Head and Neck Flashcards by Lux Smith

why are plain films of the face not ordered anymore

hard to read so much overlap it is impossible might as well go right to a CT scan but they are fast and cheap

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number of standard fews in face series

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waters view

beam below the chin

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jughandle view is helpful for looking at the

zygomatic arch Zygomatic arches = the “jugs”

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highlights frontal/maxillary sinuses seen in what plain face XRAY

Water’s View

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single lateral view

for nasal bone

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CT indications

Significant trauma ○ Fracture present or suspected ○ Infections: sinusitis, periorbital cellulitis, retrobulbar pus, cavernous sinus thrombosis

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facial infections we are worried about

sinusitis periorbital cellulitis retrobulbar (eye) pus cavernous sinus thrombosis need to know the extent and what is it

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what are standard views for a CT of the face

Sagittal, coronal, axial recons -

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Special CT views of the face

maxilofacial just the orbits (bony structures) of the eye very very thing cuts of the orbits)

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why do you see maxillary sinus opacification

you can ask the houndsfield units to see if blood or infection or just look at the story

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what is a blow out fracture

if the object fits into the orbit and push on the eye the eye will move back and the orbit will break BLOW OUT of the orbit fat will come out and in to the maxillary sinus (along with maybe blood or air)

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“tear drop” sign refers to

blow out fracture with fat coming out into maxillary sinus

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If the affected eye EOM’s impaired, they have ___________ and/or pain on looking up or out – suspect “__________”

If the affected eye EOM’s impaired, they have double vision and/or pain on looking up or out – suspect “entrapment”

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direct blow to the cheek is known as a

tripod fracture you break the maxillary sinus and the orbit

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NAME for Fractures in the zygomatic arch, orbit, wall of maxillary sinus ○ CT initial study

TRIPOD

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Mid face fracture resulting from high force injuries

● LeFort fractures

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types of LEFORT fractures

LEFORT 1: teeth fall off LEFORT 2: nose and teeth but orbit intact lefort 3: the bottom of your eyes fall off

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Maxilla, or maxilla plus maxillary sinus/orbits/nose/arch in various degrees fracture involving

LeFort

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plain film w/ circular view; takes horseshoe-shaped mandible and flattens it out

Panorex

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what are the three things you need to describe a mandible fracture

Location & number of fx’s ○ Open or closed ■ Open means fx opens into mouth - worse b/c lots of bacteria in human mouth ○ Distraction (separation)

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what is the order of operations for a mandible injury

PANOREX then CT for fracture or CT if it looks horrible ● Often fractures in >1 place due to horseshoe-shape

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what is the diagnostic test of choice for suspected deep facial infx

CT is the diagnostic choice for suspected deep facial infections/pus collections or retrobulbar processes

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test of choice in ED for retinal detachment (vision changes, halos, painless)

Ultrasound – Orbit

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what should we normally see on the ultrasound of the orbit

● Normally, should see vitreous humor (black), retina should be flat in the back

welder comes in with eye pain they were not wearing safety glasses

ULS looking for metalic object

indications for CT imaging of TRAUMA

NEXUS Low Risk Criteria ○ Canadian C-Spine Rule ○ Both address who needs imaging and who does not

when to start of with a plain film of the neck

non trauma neck pain very minor trauma persistent neck pain can look for METS

in general obtain CT of the neck if

Significant mechanism (eg, freeway speed crash + neck pain) ○ Midline pain ○ Paresthesia/numbness/weakness ○ Cannot rotate or flex w/o pain ○ ALOC (alte ---\>Age\>65 older and fall down you need this (8lb bowling ball on a stick)

3 views standard views for plain films of the neck

AP/PA views are most important in Chest; on AP view of Neck, top vertebra is usually C3 ○ 85% of diagnoses will be made with Lateral view ○ Open mouth odontoid gives better view of C1 and C2

85% of diagnoses will be made on what view on plain films of the neck

○ 85% of diagnoses will be made with Lateral view

three things that tell you if a lat neck film is adequate

Must be able to see the anterior superior corner (top of) T1 below C7 to evaluate alignment ○ Must see base of skull ○ Must see tips of C6, C7 spinous processes

what will you order if you can't get an adequate neck xray

SWIMMERS view

systematic approach to reading lateral C spine films

1.name, date 2.COUNT 3.Check 4 lines of alignment 4.Look for consistent height/shape of vertebrae 5.Look for consistent disc spaces between bones 6.Look at soft tissue contours and spaces – measure if in doubt 7. Check all spinous processes for fx

Check 4 lines of alignment

1. Anterior longitudinal ligament line = Anterior vertebral line 2. Posterior longitudinal ligament line = Posterior vertebral line 3. Spinolaminar line 4. Spinous process line

checking for alignment will tell you what about a lateral C spine xray

subluxation or ID abnormality

how much space should their be in front of C2

\<6mm

how much space should their be in front of C3/4

\<5 mm

how much space should their be in front of C6

\<22mm at C6 ■ Kids: \< ½ width V

how to remember the contour of the neck and the spaces

6mm at 2 22mm at 6

Pre-dental space (atlanto-dens interval should have how much space

≤ 3mm adults ■ ≤ 5mm kids

Reading the Odontoid View

Do the vertebral bodies of C1 and C2 line up? ● Look at symmetry of spaces between C1 and C2 ○ Is the pt rotated? Radiologist ● Look at contour of odontoid (dens) itself ○ Can you see the entire dens? ● Check lateral for clues too!

special neck views (other than swimmers)

Oblique views Flexion/Extension Views

old cspine view used for Neural foramina, facet joints ○ Less common ○ CT (fx) or MRI (spinal cord) are far superior

Oblique views

Less common ○ Not used in trauma ○ Controversial - may worsen sx’s ○ CT/MRI superior have to go to confession for a month

● Flexion/Extension Views

trauma C spine, contrast or nah?

nah, you're looking at the bone

look at slide 37

CT MRI

when would you use MRI vs CT

if you suspect a deep space abscess the initial test is going to be a CT scan MRI for spinal cord injuries

these fractures are unstable much like the pt and the exact mechanism is unknown

● Odontoid fractures are unstable; quite often, the patient is also unstable

types of odontoid fracture

Type I, Type II, Type III

what would you do for suspected odontoid

CT scan as soon as possible once stabilized

= Fracture of the ring of C1 (like how lifesavers candy falls apart after sucking on it for a long time)

Jefferson Fracture

mechanism of a Jefferson fracture

axial load (something falling on your head, or diving into shallow pool)

how to dx jefferson fracture

\*Confirm all fractures on CT scan by looking at image above and below for consistency

Posterior element fracture of C2; usually with hyperextension

Hangman’s Fx

mechanism of a hangman's fracture

: hyperextension and compression (face vs. windshield) ● Soft tissue edema

burst fracture mechanism

axial load compression

Vertebral body in multiple pieces from unstable axial load compression

burst fracture doesn't always violate the cord space but can be a very bad scene

mechanism of a wedge compression Fx

hyperflexion with axial load compression anteriorly

If posterior elements intrude on spinal canal on a wedge compression fracture

If posterior elements intrude on spinal canal, considered a burst fx

Flexion Teardrop Fx

: hyperflexion and compression (this is a diver’s fx)

ubluxation, Jumped or “Perched” Facets mechnaism

hyperflexion with distraction

name this fracture

Perched facets is essentially a ligamentous injury; fixed w/ traction

how do you describe perched fx

Describe: top vertebrae is “subluxed onto” the lower one - % of vertebral body: “20% subluxation C5 onto C6”

hyperextension is the mechanism of this fracture seen with ligamentous rupture

Anterior Avulsion Fx

stable fracture seen at the spinous process fx at C6 or C7

Clay Shoveler’s and Spinous Process Fx’s

name this fracture what's the mechanism

Clay shoveler's STABLE Sudden hyperflexion; clay stuck to shovel when tossing overhead. C6/7 Also caused by a direct blow to area. ● Classically, a ligamentous avulsion.

what is typical CM of epiglottitis

pain out of proportion to their findings, febrile, haven't eaten Sx: drooling, stridor, dyspnea as them if they are inmmunized

what type of film would we get with a fish bone pt

soft tissue lateral of the neck underpenetrated (soft tissues need only)

24 yo man w/out immunizations when young, complains of a sore troat. positive thumb sign on soft tissue

epiglottitis

thumb sign

See enlarged epiglottis, classic “thumb” sign

what type of dx would you get with suspected retropharyngeal abscess

CT???

fever sore throat and trismus in a child

trismus= can't open mouth suspect retropharyngeal absces

what does ULS tell us about a thyroid

cystic (fluid) or solid (tumor), size, composition need this before a FNA

thyroid scintigraphy, when is this indicated

Determines the functional status of a nodule (warm/hot/cold)

when would we use a ct for a thyroid

● CT reserved for complex cases, eval adjacent structures

– shows carotid/vascular flow; part of CVA work up

Duplex Ultrasound

– indicated for carotid dissection, trauma

CT angiography (CTA) –

● MR angiography (MRA) used for what in the neck

to study the vessels

History: A 45-year-old jumped into swimming pool and hit head, now with neck pain what type of fracture would you suspect

Jefferson fracture

Head and Neck Flashcards

(82 cards)