Epistaxis + facial pain

Question 1

Describe the external nose

Answer 1

upper 2/3 is bony
lower 2/3 is cartilaginous

Question 2

Describe the nasal septum

Answer 2

nasal cavity divided by a midline osteocartilaginous septum
marked deviation can cause blockage or external cosmetic deformity

Question 3

Name the 4 paired sinuses

Answer 3

frontal
maxillary
ethmoid
sphenoid

Question 4

What are the sinuses?

Answer 4

extensions of nasal cavity as air-filled spaces into skull bones

Question 5

Describe the vascular supply of the nose

Answer 5

both the internal and external carotid arteries supply the nose
the carotid system anastamoses at ‘Little’s area’ or ‘Kiesselbach’s plexus’

Question 6

Describe the nerve supply of the nose

Answer 6

sensory supply is via maxillary division of the trigeminal nerve
nasal vascular supply is constricted by sympathetic nerve stimulation and dilated by parasympathetic

Question 7

Functions of the nose

Answer 7

filtration + protection
olfaction
humidification + warming
vocal resonance

Question 8

Local causes of epistaxis

Answer 8

idiopathic
infection
trauma
neoplasia
foreign body

Question 9

General causes of epistaxis

Answer 9

hypertension
drugs (anticoagulants)
blood diseases (leukaemia)
hereditary haemorrhagic telangiectasia

Question 10

Treatment of epistaxis if nose not actively bleeding

Answer 10

naseptin, bactroban or vaseline
cauterise if bleeding point can be identified - silver nitrate cautery after local anaesthetic

Question 11

Treatment of epistaxis if nose actively bleeding

Answer 11

initial first aid measures - pressure at top of nose, lean forward, ice pack + suck an ice cube
assessment of blood loss
evaluation of the cause
procedures to stop continued bleeding

Question 12

How do you assess blood loss from epistaxis?

Answer 12

record pulse + BP
(vital to appreciate adequate BP may be maintained by rising pulse rate - decompensation may be sudden)
other signs of shock - pallor + sweating
IV fluids
FBC, clotting screen, Group + save

Question 13

How can bleeding be controlled in epistaxis?

Answer 13

nasal cautery - silver nitrate, electrocautery
nasal packing - merocel pack, BIPP ribbon gauze
surgery - ligation of vessels

Question 14

What causes septal haematoma and how is it treated?

Answer 14

may occur with nasal trauma
need to drain haematoma otherwise septal perforation or nasal deformity will occur

Question 15

How are nasal fractures treated?

Answer 15

soft tissue swelling may hide bony deformity
reduction of deformity at about 10 days
may still be residual deformity or nasal obstruction

Question 16

Common nose concerns (cosmetically)

Answer 16

deviations of nose to one side
nasal hump
nasal depression
too wide/too narrow nose
tip deformities

Question 17

How are mandibular fractures treated?

Answer 17

reduce and immobilise the fracture for several weeks by wiring teeth together

Question 18

What does a malar fracture feel like and how is it treated?

Answer 18

palpation of orbital rim will reveal a step
may damage infraorbital nerve
if fragment depressed, elevation + wiring required

Question 19

How are maxillary fractures classified?

Answer 19

Le Fort 1,2,3

Question 20

What causes maxillary fractures and how are they treated?

Answer 20

due to severe force, eg. RTA
movement of hard palate while forehead is held stationary
requires reduction + splinting

Question 21

What causes auricular haematoma?

Answer 21

occurs following blunt (shearing) trauma typically in sports such as rugby and boxing
can occur with ear studs through cartilage of pinna
haematoma develops between cartilage and perichondrium

Question 22

How is auricular haematoma treated?

Answer 22

need to remove haematoma
simple aspiration or incision and drainage
pressure dressing or suturing
not treated properly = degeneration of cartilage + scarring = cauliflower ear

Question 23

General causes of facial pain?

Answer 23

rhinological
dental
vascular
neuralgia
non-organic

Question 24

What dental causes can cause facial pain?

Answer 24

temporomandibular joint dysfunction
myofascial pain
dental disease

Question 25

Vascular causes of facial pain

Answer 25

migraine
cluster headaches
temporal arteritis

Question 26

What types of neuralgia can cause facial pain?

Answer 26

trigeminal
glossopharyngeal
post-herpetic