Resident Manual of Trauma to the Face, Head and Neck

1. Tympanic Membrane Repair................................................ 158 2. Ossicular Reconstruction...................................................... 158 3. Facial Nerve Repair................................................................. 159 VI. Prevention and Management of Complications ........................ 159 A. Indications for Antibiotics........................................................... 159 B. Hearing Loss...................................................................................160 C. Facial Nerve Injury........................................................................160 D. CSF Leaks......................................................................................... 161 E. Cholesteatoma and External Auditory Canal Injury.............. 161 F. Late Meningocele and/or Encephalocele Development..... 162 G. Late Meningitis.............................................................................. 162 VII. Summary ............................................................................................... 162 VIII. References and Suggested Readings ............................................ 163 Chapter 7: Penetrating and Blunt Neck Trauma .....................................164 I. Penetrating Neck Trauma .................................................................164 A. Introduction....................................................................................164 B. Projectiles, Ballistics, and Mechanisms of Injury..................164 1. The Most Lethal Missiles...................................................... 165 2. Temporary and Permanent Bullet Cavities....................... 165 3. Historical Categorization, Types, and Treatment of Penetrating Neck Wounds.................................................... 165 4. Historical Treatment of Penetrating Neck Wounds.......166 C. Emergency Room Management................................................166 1. Initial Orderly Assessment...................................................166 D. Anatomy.......................................................................................... 167 1. Vital Structures in the Neck.................................................. 167 2. Skeletal Anatomy.................................................................... 167 3. Muscular Landmarks.............................................................. 167 4. Neck Zones...............................................................................168 5. Vascular Injuries...................................................................... 170 E. Diagnostic Evaluation and Surgical Treatment...................... 170 1. Selective Neck Exploration................................................... 170 2. Mandatory Neck Exploration ............................................... 171 3. Computed Tomographic Angiography................................ 171 4. Evaluation of Aerodigestive Tract Injuries........................ 172 F. Conclusion...................................................................................... 173 II. Blunt Neck Trauma ............................................................................. 173 A. Introduction.................................................................................... 173 B. Presenting Signs and Symptoms............................................... 173 1. Initial Diagnostic Airway Evaluation. ................................. 173 2. Hemodynamic Instability or Signs of Vascular Injury...... 174

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