and passes above the teeth apices

Le fort II - pyramidal

Le fort III - transverse

52
Q

Surgery for vertical buttresses?

A

Reduce the fracture and fixate

Year 2 Clinical (119 decks)

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