Facial Trauma Flashcards by Francesca Savio

Common reasons to see facial trauma?

Occupational injuries
Interpersonal injuries - alcohol
Sports injuries
RTA

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What is ATLS?

Advanced trauma life support

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Why is ATLS used?

Allows to deal w/ multiple injuries and casualties

Deals w/ prioritisation

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What approach should be followed when assessing trauma pt?

ABCDE
Airway
Breathing 
Circulation
Disability
Exposure

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What consider in airway maintenance?

How
Head tilt and chin lift
If concerned about c-spine injury = jaw thrust

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How assess haemorrhage shock?

Blood loss in ml
Blood loss % of vol

Pulse rate
Blood pressure
Resp rate
Urinary output

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How is disability measured?

Glascow coma scale - based on movement, verbal and eyes

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Why might lose airway in OMFS situation?

Posteroinferior displacement of fractured maxilla = block nasopharyngeal airway
Bilateral fracture mandible - tongue obstruct nasopharynx
Haemorrhage of distinct vessels
Debris teeth, blood, dentures, vomit, bone

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What might see in soft tissue injuries?

Abrasions, lacerations, incisions and tissue loss

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What to be aware of with soft tissue injures?

Will scar - clean wound, remove foreign bodies, minimum debridement of tissue, re-align wound edge

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What structure is highly aesthetic in regards to repair?

Vermillion border

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What are the 3 phase of soft tissue healing?

Haemostasis and inflammation
Proliferation: angiogenesis, fibroplasia, epitheliasagtion and contraction of wound
Maturation - reorganisation collagen

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4 stages of bony healing of fracture?

Haematoma - bleed into injury = clot
Fibrocartillage callus forms
Bony callus forms
Remodelling

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What problems can arise with bony healing?

Malunion - healed wrong place

Non-union

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Most common reason see mandibular fracture?

Violence > RTA > falls

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Most common location to have mandibular fracture

Condyle = 30%

Body/ angle = 25%

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Least common place to get mandibular fracture?

Coronoid process

Ramus

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What is favourable vs unfavourable fracture?

Favourable - muscle draws bony fragments together

Unfavourable - fragments displaced by musculature forces

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What must all mandible fracture be?

Compound - all have communication w/ oral cavity via the PDL

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How diagnose mandible fracture?

Hx
Exam
Radiograph

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Imaging of choice for mandibular fracture?

PA mandible
OPT
CT if condylar fracture

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Signs/ symptoms mandible fracture

Disturbed occlusion
Numbness/ altered sensation division IDN 
Swelling
Bruising
Trismus
Disturbed occlusion
AOB
Sublingual haematoma
Mobility of fracture
Mucosal tears
Lost/ displaced teeth

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Types of mandible fracture (not location)?

Compound or closed
Comminuted - broken 2+ placed
Greenstick
Pathological

What mandible fractures are closed?

Condyle

Treatment options for mandible fracture?

1. conservative 2. closed reduction 3. open reduction 4. ORIF

When can conservation tx be used for mandibular fracture?

Undisplaced fracture

What is conservative tx?

Soft/ liquid diet | Review

Indication of closed reduction?

Grossly comminuted fractures Significant tissue loss Fractures children Condylar fracture

What is closed reduction?

Intermaxillary fixation

What can be used to do intermaxillary fixation?

Eyelet wires Leonard buttons Arch bars

Adv and disadv of closed reduction for mandibular fracture?

Adv: simple, non-invasive, maintain blood supply Disadv: oral intake, pt compliance, lack visualisation

What is usually tx of choice for mandible fractures?

Open reduction

Indications for open reduction in mandible fracture?

Displaced unfavourable fracture | Displaced bilateral condylar fracture

Adv and disadv open reduction?

Adv: rigid stability, visualisation, accurate reduction, no fixation needed Disadv: invasive, nerve damage, plate infection

What is ORIF?

Open reduction and internal fixation

What symptoms/signs may see with condylar fracture?

Gagging | AOB

How dx zygoma fracture?

Hx, exam, radiograph

Radiograph needed zygoma fracture?

Plain radiograph - occipital mental view | Complex = CT (esp midface/ orbital)

Signs/ symptoms zygomatic fracture?

``` Facial flattening Periorbital haematoma Pain, swelling, bruising, infra-orbital stepping infra-orbital paraestheisa trismus subconjunctival haemorrhage Visual changes- diplopia Enophthalmos ```

Tx of zygomatic fracture?

Ophthalmic assessment May not require tx - asess If tx - tx w/ or w/o fixation

How treat minimally displaced zygoma fractures?

Elevate w/o fixation - Gillies approach

How tx unstable zygoma fractures?

ORIF

What might see in conjunction w/ orbital floor fractures?

Zygomatic fractures

Dx orbital fractures?

Hx, exam, radiograph

Radiograph for orbital fractures?

Occipital mental view

What sign/ symptom orbital fractures?

``` Globe/ soft tissue inuries Visual changes - diplopia/ movements Paraesthesia due nerve course Retrobublar haemorrhage Raised intra-ocular pressure Sub-conjuctival haemorrhage Eye lid swelling ```

How tx orbital fracture?

Surgery

When immediate tx orbital fracture w/ surgery?

Globe injury | Retrobulbar haemorrhage

When see mid face fracture?

Blunt force injury - not low impact injury

How are mid face fracture classified?

Le Fort I Le Fort II Le Fort III

What is LeFort I?

Horizontal fracture of maxilla

What is LeFort II?

Pyramidal fracture - involve nasal-orbital-ethmoid area

What is LeFort III

Transverse fracture | Involves zygomatic arch and lateral orbital wall

How would someone with mid-face fracture present?

``` Classic facial appearance Step deformities AOB Sulcus haematoma Midline palatal split Deranged occlsion Bruising soft palate Mobile maxilla ```

What might see if nasal fractures?

Nasal deformity Bilateral panda eyes Epistaxis CSF leak