ENT Trauma Flashcards
name 5 keys points to determine in the history
- mechanism of injury
- when
- loss of consciousness?
- epistaxis
- breathing
examination of the nose - what are you looking for?
- bruising
- swelling
- tenderness
- deviation
- epistaxis
- facial tenderness
- infraorbital sensation
- CNS
what happens to the nose after frontal trauma
broadened and flattened
how is the nose examined in order to see deviation properly
from behind
septal haematoma
occurs in around 5% of cases of nasal trauma, is described to be boggy and moves
what is the DD of septal haematoma
septal deviation - this is firm
why is there a need for immediate treatment of septal haematoma
as the nasal blood supply comes from the perichondrium an untreated septal haematoma can lead to destruction of the nasal septum due to AVN
this can result in cartilage necrosis and collapse (saddle nose deformity)
treatment of septal haematoma
immediate drainage and excision
symtoms of deviated septum
obstruction of nostrils (breathing), nosebleeds, facial pain etc
is there a need for review after nasal injury?
yes, 5-7 days post incident in ENT
undisplaced nasal fracture treatment
may need none
displaced nasal fracture treatment
- Reduction under GA with post-op splintage within 2 weeks
post-op care of nasal reduction
- apply ice for 1 hour
- sleep with head elevated
- dont breathe through nose
- dont blow nose
- no vigorous exercise
septoplasty
corrects a deviated septum
septorhinoplasty
aims to striaghten and/or refashion the shape of the nose for cosmesis and to help breathing by improving the airway
complications of nasal trauma
epistaxis
CSF leak, meningitis
anosmia
which artery most commony causes epistaxis post nasal trauma
anterior ethmoidal
what causes a CSF leak post nasal trauma
ethmoid fractures that disrupt the dura and arachnoid mater
management of CSF leak post nasal trauma
conservative, usually lumbar drain and bedrest. often settle spontaneously, need repair if they dont within 10 days
- a dye is inserted into the CSF during lumbar drain, and then the nose it examined to determine the site of drainage so that it can be repaired
what causes anosmia post nasal trauma
cribriform plate fracture
most common site for epistaxis
anterior epistaxis most commonly occurs at Little’s area in the nasal septum
management of epistaxis
- resuscitate on arrival if necessary (eg dizzy, low BP)
- arrest/slow blood flow
- pressure: pinch the base of the nose and bend forward, breath through mouth
- ice: pack on dorsum of nose
- topical vasoconstrictor and numb: spray on co-phenylcaine (vasoconstrictor) ± lidocaine + adrenaline (numb)
- remove clots
- find bleeding points: anterior rhinoscopy
- apply cautery to stop bleeding: silver nitrate/diathermy
- nasendscopy
what should be elicited in history of a patient with epistaxis
anticoagulants? warfarin/heparin
lidocaine action
blocks Sodium channels responsible for signal propagation, can result in failure of postsynaptic neuron to depolarize and transmit AP
how are clots removed in management of epistaxis
ask patient to blow out nose, use suction
epistaxis management: what should be done if bleeding continue
try an anterior nasal pack
why should you not sedate patients presenting with epistaxis
there is a risk of aspiration
what is often referred to as cauliflower ear
pinna haematoma
pinna haematoma
haematoma occurs under sub perichondrium
there is a risk of necrosis and calcification, and the formation of an abscess that can destroy the elastic cartilage of the ear
management of pinna haematoma
aspirate
incise and drain
pressure dressing
when are ear lacerations usually seen
due to blunt trauma, avulsion, dog bites etc
management of ear lacerations
there is often tissue loss, essentially putting the ear back in place and suturing it
debridement may be necessary
a local anaesthetic is usually used eg adrenaline
what is recommended if an ear laceration has resulted in cartilage exposure
ABx for 5 days
what is checked in examination of temporal bone fracture?
hearing - condition of TM and ear canal
CNVII
Battle’s sign
temporal bone fracture - bruising over mastoid process
Raccoon eyes
periorbital bruising indicates a high risk of temporal bone fracture
which type of temporal bone fracture would a lateral blow cause
longitudinal
longitudinal temporal bone fracture
- occurrence
- associated symptoms - deafness?
- complications
80%
there may be bleeding from the external canal due to laceration of skin and ear drum
haemotympanum and ossicular chain disruption can cause conductive deafness
CSF otorrhoea
facial nerve involvement in temporal bone fractures
20% longitudinal
50% transverse
which type of temporal bone fracture does a frontal blow cause
transverse
transverse temporal bone fracture
can cross the IAM damaging CNVII and CNVIII (damage can cause sensorineural hearing loss and vertigo)
management of temporal bone fracture
- often a high velocity injury and there is polytrauma
- manage CSF leak if necessary
- check CN
- restore hearing if necessary - aid or ossiculoplasty
describe where transverse and longitudinal temporal bone fractures are in relation to the petrous pyramid
longitudinal fractures travel parallel to the long axis
tranverse are at right angles
longitudinal fracture
what is the best mode of imaging for checking the cervical spine after neck trauma
CT
which neck zone is the mortality highest in
zone 1
what are the vulnerable structures in a zone 1 neck injury
trachea, oesophagus, thoracic duct, thyroid , large vessels spinal cord
in which neck zone are the CN most vulnerable
CNX, XI and XII in zone 2
what determines whether neck trauma is superficial or penetrating
if it has penetrated the platysma
Le Fort Fractures
a simplification of maxillary fractures, in most instances, maxillary fractures are a combination of Le Fort types
which Le Fort fractures can disrupt the cribriform plate
II and III, result in spread of infection from nasal cavity and paranasal sinuses to anterior cranial fossa
imaging of maxillary fracture
X ray: C spine and Waters view (to image the maxillary sinuses)
CT is imaging of choice
