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13 ENT > Maxillofacial Trauma 1 > Flashcards

Maxillofacial Trauma 1 Flashcards

1
Q

inflammatory reparative remodeling occurs within ___ hours of the injury, and begins within___

A

48 hours, begins immediately, lasts 2-4 weeks

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2
Q

what is procallus formation

A
  • neovascularization from periosteum -> hematoma

- granular tissue within hematoma

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3
Q

what is soft callus formation

A
  • bone morphogenic proteins attract bone forming cells
  • collagen + procallus = soft callus
  • soft callus forms the outer shell around the fracture (cartilaginous phase)
  • timing: 2-8 weeks after injury, can take up to 3-4 weeks
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4
Q

what is hard / bony callus formation

A
  • when new bone is deposited
  • timing: 4-8 wks after injury, can take 3-4 mos
  • hard callus = new mineralized woven bone visible on x-ray
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5
Q

what is medullary bridging callus

A
  • happens to all bones
  • osteoclasts migrate to the area to eat away excess bone based on function
  • continuous remodeling
  • timing: years
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6
Q

3 types of osseous callus

A
  • periosteal bridging callus: external callus
  • medullary bridging callus: wholly within the bone medulla
  • intercortical uniting callus: bridges cortices of the bone fragments
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7
Q

timeline of bone healing

A
  • 12 hrs: bleeding stops, clots in site
  • day 1: local acute inflammation
  • day 2: early granulation tissue formation
  • day 5: earliest osteogenesis
  • 3 wks: fibrous union and patchy callus
  • 6 wks: continuity of external callus
  • 4 mos: remodeling completed
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8
Q

t/f calluses form to “splint” the bone

A

true

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9
Q

t/f granulation tissue is able to withstand 100% strain, cartilage 15%, and bone 2%

A

true

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10
Q

t/f in the most stable of repairs, we can skip all immediate tissue types and progress to direct bone formation

A

true, no callus formation

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11
Q

requirements for primary bone healing

A
  • bones are apposed against each other and held immobile
  • can be done through surgical fixation
  • bridging callouses are formed by bridging osteons (cutter cones)
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12
Q

what happens in secondary bone healing

A
  • there is a gap between fractured segments
  • the body forms a callus across the gap
  • bone without blood supply dies back
  • torn vessels form a hematoma
  • fibroblasts transform hematoma into granulation tissue (fibrin meshwork)
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13
Q

means of stabilization in primary vs secondary bone healing

A

primary: plates or wires
secondary: external splinting

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14
Q

means of healing in primary vs secondary bone healing

A

primary: contact or gap healing
secondary: callus formation

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15
Q

means of bony fusion in primary vs secondary bone healing

A

primary: cutting cones and osteons
secondary: bone formation by osteocytes

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16
Q

hormones that have a negative effect on bone healing

A

cortisone (steroids): decrease callus formation

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17
Q

hormones that have positive effect on bone healing

A

calcitonin
thyroid and pth: enhances bone remodeling
gh: increases callus volume
androgens: increase callus volume

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18
Q

factors that adversely affect bone healing

A
  • excessive damage to surrounding tissue
  • excessive motion at site
  • tissue interposition
  • distraction of bone ends (too far)
  • acute/chronic osteomyelitis
  • preexisting local blood supply anomalies (diabetes)
  • vitamin deficiencies
  • exogenous steroids
  • advanced age
  • osteoporosis
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19
Q

a condition wherein the fractured ends have healed in a faulty bony union

A

malunion

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20
Q

bones which are slow to heal after an average period wherein a similar fracture would have been expected to heal

A

delayed union

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21
Q
  • a terminal condition of failed osteogenesis where the bone is still mobile but normally wouldn’t be
  • radiological evidence of a progressive decrease in radiolucency at the site
  • presence of histologically identifiable osteogenic tissue
A

non-union

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22
Q

principles of debridement

A
  • use a stiff scrub brush and surgical soap to clean
  • irrigate with saline to remove debris (d5w has hemostatic effects)
  • curette or scalpel blade to remove gravel or bitumen
  • water jet lavage in blast type injuries
  • palpate wound for foreign bodies
  • polymixin b sulfate to remove residual grease
  • final flushing with h2o2
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23
Q

methods for hemostasis

A
  • warm pressure packs: induces hypotension for hypovolemic or normovolemic
  • direct care of the vessel
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24
Q

methods of direct care for the vessel

A
  • direct ligation (suture material)
  • electrocoagulation (cautery)
  • clips
  • ligation below the bleeder
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25
Q

t/f arterial hemorrhages are more problematic than venous

A

false, venous is more problematic

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26
Q

what is undermining

A
  • lifting the skin from the underlying tissue to stretch it enough to approximate the wound you are covering
  • necessary for large defects without excessive tension on soft tissues
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27
Q

suturing techniques for primary closure

A
  • simple interrupted
  • mattress sutures (horizontal or vertical)
  • continuous running suture
  • running interlocking suture
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28
Q

sutures that affect water tight closure

A

running interlocking and running horizontal (most watertight)

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29
Q

best suture for the oral cavity

A

silk: does not stretch and does not loosen

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30
Q

in primary closure, layers are closed from ___ to __

A

from deep to superficial

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31
Q

sutures for subcutaneous area and skin

A

sc: inverted sutures or inverted t sutures
skin: nylon 5-0, subcuticular continuous suture

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32
Q

types of material for sutures

A
  • polygenic acid or silk (remains in place)
  • plain catgut (loosens, better for oral)
  • chromic catgut (causes irritation and wound breakdown)
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33
Q

types of sutures/material for skin

A
  • 5-0 nylon or polyethelene sutures for skin closure
  • 6-0 interrupted sutures to evert the wound
  • continuous lock sutures to decrease operating time
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34
Q

uses of delayed primary closure

A
  • contaminated wound
  • first managed >48h after injury
  • large volume of patients
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35
Q

steps of delayed primary closure

A
  • debridement
  • dress it open with moist fine mesh and antiseptic gauze
  • give antibiotics, clean regularly
  • close in 3-5 days
36
Q

uses of secondary closure

A
  • warfare or terrorist attack (large number of patients)

- specific treatment is given >5 d from injury (infection)

37
Q

steps of secondary closure

A
  • remove infected tissue, debride everyday
  • drain
  • moist dressing
  • antibiotics
  • close after >5 d
38
Q

when is drain not required

A
  • superficial lacerations

- wounds above the mandible

39
Q

indications for drain

A
  • missile injuries (bullets and blasts)

- wounds below the mandible: floor of mouth, base of tongue, retromandibular area, infratemporal fossa, neck

40
Q

types of drains

A

negative pressure: sucks out fluid

ordinary: no suction

41
Q

steps in draining a wound

A
  • insert drain between sutures
  • suture to the skin edge
  • remove drain in 2-5 days when there is no purulent exudate
  • tie sutures
42
Q

general instructions for injuries

A

simple lacerations: adhesive strips

complex lacerations: compressive dressings (prevents postop edema, reduces tension, immobilizes wound)

43
Q

dressing regimen

A

read

44
Q

post-op care

A

read

45
Q

cdc classification of surgical wounds

A

read

class 1: clean
class 2: clean contaminated
class 3: contaminated
class 4: infected or dirty
46
Q

management for contusions

A
  • antibiotics not necessary

- cold compress for first 24 hrs, 10-15 mins every hr

47
Q

complications in hematoma

A

ear and nasal septum: cauliflower ear or saddle nose deformity
periorbital hematoma: ecchymosis (less swelling and blood is being absorbed)

48
Q

management for hematoma

A
  • yes antibiotics
  • ear and nasal septum: incise and drain, provide compressive continusous dressing for 3 days
  • needle aspiration not recommended
49
Q

general management for abrasions

A
  • clean with saline or mild soap
  • leave exposed
  • lightly dress with bacitracin
50
Q

specific management for abrasions

A

ordinary abrasions: spontaneous healing (weeks)

abrasions with tattooing potential (due to gravel or asphals): vigorous scrubbing, mechanical abraders with carbide tip

51
Q

most common type of injury in vehicular accidents

A

simple lacerations

52
Q

general management for simple lacerations

A
  • clean, irrigate, excise devitalized tissue, hemostasis, suture, dress
  • face: conservation of skin is important
  • always use fine sutures
53
Q

techniques in treatment for simple lacerations

A
  • vicryl or dexon to close deep lacerations
  • nylon 5-0 or 6-0
  • steristrips to immobilize the wound
  • remove sutures in 3-5 d
54
Q

t/f alignment during lip suturing is not necessary

A

false, must align because its obvious when its not

55
Q

what are puncture wounds

A

wounds that go through the body

56
Q

management of simple small avulsions

A

excise as an ellipse -> undermine -> close

57
Q

management of multiple small flaps

A

tacky technique with nylon -> pressure dressing -> dermabrade later

58
Q

management of large flaps

A
  • excise edges to produce a perpendicular edge -> undermine -> close -> z plasty later
  • important to cut off the edge so that there is better healing
59
Q

management for large defects with guarded prognosis, not amenable to full thickness grafting

A

apply thin split thickness skin graft -> local or regional flaps when the infection is reduced

60
Q

management of avulsion in nose, lip and ear

A
  • use the avulsed tissue

- clean with saline soln and suture as composite graft

61
Q

management of big “clean” defects

A

full thickness skin graft from nearby source

62
Q

most bites are caused by ___

A

dogs

63
Q

t/f human bites are more dangerous

A

true, they deliver streptococci, staphylococci, fusiform bacilli, and spirochetes

64
Q

bites on the extremities can have ___, and on the face ___

A

extremities can have secondary healing, on the face secondary healing is discouraged

65
Q

management of bites on the face

A
  • clean vigorously with a high powered jet irrigator
  • primary closure (close wound over a drain if <8 h old)
  • administer broad spectrum antibiotics
  • open the wound if infection happens
66
Q

t/f reattachments of soft tissue that has been avulsed by an animal or human bite can be successful

A

false, doomed to failure

67
Q

clinical manifestations of rabies

A

aggressive behavior, muscle spasm and convulsion, anxiety and restlessness, hypersalivation

68
Q

management for rabies

A
  • rabies post-exposure prophylaxis
  • immediately wash and flush with soap and water for 15 min
  • administer antibiotics
  • administer tetanus prophylaxis
  • 20 iu/kg human or equine rabies (hrig/erig) in category 3 exposure
69
Q

t/f patients with rabies actually have hydrophobia

A

false, they have a fear of swallowing water and aspiration (due to encephalitis)

70
Q

categories of rabies exposure

A

category 1: touching or feeding, lick NO PROPHYLAXIIS
category 2: minor scratches or abrasions without bleeding or nibbling VACCINE ONLY
category 3: transdermal bites, scratches, licks on broken skin IG AND VACCINE

71
Q

a low velocity missile retained within the tissue ( + entrance wound, - exit wound)

A

penetrating

72
Q

missile that passes through the tissue (+ entrance wound, + exit wound)

A

perforating

- high velocity = large avulsed exit wounds

73
Q

injuries related to high velocity missiles in which portions of tissues are completely removed from the patients

A

avulsive

74
Q

dirt or other foreign body particles penetrate the tissues -> shredding of tissues

A

blast injuries

  • difficult to clean
  • tattooing is inevitable
  • infection frequent
75
Q

resulting injury from a .45 caliber full metal jacket

A

penetrates and passes through body

76
Q

resulting injury from a .45 caliber hollow point

A

bigger cavitation compared to the full metal

77
Q

resulting injury from 5.56x45 mm

A

entry and exit wound, lots of kinetic energy that damages soft tissue (causes more damage than .45)

78
Q

t/f the bigger the bullet, the bigger the injury

A

true

79
Q

other aspects of bullet wounds

A

wobble and tumble due to poor rifling of the barrel

size, weight, shape

80
Q

complications from gunshot injuries

A

tissue loss due to consecutive debridements

81
Q

classification of facial nerve injuries

A

behind lateral canthus: can be repaired

medial to vertical line: no hope looking for it

82
Q

management of facial nerve injuries

A
  • aim for exact end to end fascicular anastomosis
  • 10-0 for large nerve sections
  • use cable grafting for nerves that cannot be primarily repaired
  • return of function is in 4-5 mos
83
Q

lacerations along ___ should be evaluated for parotid duct injuries

A

parotid duct line

84
Q

management of parotid duct injuries

A
  • examine
  • cannulate with polyethylene tube
  • advance tube under direct vision
  • cannulate proximal end
  • suture duct walls together (6-0)
  • suture the end of tubing to buccal mucosa intraorally and tape to cheek externally
  • remove in 7-10 d
85
Q

management of salivary gland injuries

A
  • submandiibular glands need to be removed
  • after repair of parotid gland, weeping of saliva may happen
  • heals within 2 wks
  • maintian pressure dressing

13 ENT (18 decks)

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