Trauma

A preliminary study of the use of ultrasound in defining nasal fractures: Criteria for a confident diagnosis

October 23, 2013     Farhad Ardeshirpour, MD; Keith M. Ladner, MD; Carol G. Shores, MD, PhD; William W. Shockley, MD
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Abstract

Nasal fractures are usually diagnosed by clinical examination, with or without the support of imaging studies. While plain-film radiography lacks sensitivity and specificity for diagnosing nasal fractures, and computed tomography (CT) is not always practical or cost-effective, ultrasonography (US) may be useful in this regard. The criteria by which adult nasal fractures are reliably identified on US must be clear. We conducted a preliminary prospective, controlled, observational study to define the appearance of nasal fractures on US. We used US to image 12 patients with a clinical or radiologic (CT or x-ray) diagnosis of nasal fracture. All patients presented within 2 weeks of their injury. For comparison purposes, we also obtained US images from 12 control subjects who had no history of nasal trauma or surgery. We found that we could confidently diagnose nasal fractures on lateral-view US on the basis of a disruption of bone continuity and/or displacement of fracture segments. However, our findings were not as consistent with dorsal-view US, and we do not believe it is adequate for diagnosis. We conclude that lateral US can be used to detect nasal fractures in adults, but further studies are needed to assess its sensitivity, specificity, cost-effectiveness, and practicality.

Traumatic tracheostomy and spent bullet aspiration after a gunshot injury: A case report

August 21, 2013     Jack Barasa, MD; Peter M. Nthumba, MD; and Peter Bird, FRACS
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Abstract

Penetrating tracheal injuries are rare. Even rarer is the finding of intrabronchial foreign bodies caused by penetrating objects. We report a patient who experienced a gunshot injury to the trachea and mandible. The tracheal wound was debrided and used as a tracheostomy; a spent bullet in the bronchial tree was missed on initial evaluation but later successfully retrieved bronchoscopically. Spent bullet aspiration is a very rare occurrence. A careful examination of radiographs is essential to aid with the diagnosis. Flexible bronchoscopy is the best means of bullet retrieval. Management of any associated injuries is made easier after the airway is secured.

Case report: Inadvertent carotid artery injury during myringotomy as a result of carotid artery dehiscence

July 21, 2013     Christopher Schutt, MD; Sharmila Dissanaike, MD; John Marchbanks, MD
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Abstract

We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.

Traumatic ossicle extrusion into the external auditory canal

June 11, 2013     Manish Gupta, MS(ENT); Sunder Singh, MS(ENT); and Monica Gupta, MD(Med)
article

Abstract

We report a rare case of incus dislocation into the external auditory canal following a head injury. The patient was a 35-year-old man who presented to the surgical emergency unit with a head injury that he had sustained during a traffic accident. An x-ray of the skull detected a longitudinal fracture of the right temporal bone. The ENT examination revealed the presence of a bony structure and a blood clot in the right external auditory canal. Computed tomography identified a disruption of the ossicular chain, with an incus-like bony shadow in the external canal. The wide opening of the fracture line and the impact of the accident were believed to have pushed the incus through the fracture and into the external canal. The patient was successfully treated with exploratory tympanotomy and ossiculoplasty.

Pressure ulcer of the pinna

June 11, 2013     Mainak Dutta, MS; Soumya Ghatak, MS; and Ramanuj Sinha, DLO, MS, DNB
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Pressure ulcers over the pinna usually develop as a result of local compression from oxygen mask tubing.

Endoscopic view of iatrogenic nasal septal perforations

December 31, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

While many surgically created nasal septal perforations are asymptomatic, others can create long-term problems.

Endoscopic management of a large temporal lobe encephalocele

December 31, 2012     Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
article

Encephaloceles arise when brain contents from the temporal lobe herniate through the middle cranial fossa and into the lateral sphenoid sinus.

Silent vocal fold hemorrhage

October 31, 2012     Thomas M. d'Arville, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article

Although most vocal fold hemorrhages resolve spontaneously, accurate and timely diagnosis permits the laryngologist to prescribe precautions that will prevent further damage. This is especially important for patients who use their voices in their professions.

Laryngeal ulceration and hemoptysis secondary to inadvertent alendronate overdose: Case report and review of the literature

October 31, 2012     John Hanna, DO; Joseph Bee, DO; and Robert T. Sataloff, MD, DMA, FACS
article

Abstract

Alendronate is commonly used in the treatment of osteoporosis and other bone diseases. Its drug profile includes many recognized side effects, and the literature includes case reports of esophageal irritation and ulceration. However, little has been published about laryngeal effects. We describe the case of a 77-year-old man who presented with hemoptysis secondary to laryngeal ulceration caused by the inadvertent misuse of alendronate. This case highlights the need for otolaryngologists to be familiar with alendronate and its side effects.

Dysphagia after strangulation

September 7, 2012     Jenna Briddell, MD; Andrew Mallon, DO; Rima A. DeFatta, MD; Farhad Chowdhury, DO; Matthew Nagorsky, MD, FACS
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Patients with an isolated cornu fracture can be asymptomatic in the acute setting, only to develop symptoms of chronic odynophagia and globus sensation months after the inciting injury.

Temporary blindness and ophthalmoplegia due to local anesthetic infiltration of the nasal septum

June 4, 2012     Devrim Bektas, MD; Neslihan Kul, MD; Nurettin Akyol, MD; Ahmet Ural, MD; Refik Caylan, MD
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Abstract

We report the case of a 35-year-old man who developed blindness and ophthalmoplegia during local anesthetic infiltration of the nasal septum. The complications were temporary, and the patient had full recovery without treatment. The vascular anatomy of the area and possible pathogenic mechanisms are discussed, with some suggestions on the prevention of this complication.

Endoscopic orbital decompression of an isolated medial orbital wall fracture: A case report

December 15, 2011     Erdogan Gultekin, MD, Zafer Ciftci, MD, Omer N. Develioglu, MD, Oner Celik, MD, Murat Yener, MD, and Mehmet Kulekci, MD
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Abstract

Motor vehicle and bicycle accidents are the most common causes of blunt head trauma. Other common etiologies are falls, physical violence, and sports accidents. Blunt trauma toward the superior orbital rim, lateral orbital rim, frontal region, and cranium may lead to intraorbital hematoma. A fracture following the blunt head trauma may form a one-way valve, which leads to orbital emphysema and a more pronounced increase in orbital pressure. Increased tissue pressure in an enclosed space will eventually lead to an inevitable decrease in tissue perfusion. It is important to treat the patient within the first 48 hours following the trauma, which is accepted as the “critical period.” In this report we present a case involving a 42-year-old man who was admitted to our clinic with left periorbital pain, edema, proptosis, and blurred vision after experiencing physical violence. The medical history and physical examination findings, along with imaging studies and a description of the endoscopic orbital decompression procedure within the first 24 hours, are reported.

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