Trauma of Nose and Face MCQs

This is a case of longitudinal fracture of temporal bone. The ear bleeding is a feature of longitudinal fracture. This fracture is due to parietal blow. Battle sign is ecchymosis around the mastoid tip area which is seen in temporal bone fractures. This fracture causes ossicular dislocation and hence conductive hearing loss. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 116.

Longitudinal fracture This is due to falling on the side. 80% of total fractures. Less dangerous. Cause Ossicular dislocation. Cause CHL Vertigo is uncommon. EAC bleeding and CSF otorrhoea are more Common Facial palsy is less common and delayed , it is due to edema of nerve. So, treatment is or oral steroids. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 116.

X ray of paranasal sinuses has no role in the diagnosis of CSF rhinorrhea. Beta-2 transferrin is the best confirmatory test. CT cisternogram - requires intrathecal injection of iohexol and a CT scan to localize the site of leak in cases when beta-2 transferrin cannot be done. Nasal endoscopy can be done to identify the site of leak and for its repair. OTHER TESTS FOR LOCALIZATION OF SITE OF CSF LEAK- High-resolution CT scan - important to see the bony defects. MRI - requires that CSF leak is active at the time of scan. Intrathecal fluorescein study - Dye appears bright yellow but when seen with a blue filter it appears fluorescent green. Reference – Diseases of Ear, Nose and Throat, 8 th edition, page 192

Explanation: In nasal fractures, the ideal time for closed reduction is typically within 5-7 days after injury . Timing of Nasal Fracture Reduction: Early reduction (within 12 hours): May be considered only if swelling is minimal and there is marked deformity. However, early reduction is often difficult due to swelling that can hinder the realignment of the nasal bones. (Option A ruled out) Delayed reduction (5-7 days): Preferred in most cases once swelling has reduced, allowing precise correction. This period allows swelling to subside , improving visualization and enabling accurate realignment of the nasal bones. Also ensures better cosmetic and functional outcomes while minimizing the risk of complications. Late reduction (>2 weeks) Not usually recommended, as bone healing begins, making manipulation difficult and resulting in suboptimal. (Option C, D ruled out)

The nasal bone fracture should be reduced immediately within 1-2 hours before edema starts. If edema is already there, then wait for 7 days for the edema to subside and then reduce the fracture. It is difficult to reduce a nasal fracture after 2 weeks because the process of callus formation would have started. Reference – Diseases of Ear, Nose and Throat, 8th edition, page 213

β2 transferrin is a protein seen in CSF and not in nasal discharge. Its presence is a specific and sensitive test and requires only a few drops of CSF. Perilymph and aqueous humour are the only other fluids which contain this protein. Another protein called beta trace protein is also specific for CSF and is widely used in Europe. It is secreted by meninges and choroid plexus. Reference – Diseases of Ear, Nose and Throat, 8 th edition, page 192

The cervical branch of the facial nerve is a branch of the facial nerve that supplies the muscles of the lower lip and chin region. During parotidectomy, which involves surgical removal of the parotid gland (a salivary gland located near the ear), the cervical branch of the facial nerve can be at risk of injury, leading to paralysis of the lower lip. Main trunk of facial - This is the main nerve that supplies the muscles of the face. It is not injured during parotidectomy. Parotid duct - This is the duct that carries saliva from the parotid gland to the mouth. It is not injured during parotidectomy. Temporal branch of facial - This is a branch of the facial nerve that supplies the muscles of the forehead and temple. It is not injured during parotidectomy.

Early cases of CSF rhinorrhoea can be managed by conservative measures such as bed rest, elevating the head of the bed, stool softeners, and avoidance of nose blowing, sneezing and straining. Prophylactic antibiotics can be used to prevent meningitis. Acetazolamide decreases CSF formation. If it does not resolve, surgical repair is planned. Reference – Diseases of Ear, Nose and Throat, 8 th edition, page 193