Trauma

Question 1

T bone fracture, signs and symptoms

Answer 1

FN injury

hearing loss
vertigo
CSF otorrhea
TM perforation
hemotympanum
canal laceration

Question 2

T bone fracture patterns

Answer 2

1. Longitudinal vs transverse
2. Otic capsule sparing vs involving

MC = oblique / mixed

Question 3

What is more common, transverse or longitudinal t bone fracture?

Answer 3

Long = 70-90%

Tran = 10-30%

Question 4

More likely to involve FN, transverse or longitudinal t bone fracture?

Answer 4

Transverse

But overall, MC in long since long is more common

Question 5

Longitudinal t bone fracture pattern anatomy

Answer 5

pars squamosa -->
posterosuperior bony EAC -->
roof of middle ear anterior -->
labyrinth -->
close proximity to foramen lacerum or foramen ovale

Question 6

Longitudinal t bone fracture signs

Answer 6

FN injury (20%)

EAC lac
Hemotympanum
Ossicular chain discontinuity

Question 7

MCC of CHL in t bone fracture

Answer 7

incudostapedial joint dislocation

Question 8

Trasverse t bone fracture pattern anatomy

Answer 8

foramen lacerum across petrous pyramid –>

foramen magnum

Question 9

Transverse t bone fracture signs

Answer 9

FN injury (frequent)

severe SNHL +/- vertigo if capsule destroyed

Question 10

MCC of post-traumatic vertigo

Answer 10

concussive injury to the membranous labyrinth

Question 11

Rate of CSF leak from t bone fracture

Answer 11

20%

Usually temporary

Question 12

Indication for surgical repair of orbital floor blowout fractures (4)

Answer 12

1 - Rapid onset of intraorbital bleeding and decreased visual acuity

2 - Diplopia lasting more than 7 days

3 - Entrapment

4 - Enophthalmos greater than 2 mm or involvement of one-third to one-half of the orbital floor

Question 13

MC error in orbital floor reconstruction

Answer 13

failure to repair the posterior orbital floor

Question 14

Ideal time for surgical repair of orbital floor fracture

Answer 14

is 10 to 14 days

*only urgent is entrapment with oculocardiac reflex activation

Question 15

Always perform this after repairing an orbital floor fracture

Answer 15

Forced duction test

Question 16

Signs of NOE fracture (2)

Answer 16

Telecanthus

Orbital swelling

*Assoc with skull base fracture and CSF leak

Question 17

NOE fracture types (3)

Answer 17

Type I—single, noncomminuted fragment of bone without medial canthal tendon disruption

Type II—comminution of bone, but medial canthal tendon is still attached to segment of bone

Type III—comminution of bone with disruption of medial canthal tendon

Question 18

Normal intercanthal distance

Answer 18

3 to 3.5 cm

Question 19

Main goal of NOE fracture repair

Answer 19

Rreconstruct the nasal root, into which the medial canthal tendon inserts

*May need to reapproximate medial canthal tendon with wire

Question 20

LeFort fracture types (3)

Answer 20

Type I—palate separated from midface. Involves the pterygoid plates

Type II—involves pterygoid plates, frontonasal maxillary buttress, and skull base. Often results in CSF leak

Type III—involves pterygoid plates, frontonasal maxillary buttress, and frontozygomatic buttress. Results in craniofacial separation

Question 21

Occlusion (Angle classification) classes (3)

Answer 21

Class I—normal. First maxillary molar has four cusps (mesiobuccal, mesio-lingual, distobuccal, and distolingual). Mesiobuccal cusp of the first maxillary molar fits in mesiobuccal groove of first mandibular molar

Class II—retrognathic (mesiobuccal cusp of first maxillary molar is in between first mandibular molar and the second premolar)

Class III—prognathic.

Question 22

MC locations of mandible fractures

Answer 22

Condyle, angle, and body

C-A-B

Question 23

Forces acting on the inferior rim vs superior rim of the mandible

Answer 23

Compressive - inferior

Areas of tension (distract) - superior

*Unfavorable vs favorable fractures - acted on by the pterygoid and masseter

Question 24

Closed reduction with MMF, contraindications (7)

Answer 24

Multiple comminuted fractures

Pregnant
Children
Elderly

Severe pulmonary disease

Mentally handicapped/seizures

Alcoholic

Question 25

Cervical injury zones (3)

Answer 25

Zone 1—sternal notch to cricoid cartilage

Zone 2—cricoid cartilage to angle of mandible

Zone 3—angle of mandible to skull base

Question 26

Angiography vs surgery as first step based on zone of neck

Answer 26

Zone 1 & 3 - Angiography

Zone 2 - surgery*

*esp if
Subcutaneous emphysema
Hemoptysis
Hematemesis
Hematoma / Significant bleeding
Dysphagia
Dysphonia
Neurologic injury

Question 27

Contrast study after cardiomediastinal injury indications (5)

Answer 27

Widened mediastinum

Pulse rate deficit

Supraclavicular hematoma

Brachial plexus injury

Cervical bruit

Question 28

Cardiac tamponade symptoms / signs (5)

Answer 28

Low cardiac output manifests as low blood pressure and increased heart rate

Muffled cardiac sounds

Increased central venous pressure

Decreased amplitude on electrocardiography (ECG)

Diagnosis/treatment by pericardiocentesis

Question 29

Air emobolism signs (2)

Answer 29

“To-and-fro” murmur

decreased cardiac output

*can be seen with ultrasound (echocardiogram)

Question 30

Air embolism treatment

Answer 30

Place patient in Trendelenburg (head down) and left lateral decubitus position — this traps air in the ventricle and prevents ejection into pulmonary system

Cardiac puncture may be required for aspiration of air (also possible with a Swan-Ganz catheter)