Jayita Das Trauma in Otolaryngology

Jayita Das Trauma in Otolaryngology 123 Trauma in Otolaryngology Jayita Das Trauma in Otolaryngology Jayita Das Department of Otolaryngology Pondicherry Institute of Medical Science Kalapet Pondicherry India ISBN 978-981-10-6360-2 ISBN 978-981-10-6361-9 (eBook) https://doi.org/10.1007/978-981-10-6361-9 Library of Congress Control Number: 2017958869 © Springer Nature Singapore Pte Ltd. 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Foreword Trauma in ENT practice is fairly common, but its severity varies from trivial to a life-threatening emergency such as airway obstruction. The general practitioner is taught the basics of treating minor trauma and the initial lifesaving skills in dealing with major trauma before transferring the patient/casualty to the appropriate center for specialized care. The ENT surgeon, on the other hand, is expected to manage any ENT emergency regardless of whether he or she is practicing in a standalone clinic or a tertiary referral hospital. However, the emergency surgical skills are not learned fully during the training phase, due to many reasons, one being paucity of time and the second being exposure to real emergencies. This practical textbook written by Dr Jayita Das—associate professor, Department of ENT, Head & Neck Surgery, Pondicherry Institute of Medical Sciences—gives a detailed description of all kinds of trauma that an ENT or casualty medical officer may have to face. The pathophysiology, management principles, techniques, as well as prognosis have been described along with function restoration. I compliment the author for taking up a topic which is applicable and useful, for both a GP and the ENT doctor. The topics have been dealt with system- atically and covered in depth with good illustrations. The quiz at the end attempts to test the reader in assessing his/her level of competence after reading this excellent book. This book is recommended for all medical practitioners and especially ENT doctors. I congratulate the author for her excellent overview of the subject and clar- ity in expression. I wish her the very best for the success of this maiden attempt and wish her more success in future publications. A. Ravikumar, MS, DNB, DLORCS (England), FAMS, Department of ENT, Head & Neck Surgery, Sri Ramachandra Medical College & Research Institute, Chennai, India v Preface If only the human body could handle trauma as well as biotechnology stocks do. Spy novelist Alex Berenson was perhaps ignorant of the truth about the human body, and its ability to handle trauma, better and more efficiently than one could imagine. But there is a caveat here. It does matter which part of the human body suffers the trauma and what is the magnitude of the injury. Trauma can range from major to miniscule, physical to psychological, and emotional to electrical. Major trauma to the major organ systems—the cranial cavity, airway, chest and lungs, abdomen, and pelvis and long bones—is usually fatal or at least accompanied by a very high level of morbidity. Minor trauma, on the other hand, may often go unnoticed and unremembered. Physical trauma may be exter- nally obvious, but psychological trauma may fester for long periods of time and do even more serious damage to the sufferer. Emotional trauma could stop the heart in its tracks, literally, as could an electric shock running through the body. It now becomes clear that it is almost impossible to predict or preempt trauma and, further still, to formulate treatment policies that might apply to trauma in general. Each type of trauma, and the body part it affects, must be considered as a sepa- rate entity, and suitable management protocols devised. Most of the literature on trauma describes the issues or problems surrounding the wound and perhaps some host factors such as health, nutritional status, and immu- nity. It would therefore be interesting to look at how numerous other factors, mainly social and economic, directly or indirectly impact the outcomes arising out of trauma or its treatment. For example, much trauma or injurious insult results from urbanization of societ- ies and the occurrence of motor vehicle accidents. Also, increased life spans, artifi- cial life support, and assisted reproduction have added their peculiar imprint upon the evolution of trauma in many parts of the globe. All these, coupled with the monetary and educational standards of the population, and the health infrastructure of that region, play an important role. They also define how a particular kind of trauma might be dealt with using a particular level of expertise and thereby the final consequence of the particular event. There are some unique characteristics of trauma in ENT practice. Spanning the entire gamut of major and minor trauma, there are also factors which should take vii viii Preface into consideration demographic profiles and medicolegal aspects, besides the actual business of management of the said trauma. For example, variations among differ- ent age groups, rural and urban populations, and healthcare facilities available could impact the way trauma is treated. Outcomes would also vary accordingly. It is imperative to follow sound clinical practices, evidence-based medicine, and, of course, a gut instinct in order to ensure that the best outcomes result from the treatment of trauma. Because trauma is sudden and unpredictable, the outcomes of managing it have a telling impact upon the quality of life of the patient and reflect on the quality of healthcare facility in general and the doctor in particular. This book therefore endeavors to remind all practitioners of ENT the core principles of management of trauma in this specialty. The chapters describing trauma in each region in the head and neck are presented in a simple and comprehensive manner, with a background or introduction about the relevant anatomy and pathophysiology, the body or main text dealing with the clinical implications, and finally rounding off with a section on prognosis, best practice, future directions, and/or practical applications. A brief and gentle reminder of the embryological development of the ear and nose would hope- fully serve to sensitize the reader to the implications of trauma to these organs of special sense. The book follows an easy storytelling style instead of a bullet-point handbook format, specifically with the aim to suit the casual reader, slow reader, methodical reader, or even the reader who has no time to read! The first three chapters deal with the history of trauma care and general principles in trauma, while the next three specifically discuss trauma in the ear, nose, and throat regions. Chapter 7 describes eye trauma in the context of the ENT surgeon, while Chap. 8 is devoted to foreign bodies, which may be considered to form a particular type of trauma or external insult. Controversies regarding trauma in various regions of the head and neck are discussed in the respective chapters. Chapter 9 challenges trainees and practitioners alike with case scenarios taken from both institutional and independent settings. The last section provides a quick review in the form of a quiz. It is hoped that this book shall be able to provide everything the ENT practitioner wanted to know about trauma in this specialty and that the management of trauma will turn out to be a gratifying experience for both patient and doctor, in spite of the daunting implications it carries for most individuals. Kalapet, Pondicherry, India Jayita Das Acknowledgment The author wishes to convey her heartfelt gratitude to the following: Professor Ravikumar—mentor and role model—for writing the Foreword of this book. Patients, resident doctors, peers, and superiors at the Pondicherry Institute of Medical Sciences for the opportunity and purpose to take up this enterprise. My colleagues in the Department of Radiology—Dr Linu Kuruvilla and Dr Sreshtha Hegde—have helped me immensely with the sourcing of the images. A special word of thanks goes to my residents Paresh Pramod Naik and Roshan Marie Thomas for being friends, critics, and sounding boards. And my family without whose love, patience, and support this would not have been possible. Photo credits for the images of outer ear trauma also go to Dr Paresh Naik. Springer publishers for the valuable guidance and encouragement. ix About the Author Jayita Das is an ENT specialist with more than 20 years of operative experience in all areas of general otolaryngology practice, in both the private sector and institutional settings dealing with postgraduate training.

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