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TRAUMA and FBs in ENT

TRAUMA and FBs in ENT. Dr. Badi ALDOSARI Assistant Professor Facial Plastic Surgery Consultant ENT Consultant King Abdulaziz University Hospital. Objectives of the lecture.

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TRAUMA and FBs in ENT

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  1. TRAUMA and FBs inENT Dr. Badi ALDOSARI Assistant Professor Facial Plastic Surgery Consultant ENT Consultant King Abdulaziz University Hospital

  2. Objectives of thelecture • Discuss the presentation of patients with trauma to the nose, ear or the larynx and patients with ingested or inhaled FBs or with FBS in the nose or theear. • Discuss the management of those patientwith • emphasis on the emergencytreatment.

  3. NasalTrauma

  4. Manifestations of nasaltrauma • Fracture nasalbone • Septalinjury • Displacement • Hematoma • Perforation • Synechia • CSFrhinorrhea • Epistaxis

  5. Fracture NasalBone

  6. PhysicalExamination

  7. Radiology • Usually is not necessary because treatment • depends on the clinical findings

  8. Management of fracturednasal bone • Depends upon the presence or the absence of nasal deformity (for proper assessment of the “shape” of the nose you may wait “few” days for the edema to subside) Nodeformity Deformity •Reduction if presentedearly Notreatment •Rhinoplasty if presentedlate

  9. Reduction

  10. Rhinoplasty • To correct “old”fractures

  11. Nasal SeptumInjury

  12. Displacement of nasalseptum

  13. Presentation • May beasymptomatic • Nasalobstruction • Cosmeticdeformity

  14. Treatmentof displacement ofnasal septum • No symptoms: notreatment • Symptomatic • Early presentation: Reposition • Late presentation:Septoplasty

  15. Septoplasty

  16. Septalhematoma

  17. Septalhematoma

  18. Presentation • Nasalobstruction

  19. Complications of Septalhematoma • Necrosis of thecartilage • –Deformity

  20. Complications of Septalhematoma • Necrosis of thecartilage • –Deformity

  21. Complications of Septalhematoma • Necrosis of thecartilage • Deformity • Infection • Septalabscess • Spread to theintracranium

  22. Treatment of septalhematoma • Immediate incision &drainage

  23. Traumatic septalperforation • Mostly dueto • surgicaltrauma • May be due toself • inflictedtrauma

  24. Symptoms • Nosymptoms • Whistling sound during breathing • Crusting andepistaxia

  25. Treatment • Notreatment • Nasalwash • Surgicalrepair • Insertionof silicon“button”

  26. Synechia • Usually followsurgery • May beasymptomatic • May cause nasalobstruction • If symptomatic, treatmentis by division and insertion of silastic sheets (for 10days)

  27. CSFRhinorrhea • Due to injury of the roof of thenos and thedura e 33

  28. CSFRhinorrhea • Due to injury of the roof of thenose and thedura 34

  29. CSFRhinorrhea • Due to injury of the roof of thenose and thedura • Unilateral watery rhinorrhea increases by bending forward, exertion andcoughing 35

  30. CSFRhinorrhea • Due to injury of the roof of thenose and thedura • Unilateral watery rhinorrhea increases by bending forward, exertion andcoughing • Halosign • Diagnosis is confirmed by biochemical analysis (Beta-2-transferrin) and by radiology • Most cases resolve withconservative treatment • Surgical repair may be neededin • minority ofcases 36

  31. Complications of CSFRhinorrhea • Meningitis • Tensionpneumocephalus

  32. SinusTrauma

  33. Blow-outfracture • Injury of the orbital floor (maxillary sinusroof) • due to blunt trauma to theorbit

  34. Physicalexamination • Enophthalmos • Subconjuctivalhge • Diplopia and restriction ofupward gaze

  35. Radiology Tear-dropsign

  36. Treatment • Repair

  37. Nasal ForeignBodies • May beasymptomatic • Unilateral nasalobstruction • Bad odor blood stained unilateralnasal • discharge

  38. Examination

  39. Radiology Rhinolith

  40. Treatment • Removal (general anesthesia may beneeded) • Disc batteries removal is an emergency because of sever necrosis due to release of NaOH, KOH, & mercury

  41. EarTrauma

  42. Trauma to theAuricle • Laceration

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