Chapter 70 / Otolaryngology: Head and Neck Surgery 615

What are the disadvantages?		May result in increased mortality from
		local recurrence
FACIAL FRACTURES
MANDIBLE FRACTURES
What are the symptoms?		Gross disfigurement, pain, malocclusion,
		drooling
What are the signs?		Trismus, fragment mobility and
		lacerations of gingiva, hematoma in floor
		of mouth
What are the possible		Malunion, nonunion, osteomyelitis, TMJ
complications?		ankylosis
What is the treatment?		Open or closed reduction
		MMF MaxilloMandibular Fixation
		(wire jaw shut)
MIDFACE FRACTURES
How are they evaluated?		Careful physical examination and CT scan
Classification
Le Fort I?		Transverse maxillary fracture above the
		dental apices, which also traverses the
		pterygoid plate; palate is mobile, but
		nasal complex is stable

616 Section III / Subspecialty Surgery

Le Fort II?

Le Fort III?

What is a “tripod” fracture?

Fracture through the frontal process of the maxilla, through the orbital floor and pterygoid plate; midface is mobile

Complete craniofacial separation; differs from II in that it extends through the nasofrontal suture and frontozygomatic sutures

Fracture of the zygomatic complex; involves four fractures:

1.Frontozygomatic suture

2.Inferior orbital rim

3.Zygomaticomaxillary suture

4.Zygomaticotemporal suture

Chapter 70 / Otolaryngology: Head and Neck Surgery 617

What is a “blowout” fracture? Orbital fracture with “blowout” of supporting bony structural support of orbital floor; patient has enophthalmos (sunken-in eyeball)

What is “entrapment”? Orbital fracture with “entrapment” of periorbital tissues within the fracture opening, including entrapment of extraocular muscles; loss of extraocular muscle mobility (e.g., lateral tracking) and diplopia (double vision)

What is a “step off”?

Fracture of the orbit with palpable “step off” of bony orbital rim (inferior or lateral)

Are mandibular fractures No; because the mandible forms an usually a single fracture? anatomic ring, 95% of mandible

fractures have more than one fracture site

What is the best x-ray study for mandibular fractures?

What must be ruled out and treated with a broken nose (nasal fracture)?

ENT WARD QUESTIONS

Panorex

Septal hematoma; must drain to remove chance of pressure-induced septal necrosis

How can otitis externa be	Otitis externa is characterized by severe
distinguished from otitis	pain upon manipulation of the auricle
media on examination?
What causes otitis media?	Most cases are caused by pneumococci
	and H. influenzae
What causes otitis externa?	Pseudomonas aeruginosa
What must be considered in	Nasopharyngeal carcinoma
unilateral serous otitis?
What is the most common	Bell’s palsy, which has an unidentified
cause of facial paralysis?	etiology

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What is the single most important prognostic factor in Bell’s palsy?

What is the most common cause of parotid swelling?

What is Heerfordt’s syndrome?

Which systemic disease causes salivary gland stones?

What is the most common salivary gland site of stone formation?

Whether the affected muscles are completely paralyzed (if not, prognosis is95% complete recovery)

Mumps

Sarcoidosis with parotid enlargement, facial nerve paralysis, and uveitis

Gout

Submandibular gland

What is Mikulicz’s	Any cause of bilateral enlargement of the
syndrome?	parotid, lacrimal, and submandibular glands
What are the three major	1.	Airway protection
functions of the larynx?	2.	Airway/respiration
	3.	Phonation
What is a cricothyroidotomy?	Emergent surgical airway by incising the
	cricothyroid membrane
Name the four major	1.	Prolonged mechanical ventilation
indications for a		(usually 2 weeks)
tracheostomy.	2.	Upper airway obstruction
	3.	Poor life-threatening pulmonary toilet
	4.	Severe obstructive sleep apnea
What is a ranula?	Sublingual retention cyst arising from
	sublingual salivary glands
What is Frey’s syndrome?	Flushing, pain, and diaphoresis in the
	auriculotemporal nerve distribution
	initiated by chewing
What causes Frey’s	Cutting the auriculotemporal nerve
syndrome?	causes abnormal regeneration of the
	sympathetic/parasympathetic nerves,
	which, once destined for the parotid
	gland, find new targets in skin sweat
	glands; thus, people sweat when eating

Chapter 70 / Otolaryngology: Head and Neck Surgery 619

What is the classic triad of Ménière’s disease?

What is the most common posterior fossa tumor and where is it located?

Hearing loss, tinnitus, vertigo (HTV)

Acoustic neuroma, usually occurring at the cerebellopontine angle

What is the most common	Maxillary sinus
site of sinus cancer?
What tumor arises from	Esthesioneuroblastoma
olfactory epithelium?
What cell type is most	Squamous cell
common in head and neck
cancer?

What are the most important predisposing factors to head and neck cancer?

Excessive alcohol use and tobacco abuse of any form

What is the most frequent site of salivary gland tumor?

What is the most common salivary gland neoplasm:

Benign?

Malignant?

What is the classic feature of croup?

What are the classic features of epiglottitis?

What comprises the workup of neck mass?

Parotid gland

Pleomorphic adenoma

Mucoepidermoid carcinoma

Barking, seal-like cough

“Hot-potato” voice, sitting up, drooling, toxic appearance, high fever, leaning forward

Do not biopsy; obtain tissue via FNA and complete head and neck examination