Face And Neck Flashcards
What is the defining feature of a Le Fort fracture
Fracture through the pterygoid plates leading to pterygomaxillary separation
Where does Le Fort type 1 extend
Lateral margin of nasal opening
Maxillary sinus
Upper alveolar ridge
How does Le Fort type 1 present
Ecchymosis over greater palatine vessels
Teeth mobility
Cracked pot sound on percussing upper teeth
Airway obstruction
Why do you get airway obstruction in Le Fort type 1
Medial pterygoid muscles pull the jaw back and down
Describe the fracture of Le Fort type 2
Lacrimal bones
Inferior orbital floor and rim
Maxillary sinus
How would a Le Fort type 2 present
Step deforming at infra-orbital margin Mobile midface Cheek parasthesia (infraorbital nerve)
Describe the fracture of Le Fort type 3
Nasal bone
Frontal process of maxilla
Medial, floor and lateral wall of orbit
Zygomatic arch
How does a Le Fort type 3 present
Profuse CSF rhinorrhoea (ethmoid air cells very thin)
Lengthened face
Enophthalmus
Temporalis muscle impingement
What are some signs common to all types of Le Fort
Epistaxis Gross oedema Circumorbital ecchymosis Diplopia Subconjunctival haemorrhage
What is the source of bleeding in Le Fort type 2 and 3
Maxillary
What is the prehospital management of facial fractures
Airway intubation Insert epistats Dental bite blocks Collar Inflate epistats
What do the posterior and anterior balloons of the epistats compress
Posterior - sphenopalatine
Anterior - Keisselbachs
Why is a wound to the external jugular vein help open and what are the consequences
Tightly adhered to thick fascia
Means air can enter
Fractures through the sphenoid sinuses can cause what
Torrential epistaxis from the ICA draining through the sinus then nasal cavity
Monocular blindness due to optic nerve ischaemia (ophthalmic artery is first branch of ICA)
What nerve is damaged and hence what is the consequence of a zygomatic arch fracture
Infraorbital nerve
Impaired sensation to cheek, nasal vestibule and upper lip
Where is a blow out fracture most common and what muscles prolapse where
Inferior wall - inferior rectus prolapse into maxillary sinus
Medial wall - medial rectus prolapse into ethmoid air cells
What is the defining feature of a blow out fracture
Fractured wall but with intact orbital rim
How would a blow out fracture present
Diplopia due to extraocular muscle involvement
Emphysema due to communication with sinus
Malar numbness due to infraorbital nerve involvement
Describe the pathophysiology of a retrobulbar haematoma
Bleeding from the ophthalmic artery or vein leads to RIOP, ischaemic of the optic nerve and sight loss
How does a retrobulbar haematoma present
Severe pain
Proptosis
Ophthalmoplegia
How is a retrobulbar haematoma managed
Clinical diagnosis so immediate lateral canthotomy and drainage of the retrobulbar space
What are the borders used to define penetrating neck trauma
3 - base of skull to angle of mandible
2 - angle of mandible to cricoid cartilage
1 - cricoid cartilage to clavicle
What may be injured in zone 3,2, and 1 neck traumas
3 - vertebral artery, internal/external carotid
2 - larynx, common carotid, IJV
1 - lung apex, brachial plexus, common carotid, IJV, EJV, sympathetic chain
What is the stepwise management of penetrating neck trauma
External compression —> Foley catheter balloon tamponade —> immediate surgical exploration
What investigations are required following neck trauma
CTA (possibility of carotid artery dissection)
CT to include the chest (possibility of pneumothorax)
How does Horners syndrome present?
Miosis
Partial ptosis
Anhidrosis
When would you not get anhidrosis in Horners syndrome
Post-ganglionic as sympathetics to face sweat glands have already come off
ICE aneurysm or dissection
Cavernous sinus pathologies
What could indicate a difficult airway
Obesity
Neck stiffness
Malampati (type 4 being the worst)
332 rule
What are the indications or RSI
Compromised airway Ventilatory failure Unconscious Humanitarian reasons Severe agitation
What is the procedure for RSI
Preparation Pre-oxygenation (100% for 3 minutes) Fentanyl - pretreatment Ketamine - induction agent Rocuronium - paralytic Apply cricoid pressure Place the ET tube directly between the cords Confirm its placement with ETCO2
What are the 30 second drills following failed intubation
Adjust position of patient and you
Suction
Backward,upward,rightward pressure
Change laryngoscope
When is a surgical airway done (cricothyroidotomy)
Failed intubation, failed ventilation
What is the procedure for a surgical airway
Vertical incision through the skin then horizontal through the cricothyroid membrane. Insert a gloved finger to keep the hole open, place a bougie and insert ET tube over it (Seldinger technique). Remove the bougie. Confirm position with ETCO2 monitor
When would you use an OP
Unconscious patient with no gag reflex at risk of airway obstruction
