OSB2&3 Flashcards
Signs and symptoms of a zygomatic complex fracture
-loss of facial width and reduced projection of the zygomatic complex
-Subconjunctival haemorrhage without lateral border (sign of lateral orbital wall fracture)
-Eye bruising.
-Palpable bony steps of zygomatic arch and infra-orbital rim.
-Tenderness on zygomatic buttress.
-Limited Mouth opening with reduced mandibular excursion.
-Lacerations
Information to provide when referring (phone and email letter) a facial trauma patient to an OMFS
[Situation, Background, Assessment, Recommendation]
-referrer name, where calling from, reasons for calling
-Patient name, DOB, contacts, NHS no, MH, Allergies, SH,
-Patient history of complaint
-any loss of consciousness, vomiting, nausea, headaches (all signs of brain injury), other injuries sustained, visual changes, any blood, missing teeth, if able to open mouth
-examination findings
-their general compliance and state
- if police involved if domestic violence and where children are
-findings of any imaging and to send them across
-differential diagnosis
- send a copy of notes
- last time had food or drink.
Cranial nerve tests for a facial trauma patient (that you and a DCT can carry out)
-CNV sensation: compare one side to other. (ask if they feel the same on each side) Test at areas where they exit foramen (as weak spots), frontal bone, infra orbital region, zygoma, cheek, lower lip. Often present with numbness
-CNVII motor function – facial movement. Compare one side to another. Raise forehead, scrunch eyes and resist opening, puff out cheeks and resist pushing them, wide smile, grimace and tighten neck
Different eye tests for facial trauma patients when examined by a DCT
TestingCN2,3,4,6, brain injury, drug misuse
- pupil reaction – light shone in eye should cause rapid constriction
-Diplopia (double vision) – move a pen in their vision and ask if they can see 1
-Range of eye movement – move eyes in H pattern. Shows signs of muscular entrapment or herniation, CN damage, orbital floor fracture
-Position of the eye – any bulging
-Visual acuity – reads a schnellen chart, 1 eye at a time
What is a retrobulbar haemorrhages
-bleed behind globe increasing intraocular pressure
-can result in pain, proptosis, paralysis, pupil dilation, poor vision if not managed
-a result of acute trauma
-Emergency -lateral canthotomy to reduce pressure
What is a white eye orbital floor fracture
-common in children
-symptoms can include extreme pain in affected eye, double vision, intermittent vomiting, mild bradycardia (pressure on vagus nerve), normal visual acuity, numbness of left cheek.
-called this as no subconjunctival haemorrhage present and only mild swelling if any
-eye muscle entrapment
What is a blow out fracture. symptoms
-orbital floor injury where soft content pushed backwards without rupturing the globe
-tethered inferior rectus
-Absence of autonomic stimulation
-Do not need dealing with immediately. Repair should be done within 2 weeks
-Presenting ocular symptoms= diplopia, traumatic mydriasis, subconjunctival haemorrhage, pain on eye movement, enophthalmos
-Assessment=ocular motility, diplopia, any deviation, field of gaze
5 types of domestic abuse and what is it
-controlling and threatening behaviour, violence or abuse between people who are or previously in a relationship
-physical, sexual, financial, emotional, psychological
What to do if someone shares details of domestic abuse
-Listen carefully
-Let them know they’ve done the right thing by telling you
-Tell them it’s not their fault
-Say you will take them seriously
-Don’t confront the alleged abuser
-Explain what you will do next
-Never promise to keep it a secret
-document conversation
-Reporting
-notify supervisor/ line manager/ consultant.Contact trust safeguarding team
-call 999 if immediate danger
Signs and symptoms of mid-face fractures
*Facial swelling (edema, hematoma, emphysema
- deformity
*Subconjunctival bleeding
*Oronasal bleeding
*Palpable and crepitating dislocated bony contour in the periorbital region
*Displacement of the globe
*Displacement of the medial canthal tendon
*Compromised ocular motility
*Double vision
*Sensory deficit of trigmeinal nerve (hypoesthesia, anesthesia, paresthesia)
*Localized pain
*Occlusal disturbance
*CSF leakage (in case of anterior skull base involvement)
Risks of GA
-feeling sick, sore throat, shivering, confusion following surgery.
- Damage to teeth, lips, tongue, eye.
-Postop chest infection due to less phlegm.
-Accidental awareness during GA.
-allergy -Anaphylaxis.
-Nerve damage.
-Equipment failure.
-Death or brain damage
Role of a scrub nurse
-keeping track of instruments
-adding additional instruments
-pass instruments to surgeon
What is oral epithelial dysplasia
-harmful changes in the cells, have a high risk of malignant potential
-it is not cancer
-usually seen on oral mucosa as a white, red of mixed lesion.
-Early identification of this and management may prevent transformation into oral cancer
When a lesion is a 2 week wait referral or an urgent referral
-2WW= if cancer suspected (risk factors, smoking, alcohol, FOM/tongue, ulceration, erythroleukoplakia) Letter sent via email to OMFS
-Urgent= if you do not suspect cancer. Any red/white or speckled patches (premalignacies)
Explain excisional and incisional biopsies. Indications for both
- Incisional -a small part of the lesion is removed. Indicated if suspected malignancy and would subsequently need further treatment planning (a full excision with clear margins). Also indicated if the lesion is widespread but is likely to be benign so does not need full removal
-Ideally sample should be an ellipse shape and should include an area of normal adjacent tissue (clear margin) to allow examination of the full extent of the lesion, i.e has it ‘spread’ beyond the margins which can be seen clinically. - Excisional
-remove the whole of a lesion. Used when lesion is localised, smaller, and the differential diagnosis does not involve a cancer.
