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ENT > ENT Trauma > Flashcards

ENT Trauma Flashcards

1
Q

What questions are important to ask in a history of nasal trauma?

A 
Mechanism of injury (fight, sport, falls)
When did the injury occur?
Level of consciousness?
Epistaxis?
Brething?
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2
Q

What signs are important to look for in an examination of nasal trauma?

A 
Bruising
Swelling
Tenderness
Deviation
Epitaxis

Facial Tenderness
Infraorbital sensation
CNs

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3
Q

What are the risks of haematoma?

A

Necrosis of septum cartilage

Infection can spread to intra-cranial infection

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4
Q

How is a diagnosis of a nasal fracture made?

A

Clinical diagnosis

Based on deviation/cosmesis

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5
Q

When should you review a nasal fracture?

A

Review in ENT clinic 5-7 days post injury

swelling gone down

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6
Q

What are the management options for a nasal fracture?

A

(No intervention)

MUA (manipulation under anaesthetic
within 2 weeks - can manually correct bones)

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7
Q

What are potential complications of nasal fracture?

4

A

Epistaxis (particularly anterior ethmoid fracture)
CSF leak
Meningitis
Anosmia (cribiform plate fracture)

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8
Q

What nasal fracture is particularly associated with epitaxis?

A

Anterior ethmoid fracture

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9
Q

What nasal fracture is associated with anosmia?

A

Cribiform plate fracture

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10
Q

What arteries are involved in the anastamoses in the nose?

A

ICA and ECA

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11
Q

In the nose, the vasculature runs just under:

A

Mucosa

not squamous

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12
Q

Management options for epistaxis:

A

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)

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13
Q

Epistaxis: Cauterise vessel with:

2

A

Silver nitrate

Diathermy

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14
Q

Management of CSF leak:

A

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

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15
Q

Treatment options for Pinna Haematoma:

3

A

Aspirate

Incision and drainage

Pressure dressing

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16
Q

Management for ear lacerations:

A

Debridement

Closure (Primary, Reconstruction)

Antibiotics - cartilage

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17
Q

In history of Ear trauma, ask:

6

A 
Injury mechanism
Hearing loss
Facial Palsy
Vertigo
CSF leak
Associatd injuries
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18
Q

What is “battle’s sign”?

A

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.

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19
Q

On examination of Ear trauma, look for:

3

A

Bruising (Battle’s sign)
Condition of TM and ear canal
Hearing test

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20
Q

Temporal bone fractures classified as:

A

Longitudinal

Transverse

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21
Q

Are most temporal bone fractures longitudinal or transverse?

A

Longitudinal

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22
Q

Longitudinal temporal fractures are due to _______ blows. The fracture line _________________.

A

Longitudinal temporal fractures are due to lateral blows. The fracture line parallels the long axis of the petrous pyramid.

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23
Q

Transverse temporal fractures are due to _______ blows. The fracture ___________________.

A

Transverse temporal fractures are due to frontal blows. The fracture is at right angles to the long axis of the petrous pyramid.

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24
Q

Which type of temporal fracture is more common?

A

Longitudinal

25
Q

Which type of temporal fracture can cross the interal acoustic meatus causing damage to the auditory and facial nerves?

A

Transverse

26
Q

Which type of temporal fracture is more likely to cause facial nerve palsy?

A

Transverse fracture (50%)

Longitudinal fracture = 20%

27
Q

Which type of temporal fracture can cause sensorineural hearing loss due to damage to 8th cranial nerve?

A

Transverse fracture

28
Q

Which type of temporal fracture can cause bleeding from the external canal due to laceration of skin and ear drum?

A

Longitudinal fracture

29
Q

Which type of temporal fracture can cause conductive hearing loss due to:
Haemotympanum
Ossicular chain disruption

A

Longitudinal fracture

30
Q

What are the two potential causes of conductive heearing loss in a longitudinal temporal fracture?

A

Haemotympanum

Ossicular Chain Disruption

31
Q

Which type of temporal fracture is associated with CSF otorrhoea?

A

Longitudinal

32
Q

Which type of temporal fracture is associated with vertigo?

A

Transverse

33
Q

What is CSF ottorhoea?

A

CSF drains from ear

34
Q

What causes conductive hearing loss?

4

A

Fluid - effusuion, blood, CSF

TM perforation

Ossicular problem

Stapes fixation - Otosclerosis

35
Q

Which cranial nerve is involved in sensorineural hearing loss?

A

CN VIII

Vestibulocochlear nerve

36
Q

What is in zone I of the neck?

A 
Trachea
Oesophagus
Thoracic duct
Thyroid
Vessels – brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord
37
Q

What is in zone II of the neck?

A 
Larynx
Hypoharynx
CN 10,11,12
Vessels – carotids, internal jugular
Spinal Cord
38
Q

What is in zone III of the neck?

A

Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord

39
Q

What are the different zones of the neck?

A 
Zone I (INFERIOR)
Zone II (middle)
Zone III (superior)
40
Q

Which zone of the neck is the pharynx in?

A

Zone III

41
Q

Which zone of the neck is the thyroid in?

A

Zone I

42
Q

Which zone of the neck is the trachea in?

A

Zone I

43
Q

Which zone of the neck is the larynx in?

A

Zone II

44
Q

Which zone of the neck is the hypopharynx in?

A

Zone II

45
Q

Which zone of the neck is the trachea in?

A

Zone I

46
Q

Which zone of the neck are the Cranial Nerves 10, 11 and 12 in?

A

Zone II

47
Q

Which zone of the neck are the vessels (carotids, IJV) in?

A

Zone III

48
Q

Which zone of the neck is the thoracic duct n?

A

Zone I

49
Q

Which zone of the neck are the vessels (brachiocephalic, subclavian, common carotid, thyrocervical trunk) in?

A

Zone I

50
Q

Which zone of the neck are the vessels (carotids, internal jugular) in?

A

Zone II

51
Q

Which zone(s) of the neck is the spinal cord in?

A

Zones I, II and III

52
Q

Which “zone” of the neck is most superior?

A

Zone III

53
Q

Which “zone” of the neck is most inferior?

A

Zone I

54
Q

Managment of neck trauma:

3

A

Urgent exploration! - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract

Laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy

Angiography - embolize, occlude

55
Q

Which of the Le Fort fractures is horizontal?

A

Le Fort I

Passes horizonatally above teeth apices

56
Q

Which of the Le Fort fractures is pyrimidal?

A

Le Fort II

Nasal bridge, through frontal processes of maxilla, through lacrimal bone and inferior orbital fissure, andd through the pterygoid plates

57
Q

Which of the Le Fort fractures is Transverse?

A

Le Fort III

Craniofacial dysjunctions.

58
Q

What imaging technique(s) would be used to access facial fractures?

A

(X-Ray: C-spine, Waters view)

CT imaging of choice!!

ENT (7 decks)

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