Otorhinolaryngology Emergency Flashcards
Fracture of the facial bones are composed of
Upper: Frontal, Orbital
Middle: Maxillary, Nasal bone, Zygomatic
Lower: Mandible
Facial paired bones
• Maxilla
• Lacrimal bone
• Nasal bone
• Inferior nasal conchae
• Palatine bone
Thick areas that provide support and strength in the facial bones
Buttresses of facial bones
Use of oropharyngeal airway, supraglottic airway devices, tracheal intubation/surgical airway
cricothyrotomyotracheostomy
Visible sign of shock
- Pallor
- Prolonged capillary refill time
- Clammy and cool skin
- Tachycardia
- Diminished/absent pulse pressure
GCS (Eye Opening Response)
Spontaneously 4
To speech 3
To pain 2
No response 1
GCS (Best verbal response)
Oriented to time, place and person 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
No response 1
GCS (Best motor response)
Obeys commands 6
Move to localized pain 5
Flexion withdrawal from pain 4
Abnormal flexion (decorticate) 3
Abnormal extension (decerebrate) 2
No response 1
Serious complication; collection of blood under the mucoperichondrium or mucoperiostium of nasal septal cartilage or bone; may be unilateral or bilateral (more common in severe trauma)
Nasal septal hematoma
Nasal septal abscess to the cavernous sinus thrombosis causes
Meningitis
Etiologies of Maxillofacial fractures
• 60% of patients with severe facial trauma have multisystem trauma and the potential for airway compromise
• 20-50% concurrent brain injury
• 1-4% cervical spine injuries
• Blindness occurs in 0.5-3%
• 25% of women with facial trauma are victims of domestic violence ( increase to 30% if with orbital wall fracture
• 25% of patients with severe facial trauma will develop PTSD
Emergency management airway control
o Chin lift
o Jaw thrust
o Oropharyngeal suctioning
o Manually move the tongue forward
o Maintain cervical immobilization
Intraoral examination
o Manipulation of each tooth
o Check for lacerations
o Stress the mandible
o Tongue blade test
Frontal sinus/Bone fracture associated with
- Intracranial injuries
- Injuries to the orbital roof
- Dural tears
Frontal sinus/Bone fractures clinical findings
o Disruption or crepitance of the orbital rim
o Subcutaneous emphysema
o Associated with a laceration
Frontal sinus/Bone fractures radiographic views
Facial views
- Waters
- Caldwell
- Lateral projections
Frontal sinus/Bone fractures complications
Associated with intracranial injuries:
1. Orbital roof fractures
2. Dural tears
3. Mucopyocele
4. Epidural empyema
5. CSF leaks
6. Meningitis
Naso-ethmoidal orbital fractures clinical findings
Patient complain of pain on eye movement
Clinical findings
- Flattened nasal bridge or saddle-shaped deformity of the nose
- Widening of the nasal bridge (telecanthus)
- CSF rhinorrhea or epistaxis
- Tenderness, crepitus, and mobility of the nasal complex
3 types of nasal fractures
- Depressed
- Lateral displaced
- Nondisplaced
Type I Nasal fracture
Laterally displaced fracture
Type II Nasal fracture
Disarticulation of upper lateral cartilage
Type III Nasal fracture
Posteriorly depressed fractures
Type IV Nasal fracture
Anterior nasal spine fracture
Type V Nasal fracture
Involvement of nasal septum
Type V Nasal fracture
Involvement of nasal septum
Orbital blowout fractures clinical findings
- Periorbital tenderness, swelling, ecchymosis
- Enopthalmos or sunken eyes
- Impaired ocular motility
- Infraorbital anesthesia 5. Step off deformity
Radiograph findings on Orbital blowout fractures
- Hanging teardrop sign
- Open bomb day door
- Air fluid levels
- Orbital emphysema
Most common types of fracure on zygoma
Blunt trauma
Arch fracture- most common
Tripod fracute- most serious
Most common types of fracture in zygoma
Blaunt trauma
Arch fracture- most common
Tripod fracture- most severe
Most common types of fracture in zygoma
Blaunt trauma
Arch fracture- most common
Tripod fracture- most severe
Zygomatic arch fractures clinical findings
- Palpable bony defect over the arch
- Depressed cheek with tenderness
- Pain in cheek and jaw movement
- Limited mandibular movement
Tripod fracture consist of fractures through
-Zygomatic arch
-Zygomaticofrontal suture
-Inferior orbital rim and floor
Clinical features of Zygoma tripod fractures
o Periorbital edema and ecchymosis\
o Hypesthesia of the infraorbital nerve
o Palpation may reveal step off
o Concomitant globe injuries are common
Horizontal fracture of the maxilla at the level of the nasal fossa
LeFort I/Guerin Fracture
Pyramidal fracture of the maxilla, nasal bones and medial aspect of the orbits
LeFort II/Pyramidal fracture
Fractures through maxilla, zygoma, nasal bones, ethmoid bones and base of the skull
LeFort III/Craniofacial disjunction
LeFort I/Guerin Fracture clinical findings
- Facial edema
- Malocclusion of the teeth
- Motion of the maxilla while the nasal bridge remains stable
- (+) Drawer sign
LeFort I/Guerin Fracture clinical findings
- Facial edema
- Malocclusion of the teeth
- Motion of the maxilla while the nasal bridge remains stable
- (+) Drawer sign
Lefort III/Craniofacial disjunction clinical findings
- Dish faced deformity
- Epistaxis and CSF Rhinorrhea
- Motion of the maxilla, nasal bones, and zygoma
- Severe airway obstruction
Most common fracture site of the mandible
Condylar process followed by the body
Clinical findings of Mandibular fractures
- Mandibular pain
- Malocclusion of the teeth
- Separation of teeth with intraoral bleeding
- Inability to fully open mouth
- Preauricular pain with bitting
- (+) Tongue blade test
- Check if there is hematoma on the floor of the mouth (may lead to airway obstruction)
For immboilization of mandible
Barton’s bandage
