Facial Trauma Flashcards
Common reasons to see facial trauma?
Occupational injuries
Interpersonal injuries - alcohol
Sports injuries
RTA
What is ATLS?
Advanced trauma life support
Why is ATLS used?
Allows to deal w/ multiple injuries and casualties
Deals w/ prioritisation
What approach should be followed when assessing trauma pt?
ABCDE Airway Breathing Circulation Disability Exposure
What consider in airway maintenance?
How
Head tilt and chin lift
If concerned about c-spine injury = jaw thrust
How assess haemorrhage shock?
Blood loss in ml
Blood loss % of vol
Pulse rate
Blood pressure
Resp rate
Urinary output
How is disability measured?
Glascow coma scale - based on movement, verbal and eyes
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
What might see in soft tissue injuries?
Abrasions, lacerations, incisions and tissue loss
What to be aware of with soft tissue injures?
Will scar - clean wound, remove foreign bodies, minimum debridement of tissue, re-align wound edge
What structure is highly aesthetic in regards to repair?
Vermillion border
What are the 3 phase of soft tissue healing?
- Haemostasis and inflammation
- Proliferation: angiogenesis, fibroplasia, epitheliasagtion and contraction of wound
- Maturation - reorganisation collagen
4 stages of bony healing of fracture?
Haematoma - bleed into injury = clot
Fibrocartillage callus forms
Bony callus forms
Remodelling
What problems can arise with bony healing?
Malunion - healed wrong place
Non-union
Most common reason see mandibular fracture?
Violence > RTA > falls
Most common location to have mandibular fracture
Condyle = 30%
Body/ angle = 25%
Least common place to get mandibular fracture?
Coronoid process
Ramus
What is favourable vs unfavourable fracture?
Favourable - muscle draws bony fragments together
Unfavourable - fragments displaced by musculature forces
What must all mandible fracture be?
Compound - all have communication w/ oral cavity via the PDL
How diagnose mandible fracture?
Hx
Exam
Radiograph
Imaging of choice for mandibular fracture?
PA mandible
OPT
CT if condylar fracture
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
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?
- conservative
- closed reduction
- open reduction
- 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
