3 - MaxFace

Question 1

most frequently fx’ed facial bone

Answer 1

nasal

Question 2

what is the best dx test for nasal fx?

Answer 2

trickster!! This is a clinical dx.

Question 3

What soft tissue issue are you looking for in a nasal fx? How will you treat it and why?

Answer 3

septal hematoma, drain it to reduce risk of septal necrosis

Question 4

Crepitus over maxillary sinus and CSF rhinorrhea following a head on MVA is most likely what type of fx?

Answer 4

frontal sinus

Question 5

Are frontal sinus fractures known to occur in an isolated area, or in conjunction with another fracture?

Answer 5

Look for another fx

Question 6

This fracture often has no obvious visible signs, but patient might c/o hearing loss, facial numbness, vertigo, or CSF otorrhea

Answer 6

temporal fx

Question 7

This fracture commonly presents with the Battle sign, which is bruising to the _______ or the Raccoon sign, which is bruising to the _______

Answer 7

Basilar skull fx
Battle = behind ear
Raccoon = black eyes

Question 8

This fracture presents with a flattened cheek, low eyelid swelling, pain opening mouth, cheek numbness, and possible vision changes

Answer 8

zygomatic complex fx

Question 9

Are zygomatic fractures typically isolated?

Answer 9

No, often a “tripod fx”

Question 10

Which bones are part of a tripod fx?

Answer 10

1) zygomatic arch
2) zygomaticofrontal suture
3) infraorbital foramen

Question 11

If you have a tripod fracture, which muscle is typically entrapped? Which direction CAN’T you look?

Answer 11

lateral rectus, can’t look medial

Question 12

What part of the orbit is most likely to fx?

Answer 12

floor

Question 13

When do you need to provide abx for orbital fx’s?

Answer 13

Always, risk of cellulitis = blindness

Question 14

orbital floor fractures cause pain and limited ROM when looking in what direction

Answer 14

up

Question 15

which sinus is mostly affected by orbital floor fractures?

Answer 15

Mostly maxillary….sometimes ethmoid

Question 16

If your patient has epistaxis and limitation of the lateral gaze, they most likely have what fracture? What sinus does this affect?

Answer 16

medial orbital, ethmoid

Question 17

this orbital fracture is life threatening and requires immediate neurosx consult

Answer 17

orbital roof

Question 18

This low impact orbital floor fracture causes muscle entrapment, but has few other symptoms

Answer 18

trapdoor fx, most common in kiddos

Question 19

During TBI, what confounding factor increases mortality by 50%? How can this be prevented?

Answer 19

hypoxia, provide O2 via NC, check blood gasses. Maintain adequate perfusion (MAP at 90mmHG)

Question 20

At what level on the GCS do you consider intubation

Answer 20

8-9 (depressed gag, not handling secretions)

Question 21

This brain bleed is most common in the elderly or alcoholics (brain atrophy). It is caused by a rupture of a vein or artery? Does it cross suture lines?

Answer 21

subdural, vein, yes (crescent)

Question 22

This brain bleed is fast. Patients will have brief periods of lucidity, but you shouldn’t assume they are getting better. It is caused by a rupture of a/an ________. Does it cross suture lines?

Answer 22

epidural, artery, no (lens)

Question 23

this type of brain bleed can lead to the blockage of CSF from the 3rd and 4th ventricles.

Answer 23

subarachnoid

Question 24

This type of brain bleed is deep within the brain and causes edema

Answer 24

contusion: coup/contracoup

Question 25

occurs when an athlete sustains a second concussion before being completely asymptomatic from the first and then experiences a rapid, usually fatal, neurologic decline

Answer 25

second impact syndrome

Question 26

This occurs as a result of shearing and edema that affects the nerves in the brain. It is often the cause of traumatic coma.

Answer 26

diffuse axonal injury

Question 27

How will you dx diffuse axonal injury (what imaging? and what does it look like on imaging?)

Answer 27

CT typically neg. Get MRI, look for

1) punctate hemorrhages
2) blurred gray/white matter border

Question 28

what type of skull fracture is most concerning for airway compromise?

Answer 28

Le Fort III (face smashed back and down)

Question 29

Where is the fracture line in a Le Fort III?

Answer 29

horizontally at mid eye level

Question 30

Where is the fracture line in Le Fort II?

Answer 30

triangle of nose, medial/inferior orbital, maxillary, pterygoid plates (nose smashed into dental space)

Question 31

which le fort fx is highest risk for blindness?

Answer 31

III

Question 32

This is the most common type of Le Fort fracture (use fancy name). The fracture line falls where?

Answer 32

Guerin’s fx (le fort I), horizontally across the maxilla/pterygoid plates

Question 33

what is the classification system for dental injuries?

Answer 33

Ellis:

1) chipped tooth, enamel only
2) enamel + dentin
3) enamel + dentin + pulp

Question 34

Which of the ellis classifications are true emergencies?

Answer 34

Ellis III

Question 35

If a tooth is avulsed, what do you do?

Answer 35

rinse only with saline, put it back. (unless baby tooth)….if you can’t, put in Hanks, which keeps it viable x 4-6 hours

Question 36

What ligament are you preserving by not rubbing the tooth?

Answer 36

periodontal ligament

Question 37

You’re told a patient has a maxillary fracture….what is the first thing you should assess.

Answer 37

airway. (maxillary has common a/w airway compromise)

Question 38

General observation….

Answer 38

CSF rhinorrhea seems to be bad.

Question 39

What type of history is a common MOI for a mandibular fx?

Answer 39

1) MVA

2) assault

Question 40

what are the s/s of mandibular fx?

Answer 40

1) malocclusion,
2) dental injury,
3) bruising on floor of mouth,
4) numbness of lower lip

Question 41

In general, open fractures require what medications?

Answer 41

1) tetanus

2) abx

Question 42

The _____nerve supplies the motor function of the face, and the _____nerve supplies the sensation.

Answer 42

Facial = motor
Trigeminal = sensation
(I know, they both do both….but this is a general rule of thumb….I think the exceptions are in the tongue)

Question 43

what is the best imaging for a mandibular fx?

Answer 43

Panorex (also dental fx’s)…all the rest is CT head

Question 44

when I say “craniofacial dysjunction” you say:

Answer 44

dish face….(Le Fort III)