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 1.Skin and soft tissue injury 2.Fractured nasal bone

4. Management A.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

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

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

10. 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

12. 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.

14. Larynx and Trachea a.External trauma b.Internal trauma c.Foreign body d.Caustic ingestion

15. Internal Trauma 1.E.T.T. 2.High tracheostomy 3.Endoscopy

16. Pathology 1.Edema 2.Hematoma 3.Cord avulsion 4.Arythenoid discoloration 5.Subglottic stenosis 6.Post intubation granuloma

17. 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

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

19. 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

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

21. 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.

22. 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.

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

24. 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

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

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

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

28. Treatment 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).

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

30. 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.