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EM Trauma > EM Trauma 2 (Facial trauma) > Flashcards

EM Trauma 2 (Facial trauma) Flashcards

1
Q

descending order of causes of facial fractures

A
  1. assault
  2. MVC (severe injury)
  3. falls
  4. sports
  5. GSW (severe injury)
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2
Q

descending order of facial fractures

A
  1. nasal bone
  2. orbital floor
  3. sygomaticomaxillary
  4. maxillary sinuses
  5. mandibular ramus

“Mandibular fratures anre the second most common facial fracture after nasal fracture”

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3
Q

3 screening questions in secondary survey of facial trauma

A
  1. HOW IS YOUR VISION?
  2. IS YOUR FACE NUMB?
    -check for anesthesia of the
    »forehead
    »lower eyelid
    »cheek and upper lip
    »chin
    -suggests injury to the
    »supraorbital nerve
    »infraorbital nerve
    » mental nerves
  3. DO YOUR TEETH FIT TOGETHER NORMALLY?
    -mandibular or maxillary fractures
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4
Q

remarks on abnormal vision in facial trauma

A

“Loss of vision implies injury to the optic nerve or globe”

Binocular double vision suggests entrapment of the extraocular muscles

Monocular double vision suggests lens dislocation

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5
Q

This indicates globe injury

A

Teardrop-shaped pupil

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6
Q

Telecanthus

A

Widening of the distance betweel medial canthi with normal interpupillary distance

occurs with naso-orbito-ethmoid injuries

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7
Q

Widening of the interpupillary distance

A

“hypertelorism”
-results from a “Blow-out” injury to the orbits, often resulting in Blindness

blow-out fracture
-limitation in or diplopia when looking up

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8
Q

These suggest corneal abrasions

A

foreign body sensation and photophobia

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9
Q

features of retrobulbar hematoma

A

exophthalmos
afferent nerve defects
inc IOP

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10
Q

dish face deformity on lateral view

A

classic for Le Fort III
“craniofacial dysfunction”
-entire face is separated from the skull
-from fracutres of the Frontozygomatic suture line, across the Orbit and through the base of the Nose and Ethmoids
-the entire face shifts with the globes held in place only by the optic nerve

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11
Q

remarks on CSF leak

A

in trauma, presence of rhinorrhea or otorrhea* is CSF leak until proven otherwise
*rhinorrhea -> temporal bone or middle cranial fossa injury

double ring or halo sign occurs when clear CSF diffuses past blood when dropped on a paper towel
not specific or sensitive

serum BETA-2 TRANSFERRIN
-highly sensitiv and specific

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12
Q

Battle’s sign

A

bruising over the mastoid process
suggests basilar skull fracture

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13
Q

I&D of auricular hematoma is required to prevent

A

destruction of cartilage resulting in a cauliflower deformity

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14
Q

malocclusion occurs in

A

mandibular fractures
Le Fort fractures
zygomatic fractures

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15
Q

test to indentify clinically significant mandibular fracture injuries

A

tongue blade test

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16
Q

diagnostic for forntal bone fracture

A

low suspicion
-head CT

if with significant clinical findings
-head CT with skull windows

if with involvement of the supraorbital ridge
-include a facial CT with axial and coronal section

17
Q

Diagnostic for midface fractures

A

low suspicion
-Water’s view

if with significant clinical findings
-face CT with coronal and axial sections
(this is also the imaging study of choice for patients with an abnormal Water’s view”

Head CT may replace an additional Water’s view

*multiplanar computer reconstructions increase the effectiveness of visualization of fractures, especially in the case of fractures in the INFERIOR ORBITAL WALL

18
Q

imaging for mandibular fractures

A

low suspicion
-Panorex (orthopantomogram) (initial)

if with significant clinical findings
-Mandible CT (gold standard)

19
Q

remarks on intubation in facial trauma

A

To prevent the “can’t intubate/ can’t oxygenate” failred airway, do not administer paralytics unless a patient can be bagged effectively or alternative airway devices of plans are in place

etomidate and ketamine both provide sedation with preservation of respiratory drive

20
Q

remarks on blood supply of the face

A

face: primarily from the sphenopalatine and greater palatine branches of the ECA

nasal: anterior and posterior ethmoidal branches of the ICA

21
Q

Most common finding in ocular injuries in patients with frontal bone fractures

A

afferent pupillary defect

22
Q

remarks on sinus fractures

A

oral antibiotics, such as first-gen cephalosporins or amoxicillin clavulanate, are recommended with any sinus fracture

23
Q

features of naso-orbito-ethmoid fractures

A

”PTEC”
pain on eye movement
traumatic telecanthus
epiphora (tears spilling over the lower lid)
CSF leak

requires admission for specialty consultation with facial surgery and neurosurgery*PTEC

24
Q

remarks on ocular injuries in facial trauma

A

emergent ophthalmology consultation is required for associated ocular injury

retrobulbar hematoma or malignant orbital emphysema may create an ocular compartment syndrome, resulting in an acute ischemic optic neuropathy

PE:
exophthalmos
dec VA
inc IOP

tx:
emergency lateral canthotomy

25
Q

orbital fissure syndrome

A

fracture involving the superior orbital fissure

injury to the oculomotor and ophthalmic nerve

PE:
abn EOM
ptosis
periorbital anesthesia

26
Q

obital apex syndrome

A

orbital fissure syndrome + involvement of optic nerve

abn EOM
ptosis
periorbital anesthesia
DIMINISED VISUAL ACUITY

27
Q

Tripod fracture location

A
  1. zygomatic arch practure
  2. lateral orbital rim fracture
  3. inferior orbital rim fracture
  4. lateral wall of maxillary sinus fracture
28
Q

Le Fort I

A

“alveolar fracture”
transverse fracture separating the body of the maxilla from the pterygoid plate and nasal septum
only the hard palate and teeth move, similar to a loose upper denture

29
Q

Le Fort II

A

“fracutre of zygomatic maxillary complex)
a pyramidal fracture through the central maxilla and hard palate
movement of the hard palate and nose occurs, but not the eyes

30
Q

Le Fort IV

A

includes characteristics of the Le Fort III and also involves the Frontal bone (4tal bone)

31
Q

remarks on mandibular fractures

A

a mandibular fracture should be considered BILATERAL until proven otherwise

comminuted mandibular fractures could result in upper airway obstruction due to the tongue being unsupported anteriorly

presume an OPEN fracture until a thorough intraoral exam determines otherwise

32
Q

remarks on mgt of mandibular fracture

A

in the patient with a stable airway, placement of a Barton’s bandage, an ace wrap over the top of the head and underneath the mandible, will stabilize the fracture and help relieve pain

administer pain control and clindamycin 600-900mg IV

open fractures require admission for operative repair

33
Q

remarks on facial fractures in children

A

cricothyrotomy is contraindicated in patients <8 y/o bec the cricothyroid membrane is not developed until age 8 and should be avoided bet 9 and 12 years of age

the *maxillary sinuses do not begin developing until age 6y, which reduces the incidence of midfacial fractures compared with adults

EM Trauma (23 decks)

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