30902_trauma in orl

8/3/2019 30902_trauma in Orl

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DR. SAAD AL-MUHAYAWI, M.D., FRCSC

ORL Head & Neck Surgery

8/3/2019 30902_trauma in Orl


TYPES OF TRAUMATYPES OF TRAUMA

EAR & TEMPORAL BONE TRAUMA NOSE & FACIAL BONES TRAUMA

NECK TRAUMA

CAUSTIC INGESTION

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PRIORITIES IN TRAUMAPRIORITIES IN TRAUMA

A – Airway B – Breathing

–Priorities according to life threatening

situation

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AURICULAR HEMATOMAAURICULAR HEMATOMA

Blunt trauma– Shear injury

–

Hematoma

– Between cartilage and perichondrium

Fluctuant anterior swellin

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– Needle aspiration: inadequate

– Incision & drainage: recommended

– Com ressive dressin

– Antistaph antibiotics

Complications

– Infection / abscess

– auliflo er ear

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8/3/2019 30902_trauma in Orl


TEMPORAL BONE FRACTURETEMPORAL BONE FRACTURE

Blunt > penetrating – MVA, fall and assault– Associated with life threatening conditions

– Trauma protocol / clear c – spine

– Assess facial nerve function early

Immediate vs. delayed– Ear examination: hemotympanum, csf leak, TM

perforation.

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– Assess function: tunning forks, audiogram

Radiology

– Head CT scan: evaluate for head in ur

HRCT of temporal bone with bony window

– va ua e ex en o e rac ure

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8/3/2019 30902_trauma in Orl


– Facial nerve paralysis

Immediate: operative exploration and repair

Delayed: observe, steroids, eye protection– CSF leak

Conservative management

Bed rest vs. lumbar drain > 90 % resolve in 2 weeks

– Hearing loss

Conductive loss: ossicular reconstruction

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er go:– Treat symptomatically

– Meclizine, physical therapy

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Physical examinationPhysical examination

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CT findingsCT findings

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NASAL FRACTURENASAL FRACTURE

Very common– ost common ac a racture

– 3rd most fractured bone

g n ex o susp c on or rac ure

– Mechanism, change in appearance

– p s ax s, nasa o s ruc on

Examine and palpate nose carefully

– ns a y, mo y, crep a on

– Fracture, septal hematoma

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8/3/2019 30902_trauma in Orl



Management

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8/3/2019 30902_trauma in Orl


ZYGOMA FRACTUREZYGOMA FRACTURE

Signs and symptoms– Subconjunctival hemorrhage

–

– Depressed malar eminence

– r smus ony s ep o

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Evaluat on– Facial CT – coronal cuts

– Ophthalmology evaluation

Management

– Open reduction / internal fixation ( ORIF)

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8/3/2019 30902_trauma in Orl


ORBITAL FLOOR FRACTUREORBITAL FLOOR FRACTURE

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8/3/2019 30902_trauma in Orl


MANDIBLE FRACTUREMANDIBLE FRACTURE

1/3– ½ facial fractures Signs and symptoms

– ,

– Floor of mouth hematoma

– Chin ( V3) hypoesthesia

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Evaluation– ecure air a – as needed

– Rule out associated injury

C – spine, facial fracture

oo asp ra on

– ( panarox, mandible series) plain x – ray

– CT – scan

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8/3/2019 30902_trauma in Orl


– Soft diet, severe fractures

e atr c, norma occ us on

Non – displaced

– ,

Closed reduction

– Minimall dis laced

Open reduction

Complications

– – Malocclusion

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MIDFACE FRACTURESMIDFACE FRACTURES

Diagnosis– Malocclusion, depressed midface, open bite

–

– CT scan – axial, coronal cuts

anagement

– Secure airway ( oral intubation if possible ) C – spine injury or laryngeal fracture: surgical

airway

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– Avoid nasal instrumentation , cranialpenetration

– Recognize and treat closed head injury

– –

packing

– uspec ea

– Open reduction and internal fixation

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8/3/2019 30902_trauma in Orl


MIDFACE FRACTURESMIDFACE FRACTURES

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MIDFACE FRACTUREMIDFACE FRACTURE

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8/3/2019 30902_trauma in Orl


BLUNT LARYNGEAL TRAUMABLUNT LARYNGEAL TRAUMA

Mechanism: MVA,Sport,Assault Signs and Symptoms

, ,

Sub-Q emphysema, Hemoptysis

Secure Airway

Oral Intubation- roblematicTracheotomy(not cricothyrotomy)

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Flexible FiberopticLaryngoscopy

CT Scan- evaluate

skeletal derangement

Explporation/

Repair

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EVALUATIONEVALUATION

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Indications for CT scanSignificant voice alteration

Laceration or blood on endoscopy

oca o para ys s

Palpation suspicious of fracture

After tracheotomy- before definitive treatment

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MANAGEMENTMANAGEMENT

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PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA

Secure Airway, Clear C-spine Assume Multiple Injuries

-

Foreign bodies, Pneumothorax

Bony trauma

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Weapons- Knife, Gun Determine Zone

-

2- cricoid to angle of mandible(78%)

3- above angle of mandible(6%)

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8/3/2019 30902_trauma in Orl


PATTERNS OF INJURYPATTERNS OF INJURY

Vascular Injury

arot n ury

Signs & Symptoms

-

Expanding Hematoma- 2/3Clinically silent- 15%

Arteriogram- 97% sensitive

Embolization Possible-zone 1,3& vertebral artery

omp ca onsStroke, Exsanguination

Pseudoaneur sm, AV fistula

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PATTERNS OF INJURYPATTERNS OF INJURY

Pharynx& esophagus- 10%

a n, ysp ag a, ematemes s

Barium Swallow/ Esophagoscopy

Mediastinitis, Sepsis, Fistula

-

Hoarseness, Stridor, Hemoptysis

Complications

Laryngeal Dysfunction, Stenosis

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8/3/2019 30902_trauma in Orl


CAUSTIC INGESTIONCAUSTIC INGESTION

Esophagus, pharynx, larynx Bases

Electric dishwasher soap

Hair relaxant

Acids Bleaches

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Alkalis – pH > 7 Liquefaction necrosis

–

Coagulation necrosis

Bleaches – pH = 7

Irritants

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Children- most common, accidental Adults- suicide attempt

Determine- brand name, quantity ingested

Call poison control center

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Examination not predictive of severityMost without oral lesions

Flexible Laryngoscopy

Esophagogram

Esophagoscopy- early

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30902_trauma in orl

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