Facial Injuries

Question 1

Dental avulsion

• Describe
• Initial eval

Answer 1

• Complete removal of tooth including root
• Hx: how long has it been out, has it be preserved?
• In ED: place tooth in saline or toothsaver
• CT: ensure no facial fractures

Question 2

Dental avulsion

- tx

Answer 2

• Nerve block
• Irrigate the hole (remove clot and debris)
• Push tooth back in (hard)
• Coe-Pak: temporary bond
• Can dry with O2
• Ensure good dental f/u

Question 3

Facial fracture

- initial eval

Answer 3

• Always suspect c-spine injury
• Stat imaging: CT face/head, panorex (do not use XR)
• Neuro and eye exam: double vision at extremes of visual field: suspect orbital fx, trismus: mandibular injury
• Use LeForte fx to classify

Question 4

LeForte Fx

Answer 4

I: Palatal segment separated from upper midface

II: Pyramidal fragment containing upper teeth is separated from face through inferior orbital rims and nose

III: Separation of facial bone from cranial bones, fx line runs through zygomaticofrontal sutures, across floor of orbit and nasofrontal junction

(good picture in slides)

Question 5

Facial fracture

- Tx

Answer 5

• Stabilize
• Pain management
• Fluids (hard to swallow)

Question 6

Orbital fracture

• overview
• s/sx
• PE

Answer 6

• Ophthalmic emergency
• Can impinge eye muscles and nerves
• S/sx: No full EOM, pain with EOM, double vision
• Soft tissue swelling – hard to do PE. Use Pain meds bc must open to eval for globe injury

Question 7

Orbital fracture

- Tx if there is globe injury

Answer 7

• ophthalmologist consult
• abx
• eye shield

Question 8

Mandible injury

• types
• S/sx

Answer 8

• Dislocation, fracture, or both

Dislocation

• Lateral blow more common to cause
• Mouth stuck open

Fracture

• Might present with little deformity!
• Assess airway, assess if can handle secretions
• Maxofacial surgery for plates or wires

Question 9

Lip lacerations

• assessment
• repair/tx

Answer 9

• Assess for severity: through and through or vermillion border involvement.
• Dt cosmetics, be careful (legal risk)
• Align vermillion border with 1st suture (have pt or family look to see if it looks normal), if can’t align call plastics
• Through and through:
  • Interior: gut or vicryl, do first, then exterior
  • Exterior: ethilon/prolene
  • Abx

Question 10

Nasal injuries

- general trauma

Answer 10

• XR: hard to see dt overlapping bones
• CT: may be overkill if no major deformity
• Only need to reset if patency is lost
• Refer to plastics

Question 11

Nasal injuries

- Septal hematoma

Answer 11

• Can be d/t septal fx
• Bilateral: risk for patency
• Urgent ENT referral: I&D
• IV abx to prevent infection which can lead to permanent deformity, osteo issues, intercranial abscess which can lead to meningitis