Trauma Flashcards
What are key factors in nasal trauma?
Bruising Swelling Tenderness Deviation Epistaxis Facial tenderness Infraorbital sensation CNs PRESENCE OF SEPTAL HAEMATOMA!
what is anosmia?
inability to smell due to an inflammation of the nasal mucosa, blockage of nasal passages or a destruction of one temporal lobe (cribriform plate fracture)
what are the arteries of the nose?
external and internal carotid arterial branches: Sphenopalatine AA Anterior & Posterior Ethmoid Greater Palatine A Lateral nasal branches Superior labial
what is the arterial supply to the eye?
supratrochlear supraorbital lacrimal central artery to the retina opthalmic
management of acute epistaxis?
Resuscitate on arrival if necessary
Arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)
Remove clot: suction, nose blowing
Anterior Rhinoscopy
Cautery / pack
300 rigid nasendoscopy
Cauterise vessel: silver nitrate / diathermy
when bleeding controlled consider arterial ligation (particularly for AEA bleed) but DO NOT SEDATE
what is a pinna haematoma and how is it treated?
Sub-perichondrial haematoma
Aspirate
Incision and drainage
Pressure dressing
No good evidence which technique is best
how do you manage ear trauma?
Debridement Closure -Primary -Reconstruction Usually LA Antibiotics - cartilage
what is the typical history of a temporal bone fracture?
Injury mechanism Hearing loss Facial palsy Vertigo CSF leak
Associated injuries
what are typical examination findings of temporal fracture?
Bruising – Battle sign
Condition of TM and ear canal
VII
Hearing test
how are temporal fractures classified?
Longitudinal vs transverse
Otic capsule involved
Otic capsule spared
longitudinal fracture?
80%
Lateral blows
Fracture line parallels the long axis of the petrous pyramid
Bleeding from external canal due to laceration of skin and ear drum
Haemotympanum (conductive deafness)
Ossicular chain disruption (conductive deafness)
Facial palsy (20%)
CSF otorrhoea
transverse fracture?
20%
Frontal blows
Fracture at right angles to the long axis of the petrous pyramid
Can cross the internal acoustic meatus causing damage to auditory and facial nerves
Sensorineural hearing loss due to damage to 8th cranial nerve
Facial nerve palsy (50%)
Vertigo
structures in zone 1 of the neck?
Trachea Oesophagus Thoracic duct Thyroid Vessels – brachiocephalic, subclavian, common carotid, thyrocervical trunk Spinal cord
structures in zone 2 of neck?
Larynx Hypoharynx CN 10,11,12 Vessels – carotids, internal jugular Spinal Cord
zone 3 of neck?
Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord
investigation of neck trauma?
FBC, G&S / XM
AP/Lateral neck - ?FB
CXR – haemo-pneumothorax, emphysema
CT Angiogram – vascular, pseudoaneurysm, laryngeal, aerodigestive tract
MRA
management of neck trauma?
Urgent exploration – expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy
Angiography – embolize, occlude
types of facial trauma? (high energy)
maxillary fracture
orbital floor fracture (infraorbital groove is weak point)
what is the classic sign on investigation of an orbital blowout fracture?
teardrop sign on CT sinuses (medial wall and floor)
management of orbital blowout?
Conservative
Surgical repair of bony walls if:
Entrapment
Large defect
Significant enophthlamos
what are the 3 types of Le Fort fracture?
1 Horizontal. Passes horizontally above teeth apices.
2 Pyramidal. Nasal bridge, through frontal processes of maxilla, through lacrimal bone and inferior orbital floor, then through under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.
3 Transverse. Craniofacial dysjunctions.
what do you palpate for in LF fractures?
Palpate - detect for bony irregularities, step-offs, crepitus, and sensory disturbances. CT is gold standard investigation.
Surgery - vertical buttress, horizontal buttress (reduction and fixation)
