AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 11

neck; and observation. Any patient with a suspected laryngeal trauma (thyroid or cricoid cartilage fracture) should not be transorally intubated, as it will worsen the fracture (the act of placing an endotracheal tube could worsen potential cricotracheal separation and push the trachea inferiorly into the chest). The patient will need urgent otolaryngology evaluation to evaluate and to help secure a safe airway. Penetrating wounds to the neck may also indicate injury to the vascular structures, esophagus, or airway. Immediate expert evaluation will determine if surgery is required. General Concepts of Facial Fracture Management When confronted with a patient with maxillofacial fractures, mandibular fractures, or frontal sinus fractures, the otolaryngologist needs to answer If the traumatized patient has no change in his or her facial appearance and/or no change in any function, then the patient may not need any invasive treatment. Watchful waiting with close follow-up may be a very good treatment plan. However, if there is a functional deficit, the patient is not pleased with the cosmetic outcome, or the patient is at risk for noncompliance, then surgery may be needed to address the facial fractures. Frontal Sinus Fractures To understand frontal sinus fractures and other sinus fractures, we need to understand the purpose of the paranasal sinuses. We believe these sinuses serve several purposes: 1. They add vocal resonance. 2. They lighten the weight of the facial skeleton and head. 3. They act as a crumple zone (similar to the hood of a car) to protect the very soft brain. Once a patient has a frontal sinus fracture, it is important to know if the anterior and posterior walls are intact . An isolated anterior wall fracture (Figure 11.4) may only lead to a cosmetic deformity. The thickness of the patient’s skin combined with the displacement of the anterior wall will influence any cosmetic changes of the forehead. If the posterior wall is fractured, it is very possible that the patient may have a CSF leak resulting two questions when evaluating the patient: 1. What facial function is compromised? 2. What component of the facial form is compromised?

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Primary Care Otolaryngology