0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

TREATMENT

■ Airway protection must be addressed or closely monitored. Blood loss may
be heavy.
■ All patients should receive antibiotics.
■ Plastics or craniofacial consult is indicated.
■ Most Le Fort fractures require surgical repair and stabilization (often with
small plates).
■ Early repair is considered preferable in stable patients.

COMPLICATIONS

■ Airway compromise
■ Malocclusion if missed diagnosis
■ Infection

CAVERNOUS SINUS THROMBOSIS

This is a life-threatening infection and associated thrombosis of the cavernous
sinus (see Figure 14.15). Infections usually originate in the sinuses or mid-
face. Other sources of infection include facial veins, oral cavity, middle ear,
and mastoid region. The most common organism is S. aureus.

SYMPTOMS/EXAM

■ High fever
■ Toxic appearance
■ Periorbital edema and chemosis (conjunctival edema)
■ Cranial nerve palsies (CN VI is most commonly affected, presenting as a
lateral gaze palsy)
■ Decreased visual acuity and sluggish pupils may be seen due to increased
intraocular pressure.

Oculomotor N.

Optic chiasm

Internal carotid

artery

Hypophysis

Sphenoid sinus Nasopharynx

Trochlear N.

Ophthalmic N. (V 1 )

Maxillary N. (V 2 )

Abducens N.

FIGURE 14.15. Diagram of the cavernous sinus.

(Reproduced, with permission, from Ropper AH, Brown RH. Adams and Victor’s Principles of
Neurology, 8th ed. New York: McGraw-Hill, 2005:229.)