DR. SAAD AL-MUHAYAWI, M.D., FRCSC. ORL Head & Neck Surgery

Transcription

1 TRAUMA IN ORL DR. SAAD AL-MUHAYAWI, M.D., FRCSC Associate Professor & Consultant ORL Head & Neck Surgery

2 TYPES OF TRAUMA EAR & TEMPORAL BONE TRAUMA NOSE & FACIAL BONES TRAUMA LARYNGEAL TRAUMA NECK TRAUMA CAUSTIC INGESTION

3 PRIORITIES IN TRAUMA A Airway B Breathing C Circulation Priorities according to life threatening situation

4 AURICULAR HEMATOMA Blunt trauma Shear injury Contact sports / child abuse Hematoma Between cartilage and perichondrium Fluctuant anterior swelling

5 Treatment Needle aspiration: inadequate Incision & drainage: recommended Compressive dressing Antistaph antibiotics Complications Infection / abscess Cauliflower ear

6 AURICULAR HEMATOMA

7

8 AURICULAR HEMATOMA

9 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.

10 Evaluation Assess function: tunning forks, audiogram Radiology Head CT scan: evaluate for head injury HRCT of temporal bone with bony window Evaluate extent tof fthe fracture

11 TEMPORAL BONE FRACTURE

12 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

13 Vertigo: Treat symptomatically Meclizine, physical therapy

14 Physical examination

15 CT findings

16 TEMPORAL BONE FRACTURE

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

18 NASAL FRACTURE

19 Management NASAL FRACTURE

20 NASAL FRACTURE

21 ZYGOMA FRACTURE Signs and symptoms Subconjunctival hemorrhage Infraorbital hypesthesia Depressed malar eminence Ti Trismus /bony step off

22 Evaluation Facial CT coronal cuts Ophthalmology evaluation Evaluate for ocular injury Management Open reduction / internal fixation ( ORIF)

23 ZYGOMA FRACTURE

24 ZYGOMA FRACTURE

25 ZYGOMA FRACTURE

26 ORBITAL FLOOR FRACTURE

27 ORBITAL FLOOR FRACTURE

28 ORBITAL FLOOR FRACTURE

29 MANDIBLE FRACTURE 1/3 ½ facial fractures Signs and symptoms Malocclusion, step off Floor of mouth hematoma Chin ( V3) hypoesthesia

30 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

31 MANDIBLE FRACTURE

32 MANDIBLE FRACTURE

33 Management Soft diet, severe fractures Pdi Pediatric, i normal occlusion Non displaced Ramus, subcondylar Closed reduction Minimally displaced Open reduction Complications Infection / non union Malocclusion

34 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

35 Avoid nasal instrumentation, cranial penetration Recognize and treat closed head injury Brisk epistaxis common posterior nasal packing Suspect tcsf leak Open reduction and internal fixation

36

37 MIDFACE FRACTURES

38 MIDFACE FRACTURE

39 MIDFACE FRACTURE

40 MIDFACE FRACTURE

41 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)

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

43 BLUNT LARYNGEAL TRAUMA EVALUATION

44 BLUNT LARYNGEAL TRAUMA EVALUATION

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

46 BLUNT LARYNGEAL TRAUMA MANAGEMENT

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

48 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%)

49 PENETRATING NECK TRAUMA

50 PENETRATING NECK TRAUMA

51 PENETRATING NECK TRAUMA MANAGEMENT

52 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

53 PENETRATING NECK TRAUMA PATTERNS OF INJURY Pharynx& esophagus- 10% Pi Pain, Dysphagia, Hematemesis Barium Swallow/ Esophagoscopy Complications Mediastinitis, Sepsis, Fistula Larynx& Trachea-9% Hoarseness, Stridor, Hemoptysis Laryngoscopy, Bronchoscopy Complications Laryngeal Dysfunction, Stenosis

54 PENETRATING NECK TRAUMA

55 PENETRATING NECK TRAUMA

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

57 CAUSTIC INGESTION Alkalis ph > 7 Liquefaction necrosis Acids ph < 7 Coagulation necrosis Bleaches ph = 7 Irritants

58 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

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

60 CAUSTIC INGESTION