Traumatic Flashcards
(101 cards)
1
Q
What are the three stages of injury after caustic ingestion?
A
- Necrosis, bacterial invasion, sloughing of the mucosa.
- Granulation tissue and reepithelialization (days-several weeks).
- 3•Scar formation and contraction.
2
Q
What is the mortality rate of patients who develop meningitis with a traumatic CSF leak?
A
10%.
3
Q
What percent of patients with CSF leak secondary to nonsurgical trauma will develop meningitis?
A
10-25%.
4
Q
What percent of basilar skull fractures result in CSF leak?
A
10-30%.
5
Q
What percent of patients with esophageal stricture will develop esophageal cancer?
A
1-4%.
6
Q
In what age groups is caustic ingestion most common?
A
18-24 months, 20-30 years.
7
Q
What is the incidence of facial nerve paralysis in patients with longitudinal temporal bone fractures?
A
20-25%.
8
Q
How long should immobilization typically be maintained in children?
A
2-3 weeks.
9
Q
What does medical management of laryngeal injuries consist of!
A
24 hours or more of airway observation, voice rest, elevation of the head, humidified air, H2 blockers, steroids; antibiotics if lacerations are present.
10
Q
What percent of CSF leaks are from nontraumatic causes?
A
3-4%.
11
Q
What is the incidence of facial nerve injury after transverse fracture of the temporal bone?
A
40-50%.
12
Q
What percent of mandible fractures are associated with other injuries?
A
40-60%.
13
Q
What percent of children with esophageal burns will develop esophageal stricture?
A
7-15%.
14
Q
What percent of patients without oropharyngeal burn will have evidence of esophageal injury?
A
8-20%.
15
Q
What percent of CSF leaks are cranionasal?
A
8o%.
16
Q
How does the injury differ after ingestion of acidic substances versus ingestion of basic substances?
A
Acidic substances cause coagulation necrosis; the eschar limits the depth of injury. Basic substances cause liquefaction necrosis and are likely to cause deeper injury.
17
Q
What is the best way to treat mandible fractures in infants < 2 years of age?
A
Acrylic splints x 2-3 weeks.
18
Q
Where are the laceration and bony disruption in the external auditory canal most often found after longitudinal temporal bone fracture?
A
Along the tympanosquamous suture line (posterior and superior).
19
Q
What is the most likely mechanism of injury for bilateral condylar fractures?
A
Anterior blow to the chin.
20
Q
Where does the fracture line typically course in relation to the otic capsule?
A
Anterior to the otic capsule.
21
Q
What percent of skull fractures involve the temporal bone?
A
Approximately 20%.
22
Q
What is the strongest predictor of negative outcome in trauma patients?
A
Arterial hypotension
23
Q
What is the most common diagnosis inappropriately given to a child with an airway foreign body?
A
Asthma.
24
Q
When should middle ear exploration and ossicular reconstruction be performed after temporal bone fracture?
A
At least 3 months after injury.
25
What are the relative indications for open reduction of a condylar fracture?
Bilateral condylar fractures in an edentulous patient when MMF is impossible, condylar fractures when MMF is not recommended for medical reasons, and bilateral condylar fractures associated with midface fractures.
26
What is the most common etiology of dizziness after longitudinal temporal bone fracture?
BPPV.
27
What is the most common esophageal foreign body in children
Coins.
28
What is a type II NOE fracture?
Comminuted, but identifiable, central fragment.
29
What is a type C ZMC fracture?
Complex fracture with comminution of the zygomatic bone.
30
Which parts of the mandible are most commonly fractured?
Condyle (36%), body (21%), and angle (20%).
31
Which part of the mandible is most commonly fractured in children?
Condyle.
32
Which teeth can be used in children between the ages of 5 and 8 for immobilization?
Deciduous molars.
33
What are the most common injuries associated with facial trauma in children?
Dental injuries.
34
What are the absolute indications for open reduction of a condylar fracture?
Displacement of the fracture fragments into the middle cranial fossa; Inadequate reduction; extracapsular displacement of the condyle and foreign-body in the joint.
35
After caustic ingestion, what sign is most likely to signal the development of a complication?
Drooling.
36
What are the most common etiologies of nerve dysfunction after longitudinal temporal bone fracture?
Edema and intraneural hemorrhage.
37
Which types of laryngeal injuries are best managed medically?
Edema; small hematoma with intact mucosa; small glottic or supraglottic lacerations not involving the free margin of the vocal cords or the anterior commissure and without cartilage exposure; single nondisplaced thyroid cartilage fractures.
38
What is the medical management of CSF leak?
Elevation of the head of bed, antitussives, laxatives, antihypertensives, analgesics, bed rest, lumbar drain.
39
What is the management of patients with evidence of grade 2 or 3 injury (transmucosal or transmural) on endoscopic exam?
Esophageal rest (NPO), reflux precautions, +I- steroids, +I- antibiotics, +I lathyrogens, +I- subcutaneous heparin, +I- nasogastric tube, +I- prophylactic bougienage.
40
True/False: Airway foreign bodies are more common than esophageal foreign bodies.
False.
41
'What is the typical course of the fracture line in transverse temporal bone fractures?
Foramen magnum across the petrous apex, across the internal auditory canal and otic capsule, to the foramen spinosum or lacerum.
42
What is a class I mandible fracture?
Fracture between two teeth.
43
What is a class III mandible fracture?
Fracture in an edentulous area.
44
What are favorable fractures?
Fractures where the muscles tend to draw the fragments together.
45
What are the contraindications to steroid use?
Grade 3 burns, esophageal or gastric perforation.
46
Transcatheter arterial embolization is most useful in the management of what type of neck injury?
Gunshot wound to zone III of the neck.
47
What are the two types of nontraumatic cerebrospinal fluid (CSF) leaks?
High pressure and normal pressure.
48
What is the optimal treatment for a nondisplaced condylar fracture?
If occlusion is normal, soft diet and close observation; bilateral fractures or unilateral fractures with malocclusion should be treated with MMF for 3 weeks, then elastics for 2 weeks.
49
What should be done for the patient who has ingested a battery?
If the battery is still in the esophagus (confirmed by radiographs), immediate esophagoscopy is indicated. If it has passed into the stomach, it can be allowed to pass.
50
What is the strongest predictor of poor recovery of facial nerve function following temporal bone trauma?
Immediate onset of facial paralysis in a patient with a closed head injury.
51
What are the sequelae of untreated lateral zygomatic arch fractures?
Increased midfacial width and malar flattening.
52
What is the most common mechanism of CHL in longitudinal fractures?
Incudostapedial joint dislocation.
53
What is a type B ZMC fracture?
Injury to each of the four supporting structures.
54
What are the treatment options for children between 2 and 5 years of age?
Interdental eyelet wiring, arch bars, cap splints, or soft diet.
55
What are the three types of paediatric condylar fractures?
Intracapsular crush fractures of the condylar head, high condylar fractures through the neck above the sigmoid notch, and low subcondylar fractures.
56
Among children, which mandible fractures result in the highest incidence of dentofacial abnormalities?
Intracapsular crush fractures of the condyle.
57
What is a type A zygomaticomaxillary complex fracture (ZMC) fracture?
Isolated to one component of the tetrapod structure (zygomatic arch, lateral orbital wall, or inferior orbital rim).
58
Which types of laryngeal injuries require open exploration and repair?
Lacerations involving the free margin of the vocal cord or anterior commissure; large mucosal lacerations with exposed cartilage; multiple displaced cartilage fractures; avulsed or dislocated arytenoids; vocal cord immobility.
59
Which of the LeFort fractures involves the infraorbital rim?
LeFort II.
60
What is the major advantage of immediate aggressive reconstruction after a high-energy gunshot wound to the face?
Less soft tissue scarring and contracture.
61
Which of these is most common?
Longitudinal (80-90%).
62
What are the three types of temporal bone fractures?
Longitudinal, transverse, and mixed.
63
Which of these is associated with conductive hearing loss (CHL)?
Longitudinal.
64
Which of these accounts for the majority of facial nerve injuries?
Longitudinal.
65
Which type of paediatric condylar fracture is most common?
Low subcondylar fracture (often incomplete or "greenstick" injury).
66
What are the sequelae of untreated maxillary fractures?
Midface retrusion, facial elongation, and anterior open bite deformity.
67
What is the management of patients with evidence of grade 1 injury (superficial) on endoscopic exam?
No intervention; schedule for esophagogram in 3 weeks.
68
What is the most likely consequence of ingesting hair relaxer?
No long-term sequelae.
69
What sort of neurologic sequelae usually result from isolated unilateral vertebral artery injury?
None.
70
What is the most common cause of CSF leak?
Nonsurgical trauma.
71
What is the most common type of temporal bone fracture in children?
Obliquely oriented fractures.
72
In patients with mandible fractures, what mechanisms of injury are most predictive of an associated cervical spine injury?
Penetrating high-velocity gunshot injury; high-velocity MVA.
73
What is the most common area of facial nerve injury following trauma?
Perigenicular area.
74
What is the appropriate management for a deep puncture wound from a dog or cat bite?
Post-exposure rabies prophylaxis should be considered for all bites. If the animal is healthy, it should be quarantined for 10 days to exclude rabies. If the animal is unavailable or suspected rabid, immediate vaccination and immunoglobulin therapy should be administered. In addition, antibiotic coverage to include Pasteurella multocida should be initiated.
75
Once the ABCs have been stabilized, what is the acute management of caustic ingestion injury?
Prevent ongoing injury with irrigation of eyes, skin, and mouth, +I- flushing of the esophagus and stomach with water or milk
76
Which teeth can be used in children between the ages of 7 and 11 for immobilization?
Primary molars and incisors.
77
Why should all patients with history of caustic ingestion be followed for life with repeated esophagograms and endoscopy?
Risk of SCCA of the esophagus is 1000 times that of the general population.
78
What is a type III NOE fracture?
Severely comminuted fracture with disruption of the medial canthal tendon or too small of a central fragment to be repaired directly.
79
What is a type I NOE fracture?
Single, noncomminuted central segment fracture.
80
What is the usual treatment of condylar fractures in children?
Soft diet.
81
In a child, what is the treatment for an incomplete monocortical crack of the mandibular body with normal occlusion and movement?
Soft diet.
82
Which types of laryngeal injuries are more common in children than in adults?
Soft tissue injury with edema, arytenoid dislocation, and recurrent laryngeal nerve injury; telescoping injuries where the cricoid becomes displaced under the thyroid.
83
Where is the most likely site of injury after ingestion of an acidic caustic agent?
Stomach.
84
What injuries are more commonly associated with laryngotracheal separation than with other laryngeal injuries?
Subglottic stenosis and bilateral recurrent laryngeal nerve injury.
85
What is a class II mandible fracture?
Teeth are present on only one side of the fracture.
86
What is a serious complication of lumbar drainage?
Tension pneumocephalus.
87
What is the difference in tooth viability when comparing plates versus wires for fixation of mandible fractures?
There is a significant increase in the nonviability of teeth in the line and adjacent to fractures of the mandible treated by plates compared with those treated with wires.
88
What structure is most likely to be fractured after blunt trauma to the anterior neck?
Thyroid cartilage.
89
Which of these fractures is most likely to result in facial nerve paralysis?
Transverse.
90
Which type of temporal bone fracture is most likely to occur from a blow to the occiput?
Transverse.
91
True/False: Cranio-aural CSF leaks are more likely to spontaneously close than cranionasal CSF leaks.
True.
92
True/False: A mandible fracture in a child is much more likely to be associated with other injuries than in an adult.
True.
93
True/False: Inducing emesis and activated charcoal are contraindicated in the management of caustic ingestion.
True.
94
True/False: The incidence of foreign body aspiration is equal between the right and left bronchus in children.
True: The left bronchus is not as obliquely angled in children as in adults.
95
Which of these is least common?
Type A.
96
How do type I, II, and III NOE fractures differ in terms of management?
Type I fractures usually can be repaired with microplates; type II fractures usually require transnasal wires in addition to plate fixation; type III fractures usually require at least two sets of transnasal wires and may require bone grafting.
97
What are the typical features of esophageal cancer occurring after esophageal stricture from burn injury?
Usually SCCA, with onset 25-70 years postinjury, occurring within the scar tissue, with a lower incidence of distant metastases and higher chance of cure with surgical resection.
98
When is it too late to attempt carotid artery revscularisation after injury?
When coma has occurred beyond 3 hours, if an anemic infarction has occurred, or if no vascular back flow is present.
99
When can bicortical plates be used in children?
When permanent dentition is present.
100
What are the indications for open reduction of condylar fractures in children?
When the fractured condyle directly interferes with jaw movement; when the fracture reduces the height of the ramus and results in an open-bite deformity; when the condyle is dislocated into the middle cranial fossa.
101
When should open exploration be performed after injury?
Within 24 hours.
