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TRAUMA IN ORL

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					         TRAUMA IN ORL
Dr. MOHIEDDIN MANDURA   FRCSI
     TYPES OF TRAUMA

   EAR & TEMPORAL BONE TRAUMA
   NOSE & FACIAL BONES TRAUMA
   LARYNGEAL TRAUMA
   NECK TRAUMA
   CAUSTIC INGESTION
    PRIORITIES IN TRAUMA

 A – Airway
 B – Breathing
 C – Circulation
Priorities according to life threatening
  situation
     AURICULAR HEMATOMA

   Blunt trauma
     Shear injury
     Contact sports / child abuse

   Hematoma
       Between cartilage and perichondrium
   Fluctuant anterior swelling
   Treatment
       Needle aspiration: inadequate
       Incision & drainage: recommended
       Compressive dressing
       Antistaph antibiotics


   Complications
       Infection / abscess
       Cauliflower ear
AURICULAR HEMATOMA
Treatment of Auricular
     Hematoma
    TEMPORAL BONE FRACTURE

   Blunt > penetrating – MVA, fall and
    assault
       Associated with life threatening
        conditions
   Evaluation
     Trauma protocol / clear c – spine
     Assess facial nerve function early
          Immediate   vs. delayed
       Ear examination: hemotympanum, csf
        leak, TM perforation.
Physical examination
TEMPORAL BONE FRACTURE
   Evaluation
       Assess function: tunning forks, audiogram
   Radiology
       Head CT scan: evaluate for head injury
   HRCT of temporal bone with bony
    window
       Evaluate extent of the fracture
CT findings
TEMPORAL BONE FRACTURE
   Management
       Facial nerve paralysis
            Immediate: operative exploration and repair
            Delayed: observe, steroids, eye protection
       CSF leak
            Conservative management
            Bed rest vs. lumbar drain
            > 90 % resolve in 2 weeks
       Hearing loss
            Sensorineural loss: hearing aid
            Conductive loss: ossicular reconstruction
   Vertigo:
     Treat symptomatically
     Meclizine, physical therapy
             NASAL FRACTURE

   Very common
       Most common facial fracture
       3rd most fractured bone
   High index of suspicion for fracture
       Mechanism, change in appearance
       Epistaxis, nasal obstruction
   Examine and palpate nose carefully
       Instability, mobility, crepitation
       Fracture, septal hematoma
NASAL FRACTURE
                 NASAL FRACTURE

   Management
           Complications




Septal deformity   Septal hematoma
        ZYGOMA FRACTURE

   Signs and symptoms
     Subconjunctival hemorrhage
     Infraorbital hypesthesia
     Depressed malar eminence
     Trismus / bony step off
   Evaluation
     Facial CT – coronal cuts
     Ophthalmology evaluation
          Evaluate   for ocular injury
   Management
       Open reduction / internal fixation ( ORIF)
ZYGOMA FRACTURE
ZYGOMA FRACTURE
ORBITAL FLOOR FRACTURE
ORBITAL FLOOR FRACTURE
ORBITAL FLOOR FRACTURE
        MANDIBLE FRACTURE

     ½ facial fractures
    1/3–

 Signs and symptoms
     Malocclusion, step off
     Floor of mouth hematoma
     Chin ( V3) hypoesthesia
   Evaluation
     Secure airway – as needed
     Rule out associated injury
         Closed head injury
         C – spine, facial fracture
         Tooth aspiration

     ( panarox, mandible series) plain x – ray
     CT – scan
MANDIBLE FRACTURE
MANDIBLE FRACTURE
   Management
       Soft diet, severe fractures
            Pediatric, normal occlusion
            Non – displaced
                 Ramus, subcondylar
            Closed reduction
                 Minimally displaced
            Open reduction

   Complications
       Infection / non union
       Malocclusion
        MIDFACE FRACTURES

   Diagnosis
     Malocclusion, depressed midface, open
      bite
     Assess midface mobility
     CT scan – axial, coronal cuts

   Management
       Secure airway ( oral intubation if
        possible )
         C – spine injury or laryngeal fracture:
          surgical airway
 Avoid nasal instrumentation , cranial
  penetration
 Recognize and treat closed head injury
 Brisk epistaxis common – posterior nasal
  packing
 Suspect CSF leak
 Open reduction and internal fixation
MIDFACE FRACTURES




      Open bite
MIDFACE FRACTURE
MIDFACE FRACTURE
MIDFACE FRACTURE
    BLUNT LARYNGEAL TRAUMA

 Mechanism: MVA,Sport,Assault
 Signs and Symptoms
      Hoarseness, Voice change, Stridor
      Sub-Q emphysema, Hemoptysis
   Secure Airway
      Oral Intubation-problematic
      Tracheotomy(not cricothyrotomy)
       BLUNT LARYNGEAL TRAUMA

 Flexible Fiberoptic
  Laryngoscopy
 CT Scan- evaluate
    skeletal
    derangement
   Surgical
    Explporation/
    Repair
BLUNT LARYNGEAL TRAUMA
      EVALUATION
BLUNT LARYNGEAL TRAUMA
      EVALUATION




   R vocal cord hematoma
    BLUNT LARYNGEAL TRAUMA

   Indications for CT scan
       Significant voice alteration
       Edema or hematoma on endoscopy
       Laceration or blood on endoscopy
       Vocal fold paralysis
       Palpation suspicious of fracture
       After tracheotomy- before definitive
    treatment
BLUNT LARYNGEAL TRAUMA
     MANAGEMENT
 PENETRATING NECK TRAUMA

 Secure Airway, Clear C-spine
 Assume Multiple Injuries
 X-rays Neck and Chest
    Foreign bodies, Pneumothorax
    Bony trauma
    PENETRATING NECK TRAUMA

   Weapons- Knife,
    Gun
   Determine Zone
        1- below
    cricoid(16%)
        2- cricoid to
    angle of
    mandible(78%)
        3- above angle
    of mandible(6%)
PENETRATING NECK TRAUMA
PENETRATING NECK TRAUMA
PENETRATING NECK TRAUMA
      MANAGEMENT
    PENETRATING NECK TRAUMA
           PATTERNS OF INJURY
   Vascular Injury
    Carotid injury
   Signs & Symptoms
        Neurologic Deficit- ¼
        Expanding Hematoma- 2/3
        Clinically silent- 15%
   Arteriogram- 97% sensitive
        Embolization Possible-zone 1,3& vertebral artery
   Complications
        Stroke, Exsanguination
        Pseudoaneurysm, AV fistula
    PENETRATING NECK TRAUMA
          PATTERNS OF INJURY
   Pharynx& esophagus- 10%
       Pain, Dysphagia, Hematemesis
       Barium Swallow/ Esophagoscopy
       Complications
             Mediastinitis, Sepsis, Fistula
   Larynx& Trachea-9%
       Hoarseness, Stridor, Hemoptysis
       Laryngoscopy, Bronchoscopy
       Complications
             Laryngeal Dysfunction, Stenosis
PENETRATING NECK TRAUMA
PENETRATING NECK TRAUMA
         CAUSTIC INGESTION

   Esophagus, pharynx, larynx
   Bases
       Drain cleaners
       Electric dishwasher soap
       Hair relaxant
   Acids
   Bleaches
         CAUSTIC INGESTION

   Alkalis – pH > 7
       Liquefaction necrosis
   Acids – pH < 7
       Coagulation necrosis
   Bleaches – pH = 7
       Irritants
        CAUSTIC INGESTION

 Children- most common, accidental
 Adults- suicide attempt
 Do not induce vomiting
 Determine- brand name, quantity
    ingested
        Call poison control center
        Alkali worse than acids
       CAUSTIC INGESTION

   Examination not predictive of severity
       Most without oral lesions
   Urgent speciality consultation
       Flexible Laryngoscopy
       Esophagogram
       Esophagoscopy- early
CAUSTIC INGESTION