Trauma + Surgery Flashcards
(19 cards)
What is septal haematoma?
Why does it need treated promptly?
Treatment?
This is when blood collects between the perichondrium and septal cartilage – can lead to abscess and necrosis
Urgent incision and drainage
Treatment for nasal #?
Manipulation under anaesthetic
Give three complications of nasal fracture
- Epistaxis – particularly ant ethmoid
- CSF leak, meningitis
- Anosmia – cribriform plate fracture
What should you not do in epistaxis?
Don’t sedate
What is pinna haematoma?
Treatment?
Complication?
Bleeding in the sub-perichondral plane, elevating the perichondrium
Arrange incision of the haematoma with primary closure + packing to prevent reaccumulation
Aspiration is rarely adequate due to thickness of the clot
Poor treatment can lead to ischaemic necrosis -> cauliflower ear
Treatment of pinna laceration?
Basically return it to anatomical position and suture shut + antibiotics
What things should you ask about in temporal bone #?
Injury mechanism Hearing loss Facial palsy Vertigo CSF leak
What are the two classifications of temporal bone #?
Longitudinal vs transverse
Otic capsule involved vs otic capsule spared
What is the most common type of temporal bone #?
Give some features
Longitudinal
- Lateral blows
- Fracture line parallels the long axis of the petrous pyramid
- Bleeding from external canal due to laceration of skin and ear drum
- Haemotympanum (conductive deafness)
- Ossicular chain disruption (conductive deafness)
- Facial palsy (20%)
CSF otorrhoea
Give some features of transverse temporal bone #
- Frontal blows
- Fracture at right angles to the long axis of the petrous pyramid
- Can cross the internal acoustic meatus causing damage to auditory and facial nerves
- Sensorineural hearing loss due to damage to 8th cranial nerve
- Facial nerve palsy (50%)
- Vertigo
Give some causes of conductive and sensorineural hearing loss
Conductive
- Fluid: effusion, blood, CSF
- TM perforation: traumatic or chronic
- Ossicular disruption/fixation – traumatic, erosion
- Stapes fixation – otosclerosis
Sensorineural
- Sensory – cochlea
- Neural – 8th cranial nerve
Which structures are at risk in penetrating injury of zone 1 of the neck?
Trachea Oesophagus Thoracic duct Thyroid Vessels - Brachiocephalic Subclavian - Common carotid - Thyrocervical trunk Spinal cord
Which structures are at risk in penetrating injury of zone 2 of the neck?
Larynx Hypoharynx CN 10,11,12 Vessels – carotids, internal jugular Spinal Cord
Which structures are at risk in penetrating injury of zone 3 of the neck?
Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord
What is the most important structure to inspect in penetrating neck injury?
Platysma - if intact then you can suture up the skin
What is the weak point in the orbit?
What is the mechanism of this injury?
Infraorbital groove
Sudden increase in intraorbital hydraulic pressure. A high-velocity object that impacts the globe and upper eyelid transmits kinetic energy to the periocular structures. This energy results in pressure with a downward and medial vector usually targeting the infraorbital groove
What is the tear drop sign suggestive of?
Treatment?
Blow out fracture - occurs when there is a fracture of one of the walls of orbit but the orbital rim remains intact. Typically, this is caused by a direct blow to the central orbit from a fist or ball. Usually conservative Consider surgical repair if: - Entrapment - Large defect - Significant enophthlamos
Define
- Otoplasty
- Mentoplasty
Otoplasty = surgery for prominent ears Mentoplasty = surgery to reshape the chin
What causes bags under the eyes in older people?
Weakened orbital septum - allow fat to fall through
Effectively a hernia
