Trauma aurikula

Trauma: tajam / tumpul

Laserasi ekspose kartilago
Kontusio
Hematom

perikondri
tis
Hilang
penyangg
a

Organisasi
(fibrosis)
Deformitas
aurikula

Laserasi / Avulsi Aurikula

Harus segera dijahit
Harus aseptis (cegah infeksi)
Vaskularisasi bagus hasil bagus

Hematoma
Prinsip : evakuasi darah + bebat tekan
Aspirasi / insisi (+ kuretase bila clott + )
Bebat tekan cegah reakumulasi
Harus aseptis

Trauma Meatus Akustikus

Eksternus
&
Membran
Terjadi saat korek telinga / ekstraksi korpus
Timpani
allienum
laserasi perdarahan >> (tp biasanya
berhenti sendiri.

Dpt terjadi infeksi sekunder (OE)

Batere luka bakar
Dpt terjadi ruptur membran timpani

Ciri Ruptur MT
Bentuk tidak teratur / bintang / stelata
Terdapat perdarahan / clott pada tepinya
Riwayat trauma sebelumnya
Ruptur MT dapat juga terjadi krn tekanan

(udara / air) yang kuat, misal:

Ditampar, ledakan
Menyelam , terjun ke air

Ruptur MT tanpa komplikasi

hearing loss 10 15 dB
Bila tekanan sangat besar dpt merusak
tulang pendengaran Hearing loss lebih
berat
Bila terjadi subluksasio stapes / kebocoran
round window (tulang pendengaran intak)
terjadi kebocoran labirin
Hearing loss
Vertigo

Atau
keduanya

Traumatic perforation
fresh blood or a
blood clot on
the drum. (b)

A blow on the ear with the hand

is a common cause of traumatic
perforation
which has an irregular margin
(a)

The defect is frequently slitshaped (c)

Penatalaksanaan

Laserasi MAE : antiseptik topikal + analgesik

Perdarahan MAE : oortoilet + antiseptik +

tampon steril + analgesik

Ruptur MT kecil : dapat sembuh sendiri, cegah
infeksi
Bila terjadi kerusakan yang berat / Ruptur
menetap operasi

Otitik Barotrauma
Terjadi akibat peruahan tekanan scr tiba-tiba

menyelam / penerbangan
Nyeri, pendengaran , ruptur MT, injury
labirin
Pada penerbangan: ascend tekanan udara
tekanan dalam kavum timpani > MAE /
nasofaring tuba Eustachius terbuka scr
pasif.
saat descend: terjadi hal sebaliknya

Tekanan udara MAE/ nasofaring tekanan

dalam kavum timpani <.

Bila tuba Eustachius gagal membuka tek
kavum timpani tetap < MAE retraksi MT

Tekanan negatif dlm kavum timpani

30 mmHg selama 15 menit transudasi

( 1 mmHg 13,59 mmH2O)

Perbedaan tekanan 90 mmHg

(perbedaan tekanan kritis)
mengunci (m tensor veli palatini
tdk dapat membuka tuba
Eustachius)
Perbedaan tekanan 100 mmHg ruptur MT

Mekanisme kompensasi bila tekanan kavum

timpani <<
Transudasi
Bila tiba-tiba: perdarahan / Ruptur MT / Ruptur

oval / round window (kerusakan

kokleovestibular dpt permanen)

Penatalaksanaan
Ruptur MT sda
Ruptur labirin
Bed rest total , kepala elevated
Pendapat lain: bila gejala fistula + atau saat

bedrest gejala memburuk eksplorasi

Pencegahan
Menyelam / terbang : fungsi tuba Eustachius

harus baik
Anak kecil dg ISPA : jangan terbang
Oral / topikal nasal dekongestan : untuk
membantu fungsi tuba Eustachius
Mengunyah, menelan, menguap membuka
tuba Eustachius:
Bayi disusui, posisi tegak
Anak-anak / dewasa diberi makanan
Posisi badan dan kepala tegak saat landing

Fraktur Os Temporale
Klasifikasi:
Fraktur transfersal
Fraktur longitudinal
Mayoritas:

oblique / mixed

Relatif thd sumbu

panjang os temporale

Drawing depicts the anatomy of the skull

base. On the left is a longitudinal or extracapsular
fracture.
On the right is a transverse or capsular fracture.

Klasifikasi lain:
Sparing /disrupt otic capsule
Sparing :
fr. Pars squamous os temporal & dinding
posterosuperior MAE : melalui mastoid, telinga
tengah, fr.tegmen mastoid, tegmen timpani dan
berlanjut ke anterolateral kapsul otik
memisahkan tegmen di daerah kapsul otik
tegmen di daerah facial hiatus.
result from a blow to the temporoparietal region

Fraktur dg disrupt kapsul otik: mengenai

struktur sbb:
foramen magnum
petrous pyramid
jugular foramen
internal auditory canal
foramen lacerum
Tdk mengenai ossicular chain / MAE

result from blows to the occipital region

Gejala klinis
Perdarahan / ecchymosis (os mastoid &

mastoid tip)
Ruptur MT
Hemotympanum
Hearing loss
Vertigo
Paralisis N VII
Battle sign fr basis cranii curiga fr os
temporal

Diagnosis
Anamnesis
Pemeriksaan fisikseaseptis mungkin: tidak

boleh irigasi telinga untuk bersihkan debris

CT scan kepala
Tes pendengaran dan tes keseimbangan :
tidak cito

Penatalaksanaan
Tidak ada komplikasi: konservatif
Tx : Sesuai komplikasi yang ada
Hearing loss
Paralisis N VII
Kebocoran CSF

INCIDENCE OF COMMON COMPLICATIONS OF TEMPORAL

BONE FRACTURES IN THE GENERAL AND PEDIATRIC
POPULATIONS

The indications for exploratory tympanotomy

and ossicular reconstruction are conductive

hearing loss greater than 30 dB that persists
for more than 2 months postinjury

Bone conduction thresholds > 30 dB worse

than in the contralateral ear, reconstruction,

even with an excellent closure of the
conductive component of the hearing loss, will
provide minimal subjective improvement.
Patient would still require a hearing aid to
attain usable hearing in the surgical ear.
Consequently, unless the mixed loss is
profound and the patient cannot benefit
preoperatively from a hearing aid, ossicular
reconstruction is not recommended.
If the conductive hearing loss is in an onlyhearing ear, surgery is contraindicated

Management
of traumatic
facial paralysis
ENoG:
electroneuronog
raphy MST:
maximal
stimulation test

MANAGEMENT OF TRAUMATIC INJURIES WITH

COMPLETE FACIAL NERVE PARALYSIS

CT; computed tomography; EMG,

electromyography; ENoG, electroneurography;

NET, nerve excitability test.

CLASSIFICATION OF RECOVERY FROM FACIAL

PARALYSIS
(House Brackmann)
I. Normal : Normal facial function in all areas
II. Mild dysfunction
Gross :
Slight

weakness noticeable on close

inspection May have very slight synkinesis.
At rest, normal symmetry and tone
Motion:
Forehead: moderate-to-good function
Eye: complete closure with minimal effort
Mouth: slight asymmetry

III. Moderate dysfunction

Gross:
Obvious, but not disfiguring difference
between the two sides Noticeable but not
severe synkinesis, contracture, or hemifacial
spasm At rest, normal symmetry and tone
Motion:
Forehead: slight-to-moderate movement
Eye: complete closure with effort
Mouth: slightly weak with maximum effort

IV. Moderately severe dysfunction

Gross :
Obvious weakness and/or disfiguring
asymmetry.
At rest, normal symmetry and tone
Motion
Forehead: none
Eye: incomplete closure
Mouth: asymmetric with maximum effort

V. Severe dysfunction
Gross:
Only barely perceptible motion.
At rest, asymmetry

Motion

Forehead: none
Eye: incomplete closure
Mouth: slight movement

VI. Total paralysis

No movement

Treatment
algorithm for
closure of a
cerebrospinal
fluid fistula

Axial cut high-resolution computed tomography

demonstrating a longitudinally oriented fracture that
is sparing the otic capsule. Black arrows point along
the fracture line.

Axial cut high-resolution computed tomography

demonstrating a transverse oriented fracture,
secondary to a gunshot injury, disrupting the
otic capsule. The black arrow points to the
fracture line.

Axial cut high-resolution computed tomography

demonstrating a mixed oriented fracture that
spares the otic capsule. The white arrows point
to the fracture lines.

Otoscopic image demonstrating a

nondisplaced fracture along the scutum
(black arrow). Blood is layering out
inferiorly.

Otoscopic image demonstrating a

displaced fracture along the
scutum (black arrow).

Otoscopic image demonstrating a

hemotym-panum