Why must a septal haematoma be excluded in a patient with nasal trauma?
It may cause infection and septal abscess
It can lead to ischaemia and cartilage death
What are the complications associated with nasal fracture?
Epistaxis
CSF leak and meningitis
Anosmia (if cribriform plate fracture)
Which inherited condition can cause severe epistaxis?
Hereditary hemorrhagic telangiectasia
How is epistaxis treated?
Pinch lower bony part of nose
Lean head forward slightly
(do not put head between legs, this only increases venous pressure in the head)
How is a severe epistaxis treated?
- Resus
- Slow blood flow (pressure, ice, topical vasoconstrictor)
- Remove clot
- Anterior rhinoscopy
- Cautery
What is a rapid rhino pack?
A tool to stop nose bleeding
Inserted into nose and inflated
What is a pinna haematoma?
Bleeding beneath the perichondrium
May calcify and cause cauliflower ear
How is a pinna haematoma treated?
- Aspirate
- Incision
- Drainage
- Pressure dressing
What is Battle’s sign?
Indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma
It involves injury to mastoid process leading to bruising
How can temporal bone fractures be classified?
- Longitudinal or transverse
- Otic capsule sparing or involved
What is the most common type of temporal bone fracture?
Longitudinal (80%)
(fracture line parallels the long axis of the petrous pyramid)
What is Haemotympanum?
Blood in the middle ear space
(a cause of conductive deafness)
Why is a transverse temporal bone fracture more likely to damage the auditory and facial nerves versus a longitudinal fracture?
The fracture line is at right angles to the petrous pyramid and may cross the internal acoustic meatus
Which type of hearing loss may occur with a transverse temporal bone fracture?
Sensorineural (damage to CN VIII)
Which type of temporal bone fracture is most affected by vertigo?
Transverse
What are the four types of hearing loss?
- Conductive
- Sensorineural
- Mixed
- Central
What may cause conductive hearing loss?
- Fluid e.g. effusion, blood, CSF
- Tympanic membrane perforation
- Ossicular issues
- Otosclerosis
What is Otosclerosis?
A bony growth in the middle ear usually affecting the stapes
What may cause sensorineural hearing loss?
Cochlear damage
Neura (CN VIII) damage
How are most CSF leaks into the ear managed?
Most are self limiting (10 days)
Repair may be indicated
What are the 3 zones of the neck which can be affeted by trauma?
Zone 1 - Lower aspect (root)
Zone 2 - Larynx to carotid arteries
Zone 3 - Upwards from larynx and pharynx
What is the classical sign for an orbital fracture on CT?
Tear drop sign
(in a blow-out fracture)
When will repair be attempted in a blow out fracture?
- Entrapment
- Large defects
- Significant enophthalmos
