GR0UP D ENT TUTORIAL 2 get ENT knowledge through assignment

Equip yourself with ENT knowledge, assessment, through answering a few the available questions

1. GROUP D ENT TUTORIAL

2. QN. A previously healthy man 30-year old man presented with worsening nasal obstruction for the past 4 days. Two weeks prior he was involve in a minor motor vehicle accident whereby there was a direct impact over the anterior facial region. Besides that there was no fever, headache or epistaxis. On examination, no external nasal deformity was noted. On lifting nose-tip, erythematous, smooth surfaced swelling was noted over the bilateral nasal septum. A) Most likely diagnosis. B) How can you describe the assessment of this patient. C) Treatment plan.

3. A) Most likely diagnosis. Bilateral septal hematoma, in view of erythematous smooth surfaced swelling on the nasal septum.

4. B) Assessment of the patient. Diagnosis is usually clinical and the hematoma presents within 24 to 72 hours though late presentation is reported. History. Medical history( general) Medical conditions and ENT surgeries Allergies (seasonal as well as others) Medical history specific to ENT. Trauma. Allergy, asthma, chronic cough. Frequency of ENT infections. ENT cancer or tumors.

5. Other associated Symptoms like; Fever Malaise Nausea or vomiting. Should be inquire as they guide differentials.

6. Clinical examination. Usually confirmatory. Accomplished with nasal speculum or nasal endoscope . Gentle palpation with little finger reveals soft fluctuant smooth swelling. Non resolution with vasoconstrictor or decongestant strongly suggests hematoma. Investigations; Blood for; CBC, coagulation profile etc. Imaging; x-ray, CT, MRI.

7. Treatment plan . Urgent drainage to avoid undue complications like septal abscess. Under local or general anesthesia if patient apprehensive . Small hematomas can be aspirated with a wide bore sterile needle. Larger hematomas are incised and drained by a small anteroposterior incision parallel to the nasal floor. Following drainage, nose is packed on both sides to prevent reaccumulation. Packing maintained for at least 3 days and removed in 24 hours if not draining. Systemic antibiotics should be given to prevent septal abscess and other complications.

8. REFERENCES: PL. Dhinga , S. Dhinga ; Diseases of ear, nose and throat 7 th edition. THANKS