Trauma

Question 8

Longitudinal temporal bone fracture

Answer 8

80% of fractures, 20-25% with FN paralysis, often with TM lacerations, CDHL, and bloody otorrhea

Question 9

Transverse temporal bone fracture

Answer 9

20% of fractures, 50% with FN paralysis, often with hemotypanum and SNHL

Question 10

Most common site of facial nerve injury in tbone fractures

Answer 10

perigeniculate region

Question 11

What are the zones of the neck?

Answer 11

Zone 1: thoracic outlet to cricoid cartilage

Zone 2: cricoid to angle of the mandible

Zone 3: angle of the mandible to skullbase

Question 12

How are the teeth numbered in adults?

Answer 12

Question 13

How are the teeth numbered in children?

Answer 13

Question 14

Most common cause of death in penetrating neck trauma?

Answer 14

Exsanguination (large vessel injury)

Question 15

Schaefer’s Laryngeal Trauma Classification

Answer 15

• Group I - No fracture, minor hematoma, edma, or laceration
• Group II - Nondisplaced fracture, edema or hematoma, minor mucosal disruption without exposed cartilage
• Group III - Displaced fractures, massive edema or mucosal disruption, exposed cartilage and/or cord immobility
• Group IV - Addition of 2 or more fracture lines, skeletal instability or significant AC trauma
• Group V - complete laryngotracheal seperation

Question 16

Group 1 laryngeal trauma management

Answer 16

• 23 hour observation
• HOB elevated
• Voice rest
• Humidified air
• Antireflux meds
• Steroids
• Abx
• Flexible scope exam
• +/- CT scan

Question 17

Group 2 laryngeal trauma management

Answer 17

• +/- Tracheostomy
• DL/bronch
• +/- CT
• Medical management

Question 18

Group 3 laryngeal trauma management

Answer 18

• Tracheostomy
• Direct laryngoscopy
• Bronchoscopy
• Exploration and surgical repair

Question 19

Group 4 laryngeal trauma management

Answer 19

• Tracheostomy
• Direct laryngoscopy
• Bronchoscopy
• Exploration and surgical repair
• Stent placement

Question 20

Group 5 laryngeal trauma management

Answer 20

• Tracheostomy
• Complex laryngotracheal repair

Question 21

What are the most common facial fractures?

Answer 21

1. Nasal bones
2. Mandible
3. Orbit/ZMC

Question 22

ZMC fracture has 4 components. List them

Answer 22

Not a true tripod, but rather a tetrapod

1. ZF suture
2. Zygomaticomaxillary buttress (lateral buttress, suture)
3. Orbital floor
4. Zygoma

Can get increased/decreased orbital volume leading to enopthalmos/exopthalmos, V2 numbness, diplopia, trismus if coronoid is hitting zygomatic arch.

Should be on soft diet to avoid pulling of zygoma by masseter musle. Avoid nose blowing due to maxillary sinus and orbit communication.

Question 23

Vertical and Horizontal Buttresses

Answer 23

Vertical buttresses

1. nasomaxillary
2. zygomaticomaxillary
3. pterygomaxillary

Horizontal buttresses

1. frontal bar
2. orbital rims
3. zygomatic processes of temporal bone
4. maxillary alveolus and palate
5. serrated edges of the greater wing of the sphenoid

Question 24

What is the foramina of breschet?

Answer 24

Important in frontal sinus fractures

Venous deep drainage is via transosseous venous channels through the posterior wall of the sinus

Connection of sinus to subdural space

Can be path of infectious spread

Question 25

What are the classifications of NOE fractures?

Answer 25

Type I injuries

• the central fragment remains intact and maintains the insertion of the medial canthal ligament.

Type II injuries

• the central fragment is comminuted, but maintains the insertion of the medial canthal ligament.

Type III injuries

• the central fragment is comminuted, and does not maintain the insertion of the medial canthal ligament