Revision 2Revision 2

Dr. Saad Al-Muhayawi, M.D., FRCSC

Associate Professor & Consultant

Otolaryngology Head & Neck Surgery

Etiology:• M.V.A.• Fighting• Falling

Nose

Nasal Trauma1. Skin and soft tissue injury

2. Fractured nasal bone

ManagementManagement

A. Skin and soft tissue injury1. Abrasions

2. Lacerations (small or large)• Clean the wound with antiseptic solution• Remove the foreign body (glasses)• Always anti-tetanus and antibiotics

B. Fractured nasal bone1. Frontal blow

2. Blow from the side• X-ray important from medico-legal point of

view but the diagnosis is always clinically

• Small abrasions

- Clean and apply topical antibiotics• Small lacerations

- Clean and apply stirstrips• Large lacerations

- Approximately with suture

- Remove in 5 days

Trauma of the ORLTrauma of the ORL

• Nose• Larynx and trachea• Pharynx and

esophagus• Ear

EtiologyEtiology

• M.V.A.• War• Sport

Obstructive airway is the second most common cause of death associated with head and neck trauma.

Don’t forget to look inside the Don’t forget to look inside the nose for septal hematoma and nose for septal hematoma and septal deviationseptal deviation..

• Septal Hematoma

- Incision and drainage

- Nasal packing for 48 hours

- Prophylactic antibiotic for 5 days

TypesTypes• 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.

Larynx and TracheaLarynx and Trachea

a. External trauma

b. Internal trauma

c. Foreign body

d. Caustic ingestion

Internal TraumaInternal Trauma

1. E.T.T.

2. High tracheostomy

3. Endoscopy

PathologyPathology

1. Edema

2. Hematoma

3. Cord avulsion

4. Arythenoid discoloration

5. Subglottic stenosis

6. Post intubation granuloma

ManagementManagement

• 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

• Depend on severity• Severe cases (associated with intracranial

injury, severe bleeding) needs hospitalization and A.B.C.

• 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

ManagementManagement

3. Hoarseness

- > Vocal cord injury, arythenoid discoloration

4. Dysphagia, odenophagia

- > Hyoid fracture, retropharyngeal hematoma

Treatment for mild and moderate casesTreatment 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.

On ExaminationOn 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.

Trauma to the Pharynx Trauma to the Pharynx and Esophagusand Esophagus

• External trauma• Endoscopic trauma• Foreign body• Caustic ingestion

• 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

Endoscopic traumaEndoscopic trauma

• Etiology• Iatrogenic

- Extensive biopsy of neoplasm

- Difficult removal of sharp F.B.

- Dilatation of esophageal stricture

PathologyPathology

• Perforations

- > leakage of secretions to mediastinum

causing mediastinitis.

DiagnosisDiagnosis

• Clinical features and history

1. Chest x-ray (wide mediastinum)

2. Contrast esophagram

TreatmentTreatment

1. Immediate surgical drainage of the anterior and posterior mediastinum is the treatment of choice.

2. Broad spectrum antibiotics pre, intra, and post-operative.

3. Drainage can be via neck (upper esophagus) or via thorax (mid and lower esophagus).

TreatmentTreatment

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

ManagementManagement

• 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.