ENT trauma

Question 1

Breakage of which nasal bone is most likely to cause epistaxis?

Answer 1

Anterior ethmoid

Question 2

Breakage of which nasal bone is most likely to cause anosmia?

Answer 2

Cribriform plate

Question 3

Describe how you would manage a severe epistaxis

Answer 3

1. Resuscitation if needed.
2. Lean patient forward, pressure on bridge of the nose.
3. Topical vasoconstrictor (Lignocaine + Adreanaline, Co - phenylcaine)
4. Removal of the clot (suction/nose blowing)
5. Anterior rhinscopy (too see whats happening)
6. Cautery/pack
7. Rigid nasoendoscopy
8. Cauterise vessel

Question 4

How do you treat a sub perichondiral heamatoma?

Answer 4

Either aspirate of incise and drain and then put on a pressure dressing.

Question 5

How would you manage a laceration the pinna?

Answer 5

Debridement
Closure (either primary or by reconstruction)
Antibiotics for the cartilage

Question 6

A patient with a temporal bone fracture appears to have a bluish tinge to their tympanic membrane and have mild conductive deafness.

Answer 6

Haemotympanum (bleeding into the middle ear)

Question 7

A patient who has been a gang fight has brusing behind his ears. What is damaged?

Answer 7

Most likely a fracture of the mastoid process of the temporal bone.

Question 8

Give two different ways we can classify temporal bone fractures

Answer 8

Longitudinal or transverse

Otic capsule involved or otic capsule spared

Question 9

A patient sustains a lateral blow to the side of the head. His temporal bone is fractured. Is this likely to be a transverse or a longitudinal fracture?

Answer 9

Longitudinal

Question 10

A patient sustains a frontal blow to the head. His temporal bone is fractured. Is this likely to be a transverse or a longitudinal fracture?

Answer 10

Transverse

Question 11

What kind of deafness would you most likely get with a longitudinal fracture and why?

Answer 11

Conductive deafness. Due to blood in the middle ear (haemotympanum) and ossicular chain disruption

Question 12

What kind of deafness would you most likely get with a transverse fracture and why?

Answer 12

Sensorineural due to damage to the 8th cranial nerve.

Question 13

In which type of temporal bone fractie are you most likely to get a facial nerve palsy?

Answer 13

Transverse

Question 14

In regards to the neck: What structures are in Zone 1?

Answer 14

Trachea
Oseophagus
Thoracic duct
Thyroid
Braciocephalic, subclavian, carotid, thyrocervical trunk vessels
Spinal cord

Question 15

In regards to the neck, what structures are located in zone 2?

Answer 15

Larynx
Hypopharynx
CN 10, 11, 12 (these lie in carotid sheath)
Carotid and jugualar vessels 
Spinal cord

Question 16

With regard to the neck, what structures lie in zone 3?

Answer 16

Pharynx
Cranial nerves
Carotid
Internal jugular vein
Spinal cord

Question 17

IWHat is the importance of checking if an injury has gone through the platysma muscle?

Answer 17

All the importnat strucyures are underneath the platysma muscle so if there is no penetration through this then it is likely the underlying structures are fine.

Question 18

What characteristic CT feature are you looking for in an orbital blowout fracture?

Answer 18

Tear drop sign

Question 19

What is the best imagining modality to investigate facial trauma?

Answer 19

CT