TRAUMA IN ORL

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

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 g

Treatment
Needle aspiration: inadequate Incision & drainage: recommended Compressive dressing p g Antistaph antibiotics

Complications
Infection / abscess Cauliflower ear

AURICULAR HEMATOMA

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

p perforation.

Evaluation
Assess function: tunning forks, audiogram

Radiology di l
Head CT scan: evaluate for head injury j y

HRCT of temporal bone with bony window

E l t extent of the fracture Evaluate t t f th f t

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: V ti
Treat symptomatically Meclizine, physical therapy

Physical examination

CT findings

TEMPORAL BONE FRACTURE

NASAL FRACTURE
Very common
M t common f i l fracture Most facial f t 3rd most fractured bone

High i d Hi h index of suspicion for fracture f i i f f t

Mechanism, change in appearance Epistaxis nasal obstruction Epistaxis,

Examine and palpate nose carefully

I t bilit mobility, crepitation Instability, bilit it ti Fracture, septal hematoma

NASAL FRACTURE

NASAL FRACTURE
Management

NASAL FRACTURE

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

Evaluation E l i
Facial CT coronal cuts Ophthalmology evaluation Evaluate for ocular injury

Management
Open reduction / internal fixation ( ORIF)

ZYGOMA FRACTURE

ZYGOMA FRACTURE

ZYGOMA FRACTURE

ORBITAL FLOOR FRACTURE

ORBITAL FLOOR FRACTURE

ORBITAL FLOOR FRACTURE

MANDIBLE FRACTURE
facial fractures Signs and symptoms
1/3

Malocclusion step off Malocclusion, 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, P di i normal occlusion l l i Non displaced
Ramus subcondylar Ramus,

Closed reduction
Minimally displaced y p

Open reduction

Complications
Infection / non union Malocclusion

MIDFACE FRACTURES
Diagnosis
Malocclusion, depressed midface, open bite Assess midface mobility CT scan axial, coronal cuts

Management M
Secure airway ( oral intubation if possible ) C spine injury or laryngeal fracture: surgical airway

 Avoid nasal instrumentation , cranial

p penetration Recognize and treat closed head injury Brisk epistaxis common posterior nasal packing Suspect CSF l k S t leak Open reduction and internal fixation

MIDFACE FRACTURES

MIDFACE FRACTURE

MIDFACE FRACTURE

MIDFACE FRACTURE

BLUNT LARYNGEAL TRAUMA

Mechanism: MVA,Sport,Assault Signs and Symptoms
Hoarseness, Hoarseness Voice change, Stridor change Sub-Q emphysema, Hemoptysis

Secure Airway
O Oral Intubation-problematic p Tracheotomy(not cricothyrotomy)

BLUNT LARYNGEAL TRAUMA

Flexible Fiberoptic Laryngoscopy C Scan- eva uate CT Sca evaluate
skeletal derangement

Surgical Explporation/ Repair i

BLUNT LARYNGEAL TRAUMA EVALUATION

BLUNT LARYNGEAL TRAUMA EVALUATION

BLUNT LARYNGEAL TRAUMA

Indications for CT scan
Significant voice alteration Edema or hematoma on endoscopy Laceration or blood on endoscopy Vocal fold V l f ld paralysis l i 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 X rays Neck and Chest
Foreign bodies, Pneumothorax Bony trauma

PENETRATING NECK TRAUMA

Weapons- Knife, Gun Determine Zone 11 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 i j C tid injury Signs & Symptoms
Neurologic Deficit- Expanding Hematoma- 2/3 Clinically silent- 15%

Arteriogram- 97% sensitive

Embolization Possible-zone 1,3& vertebral artery

Complications C li ti
Stroke, Exsanguination Pseudoaneurysm, AV fistula y ,

PENETRATING NECK TRAUMA

PATTERNS OF INJURY
Pharynx& esophagus- 10%
Pain, Dysphagia, Hematemesis P i D h i H t i Barium Swallow/ Esophagoscopy Complications
Mediastinitis, Sepsis, Fistula

Larynx& Trachea-9% 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 a

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