ENT Trauma Flashcards
What questions are important to ask in a history of nasal trauma?
Mechanism of injury (fight, sport, falls) When did the injury occur? Level of consciousness? Epistaxis? Brething?
What signs are important to look for in an examination of nasal trauma?
Bruising Swelling Tenderness Deviation Epitaxis
Facial Tenderness
Infraorbital sensation
CNs
What are the risks of haematoma?
Necrosis of septum cartilage
Infection can spread to intra-cranial infection
How is a diagnosis of a nasal fracture made?
Clinical diagnosis
Based on deviation/cosmesis
When should you review a nasal fracture?
Review in ENT clinic 5-7 days post injury
swelling gone down
What are the management options for a nasal fracture?
(No intervention)
MUA (manipulation under anaesthetic
within 2 weeks - can manually correct bones)
What are potential complications of nasal fracture?
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Epistaxis (particularly anterior ethmoid fracture)
CSF leak
Meningitis
Anosmia (cribiform plate fracture)
What nasal fracture is particularly associated with epitaxis?
Anterior ethmoid fracture
What nasal fracture is associated with anosmia?
Cribiform plate fracture
What arteries are involved in the anastamoses in the nose?
ICA and ECA
In the nose, the vasculature runs just under:
Mucosa
not squamous
Management options for epistaxis:
Resuscitate on arrival if necessary
Arrest/slow flow: pressure, ice, topical vasoconstrictor
Remove clot: suction/nose blowing
Anterior Rhinoscopy
Cautery/pack
(arrange admission if packed/poor social circumstances)
30 rigid nasendoscopy
Consider arterial ligation (particularly for AEA bleed)
Epistaxis: Cauterise vessel with:
2
Silver nitrate
Diathermy
Management of CSF leak:
CSF leaks often settle spontaneously. - Need repar if not settled within 10 days!
(site of fracture may be cribiform plate)
Role of antibiotics not clear - asceding infection
Treatment options for Pinna Haematoma:
3
Aspirate
Incision and drainage
Pressure dressing
Management for ear lacerations:
Debridement
Closure (Primary, Reconstruction)
Antibiotics - cartilage
In history of Ear trauma, ask:
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Injury mechanism Hearing loss Facial Palsy Vertigo CSF leak Associatd injuries
What is “battle’s sign”?
Battle’s sign, also mastoid ecchymosis, is an indication of fracture of posterior cranial fossa of the skull, and may suggest underlying brain trauma. … Battle’s sign is usually seen after head injuries resulting in injury to mastoid process leading to bruising.
On examination of Ear trauma, look for:
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Bruising (Battle’s sign)
Condition of TM and ear canal
Hearing test
Temporal bone fractures classified as:
Longitudinal
Transverse
Are most temporal bone fractures longitudinal or transverse?
Longitudinal
Longitudinal temporal fractures are due to _______ blows. The fracture line _________________.
Longitudinal temporal fractures are due to lateral blows. The fracture line parallels the long axis of the petrous pyramid.
Transverse temporal fractures are due to _______ blows. The fracture ___________________.
Transverse temporal fractures are due to frontal blows. The fracture is at right angles to the long axis of the petrous pyramid.
Which type of temporal fracture is more common?
Longitudinal
Which type of temporal fracture can cross the interal acoustic meatus causing damage to the auditory and facial nerves?
Transverse
Which type of temporal fracture is more likely to cause facial nerve palsy?
Transverse fracture (50%)
Longitudinal fracture = 20%
Which type of temporal fracture can cause sensorineural hearing loss due to damage to 8th cranial nerve?
Transverse fracture
Which type of temporal fracture can cause bleeding from the external canal due to laceration of skin and ear drum?
Longitudinal fracture
Which type of temporal fracture can cause conductive hearing loss due to:
Haemotympanum
Ossicular chain disruption
Longitudinal fracture
What are the two potential causes of conductive heearing loss in a longitudinal temporal fracture?
Haemotympanum
Ossicular Chain Disruption
Which type of temporal fracture is associated with CSF otorrhoea?
Longitudinal
Which type of temporal fracture is associated with vertigo?
Transverse
What is CSF ottorhoea?
CSF drains from ear
What causes conductive hearing loss?
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Fluid - effusuion, blood, CSF
TM perforation
Ossicular problem
Stapes fixation - Otosclerosis
Which cranial nerve is involved in sensorineural hearing loss?
CN VIII
Vestibulocochlear nerve
What is in zone I of the neck?
Trachea Oesophagus Thoracic duct Thyroid Vessels – brachiocephalic, subclavian, common carotid, thyrocervical trunk Spinal cord
What is in zone II of the neck?
Larynx Hypoharynx CN 10,11,12 Vessels – carotids, internal jugular Spinal Cord
What is in zone III of the neck?
Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord
What are the different zones of the neck?
Zone I (INFERIOR) Zone II (middle) Zone III (superior)
Which zone of the neck is the pharynx in?
Zone III
Which zone of the neck is the thyroid in?
Zone I
Which zone of the neck is the trachea in?
Zone I
Which zone of the neck is the larynx in?
Zone II
Which zone of the neck is the hypopharynx in?
Zone II
Which zone of the neck is the trachea in?
Zone I
Which zone of the neck are the Cranial Nerves 10, 11 and 12 in?
Zone II
Which zone of the neck are the vessels (carotids, IJV) in?
Zone III
Which zone of the neck is the thoracic duct n?
Zone I
Which zone of the neck are the vessels (brachiocephalic, subclavian, common carotid, thyrocervical trunk) in?
Zone I
Which zone of the neck are the vessels (carotids, internal jugular) in?
Zone II
Which zone(s) of the neck is the spinal cord in?
Zones I, II and III
Which “zone” of the neck is most superior?
Zone III
Which “zone” of the neck is most inferior?
Zone I
Managment of neck trauma:
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Urgent exploration! - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy
Angiography - embolize, occlude
Which of the Le Fort fractures is horizontal?
Le Fort I
Passes horizonatally above teeth apices
Which of the Le Fort fractures is pyrimidal?
Le Fort II
Nasal bridge, through frontal processes of maxilla, through lacrimal bone and inferior orbital fissure, andd through the pterygoid plates
Which of the Le Fort fractures is Transverse?
Le Fort III
Craniofacial dysjunctions.
What imaging technique(s) would be used to access facial fractures?
(X-Ray: C-spine, Waters view)
CT imaging of choice!!
