8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 1/60
DR. SAAD AL-MUHAYAWI, M.D., FRCSC
ORL Head & Neck Surgery
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 2/60
TYPES OF TRAUMATYPES OF TRAUMA
EAR & TEMPORAL BONE TRAUMA NOSE & FACIAL BONES TRAUMA
NECK TRAUMA
CAUSTIC INGESTION
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 3/60
PRIORITIES IN TRAUMAPRIORITIES IN TRAUMA
A – Airway B – Breathing
–Priorities according to life threatening
situation
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 4/60
AURICULAR HEMATOMAAURICULAR HEMATOMA
Blunt trauma– Shear injury
–
Hematoma
– Between cartilage and perichondrium
Fluctuant anterior swellin
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 5/60
– Needle aspiration: inadequate
– Incision & drainage: recommended
– Com ressive dressin
– Antistaph antibiotics
Complications
– Infection / abscess
– auliflo er ear
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 6/60
AURICULAR HEMATOMAAURICULAR HEMATOMA
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 8/60
AURICULAR HEMATOMAAURICULAR HEMATOMA
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 9/60
TEMPORAL BONE FRACTURETEMPORAL BONE FRACTURE
Blunt > penetrating – MVA, fall and assault– Associated with life threatening conditions
– Trauma protocol / clear c – spine
– Assess facial nerve function early
Immediate vs. delayed– Ear examination: hemotympanum, csf leak, TM
perforation.
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 10/60
– Assess function: tunning forks, audiogram
Radiology
– Head CT scan: evaluate for head in ur
HRCT of temporal bone with bony window
– va ua e ex en o e rac ure
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 11/60
TEMPORAL BONE FRACTURETEMPORAL BONE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 12/60
– 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
Conductive loss: ossicular reconstruction
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 13/60
er go:– Treat symptomatically
– Meclizine, physical therapy
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 14/60
Physical examinationPhysical examination
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 15/60
CT findingsCT findings
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 16/60
TEMPORAL BONE FRACTURETEMPORAL BONE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 17/60
NASAL FRACTURENASAL FRACTURE
Very common– ost common ac a racture
– 3rd most fractured bone
g n ex o susp c on or rac ure
– Mechanism, change in appearance
– p s ax s, nasa o s ruc on
Examine and palpate nose carefully
– ns a y, mo y, crep a on
– Fracture, septal hematoma
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 18/60
NASAL FRACTURENASAL FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 19/60
NASAL FRACTURENASAL FRACTURE
Management
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 20/60
NASAL FRACTURENASAL FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 21/60
ZYGOMA FRACTUREZYGOMA FRACTURE
Signs and symptoms– Subconjunctival hemorrhage
–
– Depressed malar eminence
– r smus ony s ep o
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 22/60
Evaluat on– Facial CT – coronal cuts
– Ophthalmology evaluation
Management
– Open reduction / internal fixation ( ORIF)
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 23/60
ZYGOMA FRACTUREZYGOMA FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 25/60
ZYGOMA FRACTUREZYGOMA FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 26/60
ORBITAL FLOOR FRACTUREORBITAL FLOOR FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 27/60
ORBITAL FLOOR FRACTUREORBITAL FLOOR FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 28/60
ORBITAL FLOOR FRACTUREORBITAL FLOOR FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 29/60
MANDIBLE FRACTUREMANDIBLE FRACTURE
1/3– ½ facial fractures Signs and symptoms
– ,
– Floor of mouth hematoma
– Chin ( V3) hypoesthesia
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 30/60
Evaluation– ecure air a – as needed
– Rule out associated injury
C – spine, facial fracture
oo asp ra on
– ( panarox, mandible series) plain x – ray
– CT – scan
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 31/60
MANDIBLE FRACTUREMANDIBLE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 32/60
MANDIBLE FRACTUREMANDIBLE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 33/60
– Soft diet, severe fractures
e atr c, norma occ us on
Non – displaced
– ,
Closed reduction
– Minimall dis laced
Open reduction
Complications
– – Malocclusion
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 34/60
MIDFACE FRACTURESMIDFACE FRACTURES
Diagnosis– Malocclusion, depressed midface, open bite
–
– CT scan – axial, coronal cuts
anagement
– Secure airway ( oral intubation if possible ) C – spine injury or laryngeal fracture: surgical
airway
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 35/60
– Avoid nasal instrumentation , cranialpenetration
– Recognize and treat closed head injury
– –
packing
– uspec ea
– Open reduction and internal fixation
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 37/60
MIDFACE FRACTURESMIDFACE FRACTURES
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 38/60
MIDFACE FRACTUREMIDFACE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 39/60
MIDFACE FRACTUREMIDFACE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 40/60
MIDFACE FRACTUREMIDFACE FRACTURE
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 41/60
BLUNT LARYNGEAL TRAUMABLUNT LARYNGEAL TRAUMA
Mechanism: MVA,Sport,Assault Signs and Symptoms
, ,
Sub-Q emphysema, Hemoptysis
Secure Airway
Oral Intubation- roblematicTracheotomy(not cricothyrotomy)
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 42/60
BLUNT LARYNGEAL TRAUMABLUNT LARYNGEAL TRAUMA
Flexible FiberopticLaryngoscopy
CT Scan- evaluate
skeletal derangement
Explporation/
Repair
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 43/60
EVALUATIONEVALUATION
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 44/60
EVALUATIONEVALUATION
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 45/60
BLUNT LARYNGEAL TRAUMABLUNT LARYNGEAL TRAUMA
Indications for CT scanSignificant voice alteration
Laceration or blood on endoscopy
oca o para ys s
Palpation suspicious of fracture
After tracheotomy- before definitive treatment
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 46/60
MANAGEMENTMANAGEMENT
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 47/60
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
Secure Airway, Clear C-spine Assume Multiple Injuries
-
Foreign bodies, Pneumothorax
Bony trauma
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 48/60
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
Weapons- Knife, Gun Determine Zone
-
2- cricoid to angle of mandible(78%)
3- above angle of mandible(6%)
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 49/60
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 50/60
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 52/60
PATTERNS OF INJURYPATTERNS OF INJURY
Vascular Injury
arot n ury
Signs & Symptoms
-
Expanding Hematoma- 2/3Clinically silent- 15%
Arteriogram- 97% sensitive
Embolization Possible-zone 1,3& vertebral artery
omp ca onsStroke, Exsanguination
Pseudoaneur sm, AV fistula
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 53/60
PATTERNS OF INJURYPATTERNS OF INJURY
Pharynx& esophagus- 10%
a n, ysp ag a, ematemes s
Barium Swallow/ Esophagoscopy
Mediastinitis, Sepsis, Fistula
-
Hoarseness, Stridor, Hemoptysis
Complications
Laryngeal Dysfunction, Stenosis
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 54/60
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 55/60
PENETRATING NECK TRAUMAPENETRATING NECK TRAUMA
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 56/60
CAUSTIC INGESTIONCAUSTIC INGESTION
Esophagus, pharynx, larynx Bases
Electric dishwasher soap
Hair relaxant
Acids Bleaches
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 57/60
CAUSTIC INGESTIONCAUSTIC INGESTION
Alkalis – pH > 7 Liquefaction necrosis
–
Coagulation necrosis
Bleaches – pH = 7
Irritants
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 58/60
CAUSTIC INGESTIONCAUSTIC INGESTION
Children- most common, accidental Adults- suicide attempt
Determine- brand name, quantity ingested
Call poison control center
8/3/2019 30902_trauma in Orl
http://slidepdf.com/reader/full/30902trauma-in-orl 59/60
CAUSTIC INGESTIONCAUSTIC INGESTION
Examination not predictive of severityMost without oral lesions
Flexible Laryngoscopy
Esophagogram
Esophagoscopy- early