TRAUMA and FBs in ENT

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

9. 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

10. Reduction

12. Rhinoplasty • To correct “old”fractures

14. Nasal SeptumInjury

15. Displacement of nasalseptum

16. Presentation • May beasymptomatic • Nasalobstruction • Cosmeticdeformity

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

18. Septoplasty

19. Septalhematoma

20. Septalhematoma

21. Presentation • Nasalobstruction

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

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

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

25. Treatment of septalhematoma • Immediate incision &drainage

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

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

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

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

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

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

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

34. 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

35. Complications of CSFRhinorrhea • Meningitis • Tensionpneumocephalus

36. SinusTrauma

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

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

39. Radiology Tear-dropsign

40. Treatment • Repair

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

42. Examination

44. Radiology Rhinolith

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

49. EarTrauma

50. Trauma to theAuricle • Laceration