- What are the clinical features of cancer of the testis, and how should it be investigated?
Clinical features of testicular cancer include:
- Painless testicular nodule or swelling
- Negative transillumination test
- Dull lower abdominal or scrotal discomfort
- If metastatic → lower back or bone pain
Cough, shortness of breath, chest pain → pulmonary, mediastinal metastases - Gynaecomastia → from excess HCG or oestrogen produced by tumor
- Paraneoplastic hyperthyroidism → alpha subunits of HCG and TSH are identical → weak stimulation of TSH
receptor in tumours with HCG overproduction
- What are the clinical features of a fractured maxilla?
Midface fractures are characterised by:
- symmetrical facial swelling,
- bilateral periorbital ecchymosis AND
- bilateral subconjunctival or periorbital haemorrhages (raccoon signs) with flattening and elongation of the midface.
Can be classified as:
Le Fort 1 fracture (horizontal) – aka floating palette fracture – horizontal fracture between hard palette and maxillary bone causing floating palette.
Le Fort 2 fracture (pyramidal) – fractured area includes nose with fracture line extending to infraorbital margins and can potentially damage infraorbital nerve
Le Fort 3 fracture – transverse fracture –craniofacial dislocation where the entirety of facial bones separate from cranial bones. Worst prognosis and involves intraocular orbit and haemorrhage can be catastrophic
- What are the clinical features of a blowout fracture of the orbit and what investigation is most useful?
In a blow out fracture the orbital contents are typically forced through a fractured orbital floor.
Clinical features can include:
- unilateral periorbital pain, oedema and ecchymoisis
- enophthalmos- which is the posterior displacement of the eye ball in the posterior compartment.
- proptosis- which is the anterior displacement. In this case due to haemorrhage behind the eye ball
- diplopia due to restricted ocular movement
- palpable misalignment of the bone at the fracture line (orbital rim “step off”)
- If the infraorbital nerve is trapped or injured then pt could also lose sensitivity to the midface from the lower eyeloid to the upper lip
- epistaxis
CT or Xray would be most useful. This would be done after visual inspection and after ruling out other life threatening injuries,
Can see:
- bleeding into sinuses, muscle entrapment and edema.
- tear drop sign on xray- sign showing soft tissue herniation into maxillary antrum
302.Refer to Photograph - This man was assaulted.
Q1. What do the images show?
Q2. Who would manage him?
- CT RECONSTRUCTION MODEL=
- BILATERAL ZYGOMATIC FRACTURE
- TRANSVERSE MAXILLA FRACTURE
- NASAL FRACTURE
- ORBITAL FRACTURE
- INFERIOR RECTUS ENTRAPMENT
CT shows a mid-face fracture. Image depicts pt with swollen face, open mouth and periorbital bruising
- Maxilofacial surgeon
POTENTIALLY ENT FOR NASAL
