46 - facial and neck trauma

Question 1

approach to nose #

Answer 1

• rarely need xrays
• allow 2-3weeks for swelling to reduce then plastics
• inspect septum for hematoma
• if pushed back into infraorbital rim, then may need urgent surg

Question 2

approach to midface #

Answer 2

• usually a direct frontal blow
• 3 lefort fractures
• all leforts need plastics

Question 3

3 types of lefort #

Answer 3

1. upper alveolar rigde and upper teeth will be mobile
2. though or just inf. to orbital rim and teeth will move as a unit
3. across the orbits and the entire face will be mobile

Question 4

approach to mandibular #

Answer 4

• usually 2 site for injury
• suspect when: irregular bite, feels misaligned, point tenderness, loose teeth, strong pain when biting
• panorex plain films

Question 5

approach to temporomandibular dislocation

Answer 5

• malocclusion but no bony tenderness

- sedate and replace

Question 6

zygomatic #

Answer 6

• if depressed, should be elevated surgically

- can be done outpatient

Question 7

4 methods to minimize scarring on face

Answer 7

1. remove at day 5
2. use smallest possible - 5-0 or 6-0
3. place at regualar, close intervals
4. adive to avoid sunlight and use sunscreen

Question 8

5 unique facial lacerations issues

Answer 8

1. search for fat protrusion in the eyelid
2. repair of skin over cart. should be done by exp. provider
3. should ensure all edges line up perfectly
4. lip should start along the vermillion border to ensure they line up well
5. ensure people are aware of potential for bleeds along the labial art. in lips

Question 9

4 types of dental injury

Answer 9

1. avulsion
2. fracture
3. subluxation (loose)
4. impaction

Question 10

mgmt of avulsion

Answer 10

• rinse socket with NS
• sterilize tooth and put in socket
• if not in milk
• xray and refer

Question 11

mgmt of fracture

Answer 11

• check if residual tooth loose

- iff ellis 3-4 (pulp) cover with bone wax for pain releif

Question 12

mgmt of subluxation

Answer 12

• palpate all front teeth

- refer to dent

Question 13

mgmt of impaction

Answer 13

• refer

Question 14

signs of obst. in neck penetration

Answer 14

• stridor
• ab. breathing
• incr. muscle use
• swelling or masses
• bleeding from mouth

Question 15

what to do if obst.

Answer 15

intubation by EXPERienced provider

Question 16

3 zones of neck and imaging

Answer 16

1 and 3 - difficult so use imaging

2 - can explore surgically

Question 17

neck zone border

Answer 17

1. above mandibles
2. mandible to clavicle
3. below clavicle