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Revision 2

Revision 2. Dr. Saad Al-Muhayawi , M.D., FRCSC Associate Professor & Consultant Otolaryngology Head & Neck Surgery. Etiology: M.V.A. Fighting Falling. Nose Nasal Trauma Skin and soft tissue injury Fractured nasal bone. Management. Skin and soft tissue injury 1. Abrasions

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Revision 2

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  1. Revision 2 Dr. Saad Al-Muhayawi, M.D., FRCSC Associate Professor & Consultant Otolaryngology Head & Neck Surgery

  2. Etiology: • M.V.A. • Fighting • Falling

  3. Nose Nasal Trauma • Skin and soft tissue injury • Fractured nasal bone

  4. Management • Skin and soft tissue injury 1. Abrasions 2. Lacerations (small or large) • Clean the wound with antiseptic solution • Remove the foreign body (glasses) • Always anti-tetanus and antibiotics

  5. B. Fractured nasal bone 1. Frontal blow 2. Blow from the side • X-ray important from medico-legal point of view but the diagnosis is always clinically

  6. Small abrasions - Clean and apply topical antibiotics • Small lacerations - Clean and apply stirstrips • Large lacerations - Approximately with suture - Remove in 5 days

  7. Trauma of the ORL • Nose • Larynx and trachea • Pharynx and esophagus • Ear

  8. Etiology • M.V.A. • War • Sport Obstructive airway is the second most common cause of death associated with head and neck trauma.

  9. Don’t forget to look inside the nose for septal hematoma and septal deviation. • Septal Hematoma - Incision and drainage - Nasal packing for 48 hours - Prophylactic antibiotic for 5 days

  10. Types • Open injury usually severe and life threatening • The close injury tends to be less severe • The most common M.V.A. injury due to sudden decleration where the neck is hyper-extended exposing the larngo-tracheal tree between the vertebral column and steering. • N.B.: Using the seatbelt and balloon reduce the trauma to the airway.

  11. Larynx and Trachea • External trauma • Internal trauma • Foreign body • Caustic ingestion

  12. Internal Trauma • E.T.T. • High tracheostomy • Endoscopy

  13. Pathology • Edema • Hematoma • Cord avulsion • Arythenoid discoloration • Subglottic stenosis • Post intubation granuloma

  14. Management • Depend on the severity • In the severe cases the A.B.C. • In less severe cases, take the history 1. Dyspnea, stridor - >60% of airway compromise 2. Hemoptysis - > mucosal injury

  15. Depend on severity • Severe cases (associated with intracranial injury, severe bleeding) needs hospitalization and A.B.C.

  16. Fibro-optic endoscopy in sub-acute stage Radiological study in sub-acute stage 1. Lateral view 2. A.P. 3. C.T. scan, axial and cronal

  17. Management 3. Hoarseness - > Vocal cord injury, arythenoid discoloration 4. Dysphagia, odenophagia - > Hyoid fracture, retropharyngeal hematoma

  18. Treatment for mild and moderate cases • Any patient with a history of laryngotracheal trauma even with minimal symptoms should be: 1. Hospitalized? – bed rest 2. Cool mist 3. Decadron and antibiotics for 48 hrs.

  19. On Examination: • Deformity of the anterior neck • Crepitious of the larynx • Subcutaneous emphysema • In-closed injury to the airway, the appearance of the neck is always misleading.

  20. Trauma to the Pharynx and Esophagus • External trauma • Endoscopic trauma • Foreign body • Caustic ingestion

  21. External trauma due to gun shot or knifing • Associated with severe chest or abdominal trauma • After treating the more life threatening injury, we evaluate the esophageal trauma

  22. Endoscopic trauma • Etiology • Iatrogenic - Extensive biopsy of neoplasm - Difficult removal of sharp F.B. - Dilatation of esophageal stricture

  23. Pathology • Perforations - > leakage of secretions to mediastinum causing mediastinitis.

  24. Diagnosis • Clinical features and history 1. Chest x-ray (wide mediastinum) 2. Contrast esophagram

  25. Treatment • Immediate surgical drainage of the anterior and posterior mediastinum is the treatment of choice. • Broad spectrum antibiotics pre, intra, and post-operative. • Drainage can be via neck (upper esophagus) or via thorax (mid and lower esophagus).

  26. Treatment • Surgical drainage and repair under cover of broad spectrum antibiotic.

  27. Management • For undisplace fracture – observation • For displace fracture – if the patient seen in the first 2 hours (Stoical reduction in the OPD). • It patient seen later, usually wait for 5 days then close reduction ubder G.A. within 10 days. • Using Walsham’s or Asche forceps for reduction.

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