Head And Neck Trauma

Question 0

what are the labeled fractures

Answer 0

Mandibular fractures

A = displaced

B = nondisplaced

Question 1

What is the most common head and neck trauma injury

Answer 1

Nasal fractures

Question 2

what is this?

Answer 2

Dental occlusion

Mandibulomaxillary fixation

(MMF)

Question 3

what joint cab be effected by mandibular fracture?

Answer 3

TMJ

may limit movement

Question 4

What’s a concern with bilateral mandibular frx?

Answer 4

tongue floation = AW obstruction

Question 5

what are some airway management considerations for this?

Answer 5

Partial loss of mandible –

– Replacement free graft
– Vascular anastomoses
– Heat preservation
– Rheology ( goal = Hct 30%, too low decreases blood flow, too high less O2 carrying capacity)
– Postop overnight support
to prevent movement
– Tracheostomy

Question 6

what is a Horizontal, maxillary mid face
separation

Answer 6

LeFort I frx

Question 7

what is a Triangular [pyramidal],
nasomaxillary-zygomataic
separation

Answer 7

LeFort II frx

can have Ethmoid fracture —> CSF leak

Question 8

what is Craniofacial disjunction

Answer 8

LeFort III frx

NOTE: Ethmoid fracture —> CSF leak

Question 9

Which LeFort frx(s) get an anode ETT or Trach for airway management?

Answer 9

II and III

(but anode is not for long term management)

Question 10

what is a major airway conern with this?

Answer 10

Blow Out frx

may not be a BMV candidate

Question 11

Things to think about with Larnygeal injuries

Answer 11

1. Type of Injury
   
   1. – Blunt
   2. – Penetrating
2. Type of Wound
   
   1. – Open
   2. – Closed
3. Associated Injuries
   
   1. – Life-threatening
   2. – Affect airway management
4. Level
   
   1. – Supraglottic
   2. – Infraglottic
5. Airway Patency
   
   1. – Patent
   2. – Partially obstructed
   3. – Obstructed

Question 12

Points of exam for laryngeal injury

Answer 12

1. INSPECTION
   
   1. – Gross appearance: open wound, closed
   2. wound, contusion, deformity, ….
   3. – Pupils
   4. – Hemoptysis
2. PALPATION
   
   1. – Trachea midline
   2. – Crepitus
   3. – Induration
   4. – Laryngeal mobility
3. AUSCULTATION
   
   1. – Hoarseness
   2. – Air flow I
4. Diagnostic Adjuncts
   
   1. CXR
      
      1. Trachea midline
      2. Barotrauma
      3. Fractures
   2. FFOB
      
      1. [Hemorrhage]
      2. Mirror
   3. Neck X-rays | Axial CT | MRI
      
      1. Internal airway mass (obstruction)
      2. External airway mass (compression)
      3. Airway interruption
      4. Larynx & trachea positions

Question 13

what is true of a “Shear-force injury”?

Answer 13

Interrupted airway

1. – Hx: sudden deceleration
   
   1. » MVA
   2. » Fall
   3. » Blunt impact
2. – Associated injury may be life-threatening
   
   1. » Aorta
   2. » Vena cava
   3. » Pulmonary artery
3. – High index of suspicion
   
   1. » Hx
   2. » EKG
   3. » CXR (1st rib, scapula)
4. – Assess: CTA, aortogram