Otorhinolaryngology Emergency

Question 1

Fracture of the facial bones are composed of

Answer 1

Upper: Frontal, Orbital
Middle: Maxillary, Nasal bone, Zygomatic
Lower: Mandible

Question 2

Facial paired bones

Answer 2

• Maxilla
• Lacrimal bone
• Nasal bone
• Inferior nasal conchae
• Palatine bone

Question 3

Thick areas that provide support and strength in the facial bones

Answer 3

Buttresses of facial bones

Question 4

Use of oropharyngeal airway, supraglottic airway devices, tracheal intubation/surgical airway

Answer 4

cricothyrotomyotracheostomy

Question 5

Visible sign of shock

Answer 5

1. Pallor
2. Prolonged capillary refill time
3. Clammy and cool skin
4. Tachycardia
5. Diminished/absent pulse pressure

Question 6

GCS (Eye Opening Response)

Answer 6

Spontaneously 4
To speech 3
To pain 2
No response 1

Question 7

GCS (Best verbal response)

Answer 7

Oriented to time, place and person 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
No response 1

Question 8

GCS (Best motor response)

Answer 8

Obeys commands 6
Move to localized pain 5
Flexion withdrawal from pain 4
Abnormal flexion (decorticate) 3
Abnormal extension (decerebrate) 2
No response 1

Question 9

Serious complication; collection of blood under the mucoperichondrium or mucoperiostium of nasal septal cartilage or bone; may be unilateral or bilateral (more common in severe trauma)

Answer 9

Nasal septal hematoma

Question 10

Nasal septal abscess to the cavernous sinus thrombosis causes

Answer 10

Meningitis

Question 11

Etiologies of Maxillofacial fractures

Answer 11

• 60% of patients with severe facial trauma have multisystem trauma and the potential for airway compromise
• 20-50% concurrent brain injury
• 1-4% cervical spine injuries
• Blindness occurs in 0.5-3%
• 25% of women with facial trauma are victims of domestic violence ( increase to 30% if with orbital wall fracture
• 25% of patients with severe facial trauma will develop PTSD

Question 12

Emergency management airway control

Answer 12

o Chin lift
o Jaw thrust
o Oropharyngeal suctioning
o Manually move the tongue forward
o Maintain cervical immobilization

Question 13

Intraoral examination

Answer 13

o Manipulation of each tooth
o Check for lacerations
o Stress the mandible
o Tongue blade test

Question 14

Frontal sinus/Bone fracture associated with

Answer 14

1. Intracranial injuries
2. Injuries to the orbital roof
3. Dural tears

Question 15

Frontal sinus/Bone fractures clinical findings

Answer 15

o Disruption or crepitance of the orbital rim
o Subcutaneous emphysema
o Associated with a laceration

Question 16

Frontal sinus/Bone fractures radiographic views

Answer 16

Facial views
- Waters
- Caldwell
- Lateral projections

Question 17

Frontal sinus/Bone fractures complications

Answer 17

Associated with intracranial injuries:
1. Orbital roof fractures
2. Dural tears
3. Mucopyocele
4. Epidural empyema
5. CSF leaks
6. Meningitis

Question 18

Naso-ethmoidal orbital fractures clinical findings

Answer 18

Patient complain of pain on eye movement

Clinical findings
- Flattened nasal bridge or saddle-shaped deformity of the nose
- Widening of the nasal bridge (telecanthus)
- CSF rhinorrhea or epistaxis
- Tenderness, crepitus, and mobility of the nasal complex

Question 19

3 types of nasal fractures

Answer 19

1. Depressed
2. Lateral displaced
3. Nondisplaced

Question 20

Type I Nasal fracture

Answer 20

Laterally displaced fracture

Question 21

Type II Nasal fracture

Answer 21

Disarticulation of upper lateral cartilage

Question 22

Type III Nasal fracture

Answer 22

Posteriorly depressed fractures

Question 23

Type IV Nasal fracture

Answer 23

Anterior nasal spine fracture

Question 24

Type V Nasal fracture

Answer 24

Involvement of nasal septum

Question 25

Type V Nasal fracture

Answer 25

Involvement of nasal septum

Question 26

Orbital blowout fractures clinical findings

Answer 26

1. Periorbital tenderness, swelling, ecchymosis 2. Enopthalmos or sunken eyes 3. Impaired ocular motility 4. Infraorbital anesthesia 5. Step off deformity

Question 27

Radiograph findings on Orbital blowout fractures

Answer 27

1. Hanging teardrop sign 2. Open bomb day door 3. Air fluid levels 4. Orbital emphysema

Question 28

Most common types of fracure on zygoma

Answer 28

Blunt trauma Arch fracture- most common Tripod fracute- most serious

Question 29

Most common types of fracture in zygoma

Answer 29

Blaunt trauma Arch fracture- most common Tripod fracture- most severe

Question 30

Most common types of fracture in zygoma

Answer 30

Blaunt trauma Arch fracture- most common Tripod fracture- most severe

Question 31

Zygomatic arch fractures clinical findings

Answer 31

1. Palpable bony defect over the arch 2. Depressed cheek with tenderness 3. Pain in cheek and jaw movement 4. Limited mandibular movement

Question 32

Tripod fracture consist of fractures through

Answer 32

-Zygomatic arch -Zygomaticofrontal suture -Inferior orbital rim and floor

Question 33

Clinical features of Zygoma tripod fractures

Answer 33

o Periorbital edema and ecchymosis\ o Hypesthesia of the infraorbital nerve o Palpation may reveal step off o Concomitant globe injuries are common

Question 34

Horizontal fracture of the maxilla at the level of the nasal fossa

Answer 34

LeFort I/Guerin Fracture

Question 35

Pyramidal fracture of the maxilla, nasal bones and medial aspect of the orbits

Answer 35

LeFort II/Pyramidal fracture

Question 36

Fractures through maxilla, zygoma, nasal bones, ethmoid bones and base of the skull

Answer 36

LeFort III/Craniofacial disjunction

Question 37

LeFort I/Guerin Fracture clinical findings

Answer 37

1. Facial edema 2. Malocclusion of the teeth 3. Motion of the maxilla while the nasal bridge remains stable 4. (+) Drawer sign

Question 38

LeFort I/Guerin Fracture clinical findings

Answer 38

1. Facial edema 2. Malocclusion of the teeth 3. Motion of the maxilla while the nasal bridge remains stable 4. (+) Drawer sign

Question 39

Lefort III/Craniofacial disjunction clinical findings

Answer 39

1. Dish faced deformity 2. Epistaxis and CSF Rhinorrhea 3. Motion of the maxilla, nasal bones, and zygoma 4. Severe airway obstruction

Question 40

Most common fracture site of the mandible

Answer 40

Condylar process followed by the body

Question 41

Clinical findings of Mandibular fractures

Answer 41

1. Mandibular pain 2. Malocclusion of the teeth 3. Separation of teeth with intraoral bleeding 4. Inability to fully open mouth 5. Preauricular pain with bitting 6. (+) Tongue blade test 7. Check if there is hematoma on the floor of the mouth (may lead to airway obstruction)

Question 42

For immboilization of mandible

Answer 42

Barton's bandage