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Year 2(B6) - E.N.T > Week 2 - F - ENT Trauma > Flashcards

Week 2 - F - ENT Trauma Flashcards

1
Q

What are important questions to ask when a patient presents with nasal trauma?

A

* mechanism of injury - high or low impact * when * LOC - level of consciousness * epistaxis ? pattern? * breathing

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2
Q

What would you examine for nasal trauma?

A

* facial tenderness * infraorbital sensation * CNs

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3
Q

What must you exclude in nasal trauma?

A

Septal haematoma

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4
Q

What is the connective tissue that envelops cartilage where it is not at a joint?

A

Perichondrium Peri - around Chondro - cartilage

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5
Q

Why is septal haematoma an emergency?

A

Perichondrium is pulled away from the septum and therefore septum is devascularised. It will necrose and can lead to abscess. Results in loss of structure of the nose but can also lead to intracranial infection.

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6
Q

What is the treatment of septal haematoma?

A

Urgent drainage is required in order to reattach the perichodrium to the cartilage and revascularise the tissue

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7
Q

What systemic disorder can cause saddling of the nose due to weakened cartilage because of inflammation of the blood vessels?

A

Wegener’s graulomatosis (granulomatosis with polyangiitis)

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8
Q

How might you tell between septal deviation and septal haematoma?

A

Septal deviation will be hard Haematoma will be boggy

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9
Q

In what time frame should a broken nose be put back into place?

A

within 2 weeks

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10
Q

What is the main artery to experience complications after nasal fracture (e.g. epistaxis)?

A

Anterior ethmoidal artery

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11
Q

How will this epistaxis present?

A

Bleeding every few hours

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12
Q

What are the main treatment options for epistaxis ?

A

* sometimes just resetting the nose will allow the artery to seal * may need to be ligated

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13
Q

Other complications of a nasal fracture?

A

* CSF leak - will largely heal itself * Meningitis * Anosmia (fracture of the cribriform plate)

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14
Q

Why can fracture of the cribiform plate cause anosmia?

A

The olfactory receptor cells pierce the cribiform plate to reach the olfactory bulb and therefore fracture of the plate may disrupt the nerve transmission

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15
Q

Why is epistaxis so common?

A

The nose is an incredibly vascular organ due to humidification requirements Vasculature runs just under the mucosa - prone to trauma

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16
Q

What are the three main arteries supplying the nose?

A

* Anterior ethmoidal artery - branch of the ophthalmic artery (branch of internal carotid artery) * Sphenopalatine artery - branch of the maxillary artery (branch of external carotid artery) * Greater palatine - branch of sphenopalatine

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17
Q

What is the foramen in the hard palate through which the greater palatine artery enters the nasal cavity?

A

It enters through the incisive foramen

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18
Q

What is the artery from the superior labial branch of the facial artery that supplies the septum?

A

The septal branch of the superior labial artery

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19
Q

Management of epistaxis? State up to packing (how is the clot removed once the blood flow has stopped)

A

* External pressure and Ice - pinch lower part of nose for 20 minutes * Clot removal e.g. suction or nose blowing * Apply a cotton soaked ball - adrenaline to cause vasoconstriction and lidocaine for analgesia * Cauterise using silver nitrate * Rhino pack if bleeding continues

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20
Q

Management of epistaxis * External pressure and Ice - pinch lower part of nose for 20 minutes * Clot removal e.g. suction or nose blowing * Apply a cotton soaked ball - adrenaline to cause vasoconstriction and lidocaine for analgesia * Cauterise using silver nitrate * Rhino pack if bleeding continues What is done for management if bleeding continues after this? (usually if a serious posterior epistaxis)

A

More invasive procedures may be required now Endoscopic ligation of the sphenopalatine artery If continues Ligation of the external carotid artery If continues Embolisation of eg internal maxillary or facial artery - last line as could cause stroke

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21
Q

What can be given after successful treatment of the epistaxis to prevent crusting and vestibulitis?

A

If first aid measures are successful, consider using a topical antiseptic such as Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis

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22
Q

What is the risk with pinna haematoma?

A

Devascularise cartilage necrose and calcify

23
Q

How is it treated?

A

* aspirate * incision and drainage * pressure dressing (no prevent recurrence)

24
Q

How can pinna be reconstructed?

A

Rib cartilage grafts

25
Q

What must you try to prevent in pinna haematoma?

A

Infection - similar to osteomyelitis - very difficult to treat

26
Q

Summary of bones of the skull

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_204258-15A1A50D63474A7DC4A.png

27
Q

Complications of temporal bone fracture? (remember the whole ear system is within the temporal bone)

A

Hearing loss Facial palsy Vertigo CSF leak

28
Q

When should you chemically cauterise?

A

Once bleeding has been controlled with vasoconstriction

29
Q

2 main types of temporal fracture?

A

* longitudinal vs. transverse OR * otic capsule involved vs. spared

30
Q

What is longitudinal fracture? (ie what type of blow (lateral or frontal) (conductive or sensorineural hearing loss)

A

Fracture line parallels the long axis of the petrous pyramid and tends to spare otic capsule. Bleeding from external canal due to laceration of skin and ear drum Can cause conductive deafness Caused by lateral blows

31
Q

What is transverse fracture?

A

* caused by frontal blows * fracture at right angles to the long axis of petrous pyramid * Can cross IAM to damage auditory and facial nerves - sensorineural HL * Facial nerve palsy more common * Vertigo

32
Q

Which type is more common between longtitudional and transverse?

A

Longitudinal - 80%

33
Q

Main causes of conductive HL in trauma?

A

* Effusion, blood, CSF * Perforation of tympanic membrane * Ossicular problem e.g. disruption of incus in trauma

34
Q

2nd most common cause of CHL which doesn’t occur through trauma?

A

Otosclerosis - fixation of stapes due to fusion, prevents the vibrations. If eardrum looks normal, consider this

35
Q

What is osteosclerosis?

A

It is the hardening/thickening of the bone causing less mvoement in the ossicles mainly affecting the stapes

36
Q

Summary of conductive and sensorineural causes

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_205543-15A1A5CEB6253F4E3E1.png

37
Q

Why is important to assess the facial nerve in A&E (often delayed in polytrauma)?

A

* if facial nerve is damaged in trauma it is likely to be severed (facial palsy) * If this arises later - it is more likely to be swelling of the nerve and will settle down * This is why it is important to know whether palsy is present in A&E or develops later

38
Q

What is present in trauma zone 1 of the neck?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_210055-15A1A613D441B7C2F6A.png

39
Q

What is present in trauma zone 2 of the neck?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_210140-15A1A61F1B74AA3B243.png

40
Q

What is present in trauma zone 3 of the neck?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_210215-15A1A626FAC7CBF3B2D.png

41
Q

What 4 main domains must you check for in neck trauma?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_210406-15A1A642E0845AA2931.png

42
Q

How would you treat a neck injury if the platysma was in tact?

A

Can safely suture wound as no major vessels or nerves lateral to platysma

43
Q

What might you do if you suspect damage?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_215033-15A1A8EB43163A9E0C4.png

44
Q

What does an expanding haematoma suggest?

A

Significant vascular injury

45
Q

What other complications can arise?

A

* hypovolaemic shock * airway obstruction * blood in aerodigestive tract

46
Q

Why is maxillary fracture potentially life threatening

A

Its affects on the airway

47
Q

What usually causes maxillary fracture?

A

High energy blunt force to the face

48
Q

Where in the maxilla will damage usually occur?

A

Infra orbital foramen

49
Q

How does this sort of fracture occur?

A

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.

50
Q

How might this present?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_215434-15A1A9270CC17F0DDD6.png

51
Q

How can movement of the eye be affected?

A

muscles can get trapped stopping patient from being able to look up

52
Q

How may the sinuses appear on CT if a fracture has occurred? What is the sign known as in a blow out fracture on CT?

A

https://s3.amazonaws.com/classconnection/111/flashcards/9781111/png/screen_shot_2017-02-07_at_215608-15A1A93CDDE5396F11E.png

53
Q

When would you repair this kind of fracture surgically?

A

If entrapment, large defect or significant enopthalmos. Otherwise it will heal itself

54
Q

What is the imaging of choice in Le Fort fractures?

A

CT

Year 2(B6) - E.N.T (32 decks)

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