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Head & Neck Trauma: Mechanisms, Management, and Complications

Explore the mechanisms, evaluation, and treatment of head and neck trauma, including auricle injuries, nasal fractures, and laryngeal trauma. Learn about complications, radiographic imaging, and surgical interventions for various traumas.

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Head & Neck Trauma: Mechanisms, Management, and Complications

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  1. Head&NeckTrauma Dr.Mohammad aloulah, MBBS,SBORL(c)AssistantProfessorKingSaudUniversity OtolaryngologyConsultant l

  2. MechanismsofTrauma • MVA • Iatrogenic • Burns and frostbite • Noise • Barotrauma

  3. Auricleinjuries • Hematomas separate the perichondrium (bloodsupply) from the cartilage Æexcise fibrous tissue • Apply pressure dressing , drain • Avulsion: - Reimplantation - Microvascular anastomosis

  4. CauliflowerEar

  5. ComplicationsofEar-Piercing

  6. Case LEFT EAR (AS) 250 500 1000 2000 4000 8000 0 102030405060708090 NR IPSI & CONTRA 100 1 110 1

  7. Hemotympanum

  8. R

  9. Longitudinal TB#

  10. ComplicationsofTB# • Hearing loss • Vertigo • Tinnitus • Facial paralysis • CSF leak • Carotid injury

  11. Naso-orbital EthmoidandFrontalSinusFractures

  12. Naso-orbital Ethmoid Fractures Failure of Diagnosis Leads to SignificantFacial Deformities

  13. Septalhematoma

  14. Nasal Fracture with Septal Hematoma

  15. Complication Nasal Deformity - Flattened Nasal Dorsum - Septal Deviation / Dislocation Intracranial Involvement - Cerebrospinal Fistula - Pneumocephalus

  16. GoalsofManagement •ABC • Soft Tissue Repair • Framework Reconstitution - Nasas Region - Orbital - Nasal Support - Sinus

  17. Anatomy/ZoneI • Cricoid Æ sternum and clavicles • Contains the - Subclavian arteries and veins - Dome of the pleura - Esophagus - Great vessels of the neck +recurrent nerve - Trachea • S/S may be hidden from inspection in themediastinum or chest

  18. Anatomy/ZoneII • Cricoid Æ Angle of the mandible • Contains the - Larynx - Pharynx - Carotid artery and jugular vein - Phrenic, vagus, and hypoglossal nerves • Injuries here are seldom occult • Common site of carotid injury

  19. Anatomy/ZoneIII • Lies above the angle of the mandible • Contains the - Internal and external carotid arteries - Vertebral artery - Several cranial nerves • Vascular and cranial nerve injuries common

  20. History • Obtain from witnesses, patient • Mechanisms of injury - stab wounds, gunshot wound, high-energy, low-energy • Estimate of blood loss at scene • Any associated thoracic, abdominal,extremity injuries • Neurologic history

  21. PhysicalExamination • Thorough head and neck exam • Palpation and stethoscope (thrills and bruits) • Neuro exam: mental status, cranial nerves, andspinal column • Examine the chest, abdomen, and extremities • Be sure to examine the back of the patient as • Don’t blindly explore wound or clamp vessel

  22. Radiographs • CXR - inspiratory/expiratory /Lateral • Cervical spine film to rule out fractures • Soft tissue neck films AP and Lateral • CT Scan • Arteriograms, contrast studies as indicated

  23. Intubation:Indications • Failure to oxygenate • Failure to remove CO2 • Increased WOB • Neuromuscular weakness • CNS failure • Cardiovascular failure

  24. LaryngealTrauma

  25. Introduction • Functions - Airway - Voice - Swallowing • Well protected (mandible, sternum) • Support: Hyoid, thyroid, cricoid • Outcome determined by initial management

  26. MechanismofInjury • Blunt - MVA, strangulation, clothesline, sports related - Significant internal damage, minimal signs • Penetrating - GSW: damage related to velocity - Knife: easy to underestimate damage

  27. InitialEvaluation •ABC • Secure airway - local tracheotomy • Intubation can worsen airway • Avoid cricothyroidotomy • Pediatric: tracheotomy over bronchoscope • Clear C-spine

  28. History • Change in voice - most reliable • Dysphagia • Odynophagia • Difficulty breathing - more severe injury • Anterior neck pain • Hemoptysis

  29. SignsofRespiratoryDistress • Tachypnea •Retractions • Tachycardia •Accessmuscles • Grunting •Wheezing • Stridor •Sweating • Head bobbing •Prolonged • Flaring expiration • Inability to lie down •Pulsusparadoxus •Apnea • Agitation •Cyanosis

  30. Physicalexam • Stridor • Hoarseness • Subcutaneous emphysema • Laryngeal tenderness, ecchymosis, edema • Loss of thyroid cartilage prominence • Associated injuries - vascular, cervical spine,esophageal

  31. PhysicalExam

  32. Flexible FiberopticLaryngoscopy • Perform in emergency room • Findings dictate next step - CT scan - Tracheotomy - Endoscopic - Surgical Exploration - Other studies

  33. Laryngoscopic Exam

  34. RadiographicImaging • C-spine • CXR • CT • Angiography • Contrast esophagrams

  35. CTScan

  36. CT Scan

  37. Laryngeal Trauma Asymptomatic or minimal symptoms F/L CT scan Displaced fracture Mild Edema (by CT or exam) Small hematoma Loss of mucosa or extensive laceration Non-displaced linear fracture Intact mucosa Bleeding Exposed cartilage Tracheotomy Small lacerations Bed rest Cool mistAntibiotics Panendoscopy SteroidsAnti-reflux Explore

  38. Laryngeal Trauma Respiratory distress, open wounds, bleeding Tracheotomy Panendoscopy Explore

  39. Laryngeal Framework Repair

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