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Resident Manual of Trauma to the Face, Head, and Neck

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Resident Manual of Trauma to the Face, Head, and Neck Resident Manual of Trauma to the Face, Head, and Neck First Edition ©2012 All materials in this eBook are copyrighted by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, 1650 Diagonal Road, Alexandria, VA 22314-2857, and are strictly prohibited to be used for any purpose without prior express written authorizations from the American Academy of Otolaryngology— Head and Neck Surgery Foundation. All rights reserved. For more information, visit our website at www.entnet.org. eBook Format: First Edition 2012. ISBN: 978-0-615-64912-2 Contents Preface ..................................................................................................................16 Acknowledgments .............................................................................................18 Resident Trauma Manual Authors ...............................................................19 Chapter 1: Patient Assessment ......................................................................21 I. Diagnostic Evaluations ........................................................................21 A. Full-Body Trauma Assessment ....................................................21 B. History ...............................................................................................22 C. Head and Neck Examination........................................................24 1. Upper Third ................................................................................24 2. Middle Third ...............................................................................24 3. Lower Third .................................................................................26 4. Otoscopy .....................................................................................26 5. Neurologic Examination ..........................................................27 D. Infection Control .............................................................................27 E. Imaging Studies ...............................................................................27 F. Laboratory Tests .............................................................................28 G. Digital Photographs........................................................................28 II. References ..............................................................................................28 Chapter 2: General Principles in Treating Facial, Head, and Neck Trauma ...............................................................................................30 I. Special Mechanisms of Injury ...........................................................30 A. Gunshot Wounds ............................................................................30 1. Ballistic Sequences ...................................................................30 2. Main Factors Affecting Projectile Strike ..............................30 B. Blast Injuries .....................................................................................32 1. Mechanisms for Causing and Types of Blast Injury .........32 II. Traumatic Brain Injuries .....................................................................34 A. Closed Head Injuries .......................................................................34 1. Classification by Presenting Signs and Symptoms ..........34 2. Classification by CT Findings .................................................34 3. Classification by Anatomy .....................................................34 4. Initial Assessment ....................................................................34 B. Penetrating Head Injury ................................................................35 C. Cautionary Notes on the Acute Management of Patients with Head Injury .............................................................35 www.entnet.org 1 III. Principles of Soft Tissue Wound Management ..........................36 A. Initial Wound Management ..........................................................36 1. Cleansing ....................................................................................36 2. Debridement ..............................................................................36 3. Passive Drains ............................................................................36 4. IV Antibiotics and Tetanus Toxoid ........................................36 5. Inspection and Documentation.............................................36 B. Primary versus Delayed Closure .................................................36 C. Laceration Care after Repair ........................................................36 1. Closing Clean Wounds Primarily ..........................................36 2. Avoiding Additional Incisions ................................................37 3. Reconstructing the Facial Framework Early .......................37 D. Bite Wounds .....................................................................................37 IV. Principles of Plating .............................................................................38 A. Reconstructive Goals .....................................................................38 B. Technical Objectives ......................................................................38 1. Stability at Each Fracture Site ................................................38 2. Three-Point Fixation of Mobile Segments ..........................38 3. Bone Fragment Contact ..........................................................38 C Plating Systems ..............................................................................38 1. Metal Plating ..............................................................................39 2. Resorbable Plating ....................................................................39 V. References and Resources ................................................................39 Chapter 3: Upper Facial Trauma I. Frontal Sinus and Anterior Skull Base Trauma .............................41 A. Introduction .......................................................................................41 B. Classification....................................................................................42 C. Presentation .....................................................................................43 1. Anterior Wall Fractures ...........................................................43 2. Posterior Wall Fractures ..........................................................43 3. Frontonasal Duct Fractures ................................................... 44 4. Corner Fractures ..................................................................... 44 5. Through-and-Through Fractures .......................................... 44 D. Management ...................................................................................45 1. Anterior Wall Fractures ...........................................................45 2. Posterior Wall Fractures ........................................................ 46 3. Frontonasal Duct Fractures ...................................................47 4. Through-and-Through Fractures .......................................... 48 II. Naso-orbital-ethmoid Fractures .......................................................51 A. Anatomic Structures of the NOE Complex ..............................52 B. Indications of Injury to the NOE Complex Structures ...........53 2 Resident Manual of Trauma to the Face, Head, and Neck 1. Symptoms (Subjective) ...........................................................53 2. Signs (Objective) ......................................................................53 C. Classification of Medial Canthal Tendon Injuries ...................57 D. Lacrimal System Injuries ...............................................................57 1. Primary Jones Dye Test ...........................................................58 2. Secondary Jones Dye Test ......................................................58 E. Isolated Orbital Fractures .............................................................59 F. Diagnostic Evaluations ..................................................................59 1. Full-Body Trauma Assessment .............................................59 2. Head and Neck Examination .................................................59 3. Ophthalmological Evaluation ................................................59 4. Inspection of the Nasal Interior............................................ 60 5. Interpupillary and Intercanthal Distance Measurements ........................................................................ 60 6. Imaging Studies ....................................................................... 60 7. Forced Duction Testing .......................................................... 60 8. Plain Radiographs of the Face ................................................61 9. Digital Photographs ..................................................................61 G. Surgical Management ...................................................................62 1. Indications for Surgery ............................................................62 2. Timing of Surgical Procedures ...............................................62 3. Surgical Exposure Options .....................................................62 4. Reconstructive Options ...........................................................66 H. Prevention and Management of Complications .....................69 1. Indications for Antibiotics ......................................................69
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