EN4.30 | Head and Neck Trauma — Summary & Reflection

KEY TAKEAWAYS

Head and neck trauma spans from isolated pinna haematoma to life-threatening penetrating neck injury with vascular disruption. The ATLS primary survey precedes all ENT-specific assessment. Key injuries and their management: (1) Haematoma auris — aspirate + pressure dressing within 7 days to prevent cauliflower ear. (2) TM perforation — most heal spontaneously; dry ear precautions; myringoplasty at 3 months if fails to heal. (3) Temporal bone fractures — longitudinal (70–80%): conductive hearing loss, haemotympanum, facial palsy in ~20% (usually delayed, neuropraxia, good prognosis); transverse (~20%): SNHL, severe vertigo, facial palsy in ~50% (immediate, often permanent). Imaging: HRCT temporal bone (1 mm axial, bone window). (4) Septal haematoma — URGENT drainage within 24–48 hours; failure leads to saddle-nose deformity. (5) Nasal fractures — closed reduction at 7–10 days. (6) CSF rhinorrhoea — beta-2-transferrin confirms; conservative management 7–10 days; neurosurgical repair if persistent. (7) Laryngeal trauma — Schaefer Group I–II: conservative; Group III–V: tracheostomy + exploration. (8) Penetrating neck trauma — Zone II hard signs: immediate exploration; Zone I/III: CT angiography first. Tuning fork rules in trauma: Rinne negative = conductive loss (lateralises to affected ear in longitudinal fracture); Rinne positive with reduced AC and BC + Weber to unaffected ear = SNHL (transverse fracture).

REFLECT

Consider the clinical vignette in the Hook: the motorcyclist with blood from the right ear, septal swelling, and hoarseness. In your emergency department posting, you will encounter patients where multiple injuries demand simultaneous attention and the team is stretched. Reflect on how you would prioritise your assessment — which finding is immediately airway-threatening, which is immediately preventable-complication-threatening, and which can safely wait an hour? How does the ATLS framework help you structure your decision-making when you are faced with several simultaneous ENT problems in a polytrauma patient? Write three sentences in your reflective journal on the clinical reasoning skills this case requires.