HNS44 Week 8 To 10 Interactive Forum

Question 1

Case 1: A 30 years old male sustained a vehicle accident with head trauma. Unconscious but with stable sign

Answer 1

1. Deviated nose —> Nasal bone fracture
2. Ethmoid fracture —> ∵ just behind nasal bone —> affect orbit
3. Hazy maxillary sinus on X-ray —> blood inside maxillary sinus due to Maxillary fracture
4. Zygomatic bone fracture on X-ray
5. Right lateral orbit fracture

Diagnosis:
Type II + III Le Fort classification of fracture of Maxilla

Orbit:
Lateral: Zygomatic
Medial: Ethmoid + Lacrimal
Superior: Frontal
Inferior: Maxilla
Deep: Sphenoid

Question 2

Symptom manifestation

Answer 2

Orbital fracture / Periorbital edema / haemorrhage
—> Diplopia
—> ∵ suspensory ligament of right eye will drop
—> 2 eyes not in same plane

Flattened nasal bridge
—> ∵ Nasal bone fracture

Malocclusion of teeth
—> ∵ Maxillary fracture
—> Maxilla move forward

Epistaxis
—> Kiesselbach area (anterior 1/3 of nose)
—> Maxillary artery, Facial artery, Ophthalmic artery

CSF Rhinorrhea
—> Fracture of Cribriform plate of ethmoid bone (part of Anterior cranial fossa)
—> Tear meninges (Dura)
—> CSF leak
—> Intracranial infection (e.g. Meninges)

Loss of sensation in cheek / infraorbital
—> injury to Infraorbital nerve (Maxillary nerve)

Anosmia
—> Cribriform plate fracture
—> damage Olfactory nerve

Reduced nasal secretion
—> fractured pterygoid plate
—> transected pterygopalatine fossa
—> damaged pterygopalatine ganglion
—> damaged parasympathetic input

Difficulty of mastication
—> Maxillary bone fracture extend posteriorly
—> involve pterygoid plate
—> unstable attachment of pterygoid muscle

Speech difficulty
—> unstable upper jaw
—> difficulty to talk

Upper airway obstructions
—> dislocation of upper jaw anteriorly
—> tongue pushed posteriorly