ENT Trauma

Question 1

What is needed for a history of nasal trauma?

Answer 1

mechanism of injury
when
LOC (loss of consciousness)
Epistaxis?
Breathing?

Question 2

Examination?

Answer 2

Bruising
swelling
tenderness
deviation (tilt head back to see clearer)
facial tenderness
infraorbital sensation
CNs

Question 3

How long can deviation be fixed?

Answer 3

2 weeks (after this the bones are set)

Question 4

How would you improve visualisation of deviation?

Answer 4

tilt head back

Question 5

How would you examine CNs?

Answer 5

eye movements - specify

Question 6

How does a septal haematoma feel?

Answer 6

Boggy swelling

Question 7

How does septal deviation feel?

Answer 7

Hard swelling

Question 8

What is crucial about a septal haematoma?

Answer 8

Can cause septal abscess or perichondrium stripped from cartilage (loss of blood supply) and both can cause necrosis of the cartilage

Question 9

Do you need to x-ray for nasal fracture?

Answer 9

No- clinical diagnosis

Question 10

When can you accurately assess nasal deviation?

Answer 10

5-7 days after injury (allow for swelling to decrease)

Question 11

How can you assess deviation?

Answer 11

Push back to straight

Question 12

What is epistaxis?

Answer 12

Nose bleed

Question 13

What is the commonest emergency in ENT?

Answer 13

epistaxis

Question 14

How many anatomies do you have in the now?

Answer 14

2 - one at front and a venous at the back

Question 15

Management of nose bleed?

Answer 15

try to arrest or slow bleed - squeeze tip and lean forward

Question 16

How can you cauterise a vessel?

Answer 16

silver nitrate or diathermy

Question 17

What does a rhino pack allow for?

Answer 17

allows you to put internal compression on the bleed (blow up a nasal tampon)

Question 18

When do CSF leaks settle?

Answer 18

spontaneously within 10 days

Question 19

What can cause CSF leaks?

Answer 19

if the fracture site is at the cribriform plate

Question 20

What is an alternative name for a pinna haemotoma?

Answer 20

Cauliflower ear, caused by the blood up of blood under the … and will result in necrosis of the cartilage

Question 21

What do you do to treat lacerations?

Answer 21

Debride, put it back into the anatomical position, and give prophylactic antibiotics

Question 22

How do you transport a lacerated part of ear?

Answer 22

wrap in gauze or a sock and put in an ice box so it doesn’t get damaged by the ice

Question 23

What do you want to ask in a temporal bone fracture?

Answer 23

mechanism
hearing loss
facial palsy?
vertigo?
CSF leak?
any other ass injuries

Question 24

What are the examination findings of a temporal bone fracture?

Answer 24

Bruising behind the ear and around eyes, asses facial nerve function

Question 25

What are the 2 types of temporal fracture?

Answer 25

longitudinal (along axis of temporal bone)

transverse (across axis of temporal - could go through otic capsule)

Question 26

What are most common fractures?

Answer 26

longitudinal

Question 27

What is common in L fracture?

Answer 27

occicular chain disruption e.g. middle ear so results in conductive deafness

Question 28

What are the 3 types of hearing loss?

Answer 28

NOT central

Question 29

Conductive?

Answer 29

sound not transmitted effectively through the tympanic membrane due to fluid (1st in non-trauma), TM perforation, ossicular problem (most commonly the incus), if you have otosclerosis then this is 2nd most common in a non-trauma patient

Question 30

Sensorineural?

Answer 30

Sensory - cochlea damage

Neural - damage to 8th CN

Question 31

Management?

Answer 31

often delayed as poly trauma and common in RTA (may wake up 5 days later with a facial palsy)
May need facial nerve decompression

Question 32

How can you restore hearing?

Answer 32

repair ossicular chain, hearing aid or ossiculoplasty

Question 33

What are the 2 most common causes of neck trauma?

Answer 33

Penetrating (knife, self harm, household accidents etc)

Blunt (MVA or sports injuries)

Question 34

Epidemiology of penetrating?

Answer 34

Males more than females
high mortality rate
Glasgow second most violent city in UK

Question 35

What is Zone 1 of the neck?

Answer 35

Low, root of the neck

big arteries and veins, significant damage if here

Question 36

Zone 2?

Answer 36

Biggest area, more accessible, not usually life threatening

Question 37

Zone 3?

Answer 37

Quite protected, jaw to cranial base, significant injuries

Question 38

History of neck injuries?

Answer 38

Mechanism
Pain?
Aerodigestive - dyspnoea, hoarseness (recurrent laryngeal)
CNS problems

Question 39

What type of examination would you do?

Answer 39

ABCDE

Question 40

What is the significance of the platysma?

Answer 40

Main muscle of the neck - if penetrate through then serious if no penetration then superficial

Question 41

When would urgent exploration be required?

Answer 41

expanding haematoma, hypovolaemic shock, airway obstruction, blood in aero digestive tract (penetrating injury)

Question 42

Would you remove the insulting instrument?

Answer 42

No as could be plugging the jugular or carotid

Question 43

What sort of mech is required to fracture maxilla?

Answer 43

High energy blunt force

Question 44

What is the commonest facial fractures?

Answer 44

1. nasal

2. orbital

Question 45

What sign will you see on CT of blow-out fracture?

Answer 45

tear-drop sign showing prolapse of orbital contents into the maxillary sinus

Question 46

Le fort 1

Answer 46

Numbness

Question 47

Le fort 2

Answer 47

pyramidal - whole of mid face can fall back, significant airway obstruction

Question 48

Le fort 3

Answer 48

Literally have to hold whole of mid face forward to prevent airway obstruction

Question 49

What does everyone get for a Le Fort fracture?

Answer 49

CT scan

Question 50

What are vertical and horizontal buttresses?

Answer 50

if fracture put back into place along these butresses then outcome is quite good