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RB Y2 ENT > ENT Trauma > Flashcards

ENT Trauma Flashcards

1
Q

name 5 keys points to determine in the history

A
  1. mechanism of injury
  2. when
  3. loss of consciousness?
  4. epistaxis
  5. breathing
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2
Q

examination of the nose - what are you looking for?

A
  • bruising
  • swelling
  • tenderness
  • deviation
  • epistaxis
  • facial tenderness
  • infraorbital sensation
  • CNS
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3
Q

what happens to the nose after frontal trauma

A

broadened and flattened

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4
Q

how is the nose examined in order to see deviation properly

A

from behind

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5
Q

septal haematoma

A

occurs in around 5% of cases of nasal trauma, is described to be boggy and moves

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6
Q

what is the DD of septal haematoma

A

septal deviation - this is firm

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7
Q

why is there a need for immediate treatment of septal haematoma

A

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)

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8
Q

treatment of septal haematoma

A

immediate drainage and excision

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9
Q

symtoms of deviated septum

A

obstruction of nostrils (breathing), nosebleeds, facial pain etc

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10
Q

is there a need for review after nasal injury?

A

yes, 5-7 days post incident in ENT

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11
Q

undisplaced nasal fracture treatment

A

may need none

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12
Q

displaced nasal fracture treatment

A
  • Reduction under GA with post-op splintage within 2 weeks
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13
Q

post-op care of nasal reduction

A
  • apply ice for 1 hour
  • sleep with head elevated
  • dont breathe through nose
  • dont blow nose
  • no vigorous exercise
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14
Q

septoplasty

A

corrects a deviated septum

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15
Q

septorhinoplasty

A

aims to striaghten and/or refashion the shape of the nose for cosmesis and to help breathing by improving the airway

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16
Q

complications of nasal trauma

A

epistaxis

CSF leak, meningitis

anosmia

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17
Q

which artery most commony causes epistaxis post nasal trauma

A

anterior ethmoidal

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18
Q

what causes a CSF leak post nasal trauma

A

ethmoid fractures that disrupt the dura and arachnoid mater

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19
Q

management of CSF leak post nasal trauma

A

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
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20
Q

what causes anosmia post nasal trauma

A

cribriform plate fracture

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21
Q

most common site for epistaxis

A

anterior epistaxis most commonly occurs at Little’s area in the nasal septum

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22
Q

management of epistaxis

A
  • 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
23
Q

what should be elicited in history of a patient with epistaxis

A

anticoagulants? warfarin/heparin

24
Q

lidocaine action

A

blocks Sodium channels responsible for signal propagation, can result in failure of postsynaptic neuron to depolarize and transmit AP

25
Q

how are clots removed in management of epistaxis

A

ask patient to blow out nose, use suction

26
Q

epistaxis management: what should be done if bleeding continue

A

try an anterior nasal pack

27
Q

why should you not sedate patients presenting with epistaxis

A

there is a risk of aspiration

28
Q

what is often referred to as cauliflower ear

A

pinna haematoma

29
Q

pinna haematoma

A

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

30
Q

management of pinna haematoma

A

aspirate

incise and drain

pressure dressing

31
Q

when are ear lacerations usually seen

A

due to blunt trauma, avulsion, dog bites etc

32
Q

management of ear lacerations

A

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

33
Q

what is recommended if an ear laceration has resulted in cartilage exposure

A

ABx for 5 days

34
Q

what is checked in examination of temporal bone fracture?

A

hearing - condition of TM and ear canal

CNVII

35
Q

Battle’s sign

A

temporal bone fracture - bruising over mastoid process

36
Q

Raccoon eyes

A

periorbital bruising indicates a high risk of temporal bone fracture

37
Q

which type of temporal bone fracture would a lateral blow cause

A

longitudinal

38
Q

longitudinal temporal bone fracture

  • occurrence
  • associated symptoms - deafness?
  • complications
A

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

39
Q

facial nerve involvement in temporal bone fractures

A

20% longitudinal

50% transverse

40
Q

which type of temporal bone fracture does a frontal blow cause

A

transverse

41
Q

transverse temporal bone fracture

A

can cross the IAM damaging CNVII and CNVIII (damage can cause sensorineural hearing loss and vertigo)

42
Q

management of temporal bone fracture

A
  • often a high velocity injury and there is polytrauma
  • manage CSF leak if necessary
  • check CN
  • restore hearing if necessary - aid or ossiculoplasty
43
Q

describe where transverse and longitudinal temporal bone fractures are in relation to the petrous pyramid

A

longitudinal fractures travel parallel to the long axis

tranverse are at right angles

44
Q
A
45
Q
A

longitudinal fracture

46
Q

what is the best mode of imaging for checking the cervical spine after neck trauma

A

CT

47
Q

which neck zone is the mortality highest in

A

zone 1

48
Q

what are the vulnerable structures in a zone 1 neck injury

A

trachea, oesophagus, thoracic duct, thyroid , large vessels spinal cord

49
Q

in which neck zone are the CN most vulnerable

A

CNX, XI and XII in zone 2

50
Q

what determines whether neck trauma is superficial or penetrating

A

if it has penetrated the platysma

51
Q

Le Fort Fractures

A

a simplification of maxillary fractures, in most instances, maxillary fractures are a combination of Le Fort types

52
Q

which Le Fort fractures can disrupt the cribriform plate

A

II and III, result in spread of infection from nasal cavity and paranasal sinuses to anterior cranial fossa

53
Q

imaging of maxillary fracture

A

X ray: C spine and Waters view (to image the maxillary sinuses)

CT is imaging of choice

RB Y2 ENT (22 decks)

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