Trauma + Surgery

Question 1

What is septal haematoma?
Why does it need treated promptly?
Treatment?

Answer 1

This is when blood collects between the perichondrium and septal cartilage – can lead to abscess and necrosis
Urgent incision and drainage

Question 2

Treatment for nasal #?

Answer 2

Manipulation under anaesthetic

Question 3

Give three complications of nasal fracture

Answer 3

1. Epistaxis – particularly ant ethmoid
2. CSF leak, meningitis
3. Anosmia – cribriform plate fracture

Question 4

What should you not do in epistaxis?

Answer 4

Don’t sedate

Question 5

What is pinna haematoma?
Treatment?
Complication?

Answer 5

Bleeding in the sub-perichondral plane, elevating the perichondrium
Arrange incision of the haematoma with primary closure + packing to prevent reaccumulation
Aspiration is rarely adequate due to thickness of the clot
Poor treatment can lead to ischaemic necrosis -> cauliflower ear

Question 6

Treatment of pinna laceration?

Answer 6

Basically return it to anatomical position and suture shut + antibiotics

Question 7

What things should you ask about in temporal bone #?

Answer 7

Injury mechanism
Hearing loss
Facial palsy
Vertigo
CSF leak

Question 8

What are the two classifications of temporal bone #?

Answer 8

Longitudinal vs transverse

Otic capsule involved vs otic capsule spared

Question 9

What is the most common type of temporal bone #?

Give some features

Answer 9

Longitudinal
- 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

Question 10

Give some features of transverse temporal bone #

Answer 10

• 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

Question 11

Give some causes of conductive and sensorineural hearing loss

Answer 11

Conductive

• Fluid: effusion, blood, CSF
• TM perforation: traumatic or chronic
• Ossicular disruption/fixation – traumatic, erosion
• Stapes fixation – otosclerosis

Sensorineural

• Sensory – cochlea
• Neural – 8th cranial nerve

Question 12

Which structures are at risk in penetrating injury of zone 1 of the neck?

Answer 12

Trachea
Oesophagus
Thoracic duct
Thyroid
Vessels
- Brachiocephalic
Subclavian 
- Common carotid 
- Thyrocervical trunk
Spinal cord

Question 13

Which structures are at risk in penetrating injury of zone 2 of the neck?

Answer 13

Larynx
Hypoharynx
CN 10,11,12
Vessels – carotids, internal jugular
Spinal Cord

Question 14

Which structures are at risk in penetrating injury of zone 3 of the neck?

Answer 14

Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord

Question 15

What is the most important structure to inspect in penetrating neck injury?

Answer 15

Platysma - if intact then you can suture up the skin

Question 16

What is the weak point in the orbit?

What is the mechanism of this injury?

Answer 16

Infraorbital groove
Sudden increase in intraorbital hydraulic pressure. A high-velocity object that impacts the globe and upper eyelid transmits kinetic energy to the periocular structures. This energy results in pressure with a downward and medial vector usually targeting the infraorbital groove

Question 17

What is the tear drop sign suggestive of?

Treatment?

Answer 17

Blow out fracture - occurs when there is a fracture of one of the walls of orbit but the orbital rim remains intact. Typically, this is caused by a direct blow to the central orbit from a fist or ball.
Usually conservative
Consider surgical repair if:
- Entrapment
- Large defect
- Significant enophthlamos

Question 18

Define

• Otoplasty

- Mentoplasty

Answer 18

Otoplasty = surgery for prominent ears
Mentoplasty = surgery to reshape the chin

Question 19

What causes bags under the eyes in older people?

Answer 19

Weakened orbital septum - allow fat to fall through

Effectively a hernia