Facial trauma Flashcards
what is the 2nd most common facial fx
mandible fracture
1st most common facial fx
nose
mandible is attached to skull by and is prone to injury in which type of sport
muscle ant TMJ, collision sport
mandibular fracture S/S
Initial obs: change in bite, jaw mobility swelling,
S/S:
bruising, or bleeding
if an athlete have increase salivation, pain on mastication, bleeding at gum, lower lip anesthesia, ecchymosis floor of month what can he have
mandibular fracture
mandibular fracture eval
If trauma occurred from one side, examine body of mandible on same side and opposite condyle
If blow straight on , both condyles at risk.
Observe points of impact / jaw movement
Rinse mouth with water if ↓ bleeding
Palpate intra/extra orally (deformity?)
Palpate border of mandible/TMJ for movement or deformity Crepitus?
mandibular fracture treatment
MANDIBULAR FRACTURE: TX
Bleeding control,
Prevent swallowing of avulsed teeth
Tx for shock , position of comfort
Allow for drainage of blood , salivation Transport side-lying: blood/ saliva drainage Stabilize/ immobilize:
MOUTHGUARD + “BARTON BANDAGE”
(looks like baby bonnet) tensor wrap around jaw - head without cutting off airway
Ice locally
Hospital: reduction/plates/screws
how do you transport an athlete with mandibular fracture
Transport side-lying: blood/ saliva drainage Stabilize/ immobilize:
MOUTHGUARD + “BARTON BANDAGE”
(looks like baby bonnet) tensor wrap around jaw - head without cutting off airway
mandibular disclocation MOI
MOI: usually lateral blow to open mouth
Mandibular condyle is anterior
what can make you prone to a mandibular dislocation
MANDIBULAR DISLOCATION (LUXATION) Involves TMJ; a bilateral synovial joint
allowing jaw movement in three planes
Inequity between condyle of mandible and mandibular fossa of temporal bone
Inequity - prone to dislocations
mandibular disclocation S/S
- Inability to close mouth
- Pain / deformity anterior to ear * Condyles may be palpable
- Malocclusion
- Chin deviated to one side (opposite)
- Spasm of surrounding musculature
- Subluxations: audible crepitis from discs
- Some clicks/pops opening/closing is normal
mandibular disclocation TX
Initial Immobilization, ice
Reduction procedure: MD/ DDS/ DO * Gloves/gauze to protect practitioner
* Intra-oral reduction required
Thumbs push inferior/posterior on molars
Complications: recurrent, malocclusion TMJ dysfunction
maxilla fracture s/s
Malocclusion
Elongated face
Epitaxis
Peri-orbital deformity
Facial ecchymosis (next day) Rhinorrhea ( clear CSF)
Infra-orbital paresthesia
Palpate: increased mobility/crepitus
if an athlete have elongate face, facial ecchymosis the next day, rhinorrhea, epitaxial, malocclusion what can he have
maxilla fracture
maxilla fracture tx
Airway maintenance Bleeding control
Ice application
Refer Hospital
zygomatic arch fracture s/s
Lateral cheek flatness
Unilateral epitaxis: maxillary sinus bleed Anaesthesia of cheek
Deformity of nose / upper lip Diplopia (double vision) Trismus (spasm of masseters)
if athlete have deformity of nose, double vision, trismus, lateral cheek flatness what can he have
zygomatic arch fracture
zygomatic arch fracture tx
Ice pack locally/gently
Patch both eyes, transport supine Hospital for x-ray/reduction prn Edema may delay correction
nasal fracture s/s
- Epitaxis, crepitus, Pain on palpation * Deformity,deviation,depression
- Swelling, laceration possible
- ↓ smell
- Ecchymosis- next day (black eyes)
- Septal hematoma
if an athlete have epitaxis, decrease smell, septal hematoma, ecchymosis the next day, swelling what can he have
nasal fracture
nasal fracture tx
Control bleeding:- rest, gauze, pinch pressure,ice,internal lubricated packing Pt Position: never supine (swallow)
lean forward , poke head Airway concerns
Do not blow nose
Cosmetic importance- reduce by 5 days Usually some aesthetic affect
pt position with nasal fracture and can he blow his nose
never supine, lean forward and no
nasal fracture need to be reduce by when
5 days
if auricular hematoma is left untreated what happen and what is the permanent deformity
fibrosis and cauliflower ear
auricular hematoma tx
Ice locally
* Sterile needle aspiration (MD)
followed by compression x 3-5 days
* Tight pressure dressing and contouring mold made with flexible collodian and gauze.
* Drain re-accumulations
* Ear protectors for 4-6 weeks
Moi of tympanic membrane rupture
Pentrating object
Rapid displacement of air
Head Slap, ball, fall
S/S of tympanic membrane rupture
Severe pain
Muffled hearing Bleeding Tinnitus
Vertigo
if an athlete have muffled hearing, vertigo, tinnitus what can he have
tympanic membrane rupture
when should an athlete must use protective eyewear when playing sport
athlete with reduced vision in one eyes
what do you palpate during eye exam
orbital rim
what do you inspect during eye exam
conjunctiva, sclera, pupil, iris,
which type of eyes laceration need expert care
lid margin
naso-lacrimal apparatus
what is subconjunctival haemorrhage + s/s + treatment
bleeding under conjunctiva
no pain or change in vision
clear spontaneously
which eyes condition don’t need treatment
subconjunctival haemorrage
what is hyphema + moi
bleeding in anterior chamber, blunt trauma to eye
what is the commonest significant eye injury in sport
hyphema
hyphema s/s
Blurred vision
Loss of field of vision
May see loss of iris detail
Rarely see a blood fluid level – happens later Clears spontaneously, may re-bleed day 4-6
if an athlete have blurred vision, loss of field of vision but blood clear spontaneously in eye what can he have
hyphema
long terme complication of hyphema
glaucoma
if an athlete have light sensitivity, double vision and irregular pupil following a blunt trauma what could he have
iris injury
iris injury tx
Immediate referral to ophthalmologist
if an athlete have blurred vision, double vision and darkening vision after a blunt trauma what could he have
lens trauma
can a lens dislocate
yes
can a lens opacify
yes, cataract occurs slowly
what is conjunctival foreign body
Dirt or other extraneous material on conjunctival membrane
conjunctival foreign body tx
Rinse eye with sterile water (or clean)
* Evert lid and use wet Q-tip if necessary
* May RTP if otherwise cleared
if an athlete have reduced visual acuity, foreign body sensation and photophobic what could he have
corneal foreign body,Material embedded in clear window of eye
what is corneal abrasion
Scratch, scrape, erosion of clear window
s/s of corneal abrasion
↓ visual acuity (depends on location)
foreign body sensation
photophobia
if an athlete have decrease visual acuity, foreign body sensation in eye and photophobia what could he have
corneal abrasion
corneal abrasion heal within
24-48h with patch and/or drug
first response for corneal abrasion
- Irrigate with sterile saline solution
- Patch eye
- Refer for opthalmic exam by physician
what can increase the risk of corneal laceration
previous laser eye surgery
if an athlete have decrease vision, increase light sensitivity and irregular pupil following an blunt or sharp trauma what could he have
corneal laceration
corneal laceration s/s
decrease vision
increase light sensitivity
irregular pupil
what is vitreous hemmorhage
Bleeding into the vitreous jelly in the posterior chamber of the eye.
if an athlete have decrease vision and floater what could he have
vitreous hemorrage
which injury is more common with athlete with myopia
detached retina
if an athlete have flashing lights, floater, blurred vision, visual field defect what could he have
detached retina
s/s of detached retina
flashing lights, floaters
blurred vision, visual field defect
As detachment progress: ”curtain is falling”
if an athlete have blurred central vision after a blunt trauma what could he have
macular injury
macular injury is often permanent why
scarring
what is orbital blowout fracture and which nerve is affected
- Fracture of the thin bones of the orbit
infra-orbital n
if an athlete have double vision, orbital bruising, air bubble, numbness below eye after a blunt trauma what could he have
orbital blowout fracture
how do you treat an extrude eye
Control bleeding, calm patient
* Wet saline notched dressing below/above
* Cover with notched cup – (optic nerve) with loose padding inside
* Secure cup with transpore tape * Cover both eyes , TLC
* Transport supine
An athlete may NOT return to play if they have any of the following:
VISUAL BLURRING
* DOUBLE VISION
* FLASHERS OR FLOATERS
* LIGHT SENSITIVITY
* ABNORMAL PENLIGHT EXAM
* PROBLEMS WITH:
lid margins, pupil changes, loss of iris detail abnormal extra-ocular movements
EYE Sideline Kit
- Visual acuity chart
- Penlight
- Cotton-tip applicator for lid eversion * Eye patches / transpore tape
- Sterile saline
- Gloves / bandaging
- Contact lens case
EYE Urgent Referral
* 911
- ruptured globe / embedded sharp object * associated injuries
Urgent Referral to Ophthalmologist (ASAP)
visual field loss with flashers / floaters
* visual acuity loss
* photophobia
* diploplia
teeth most affect in dental injury and between what ge
Most victims between ages of 8 -15 yrs old Teeth most affected: upper incisors
how many teeth per quadrant of mouth
8
teeth in mid-line in
2 incisors, 1 canine, 2 premolar 3 molars
what can we see when we smille
crowns
root are attached to and hidden by
Roots are hidden supporting structures
which attach to skull via peridontal ligs
what are the 3 layer of the teeth
All teeth have 3 layers:
* *
Enamel – hard outer layer caps the tooth
Cementum – coats root surface, attaches
tooth to peridontal lig of socket
Dentin – forms bulk of tooth/walls for pulp
what is located in the pulp chamber
space in middle contains
nerve, blood for tooth viability
crown fracture may involve what
enamel only
* enamel and dentin
* enamel, dentin, and pulp
* The more severe the fracture, the greater discomfort, more immediate the need for treatment by a dentist.
what is a root fracture
Breakage of the root of a tooth
* Surrounding teeth are also likely involved * Trauma usually greater than in crown fx.
what is tooth luxation- concussion
Breakage of the root of a tooth
* Surrounding teeth are also likely involved * Trauma usually greater than in crown fx.
what is a tooth subluxation
a mobile but undisplaced tooth, sensitivity
may be some bleeding at gum margins
what is tooth luxation
displacement of tooth, intrusive, extrusive, labial lingual, or lateral depending on force direction blood supply is fully compromised.
what is tooth avulsion
tooth is “out of socket”
what is a alveolar fracture
Fracture of the supporting bony ridge of the teeth, called the alveolus
if an athlete have mobility for a group of teeth what could he have
The affected area will show mobility for a group of teeth
dental injuries examination
Work top-to-bottom , inside out
* Look for fluid, note its colour
* Look for lacerations,contusions,abrasions * Wound under chin…jaw fracture?
* Some injuries apparent, others hidden
* Do not assume absence of other injuries
dental injury verification
- Mobility of teeth in affected area by gently
trying to move them with gloved hand instrument best-to pick up subtle movement
En bloc movement is sign of alveolar fx
what is the finger pressure test
mild pressure inward then outward on teeth
difference between concussion dental injury and subluxation
concussion -> no looseness
subluxation -> loose but not displaced
A tooth chipped to dentin layer will show
colour change from whitish enamel to the more yellow dentin. Sensitive to hot/cold
crown fracture management
If pulp (nerve) involved, see small bleeding from tooth itself. Need to cover fx part ASAP
* Need urgent dental tx to prevent infection and prevent need for root canal
* Locate missing pieces of teeth. Out of mouth, in soft tissue,swallowed, inhaled (pneumonitis!)
tooth displacement management
Whether root fx, crown root fx, tooth
luxation,or alveolar fx:
PUT AFFECTED TEETH BACK INTO AS
NORMAL A POSITION AS POSSIBLE
Hold them in place: custom or stock mouthguard, or cotton rolls.
Immediate dental consult for wire splint
with tooth avulsion, tooth need to be place in socket within
3 min
tooth avulsion management
Rinse debris off tooth, DON’T scrub tooth * Handle tooth by the crown, NOT the root * Clean a blood clot out of socket with
LIGHT GENTLE irrigation
if tooth can’t be re-implanted immediately what need to be done
STORE tooth in appropriate medium
HBBS, Egg White,Coconut Water,Milk, * Don’t let tooth dry out
* Don’t re-implant a baby tooth
do you re-implant a baby tooth
no
storage medium time
dry <30min
tap water 30-60min
vestibule of mouth 90-120 min
physiologic saline 90-120min
cold milk 3h
coconut water better than milk
egg with +++
viaspan >24h
