Facial trauma 3: Examining pts with facial trauma

Question 1

What 3 things must we check first when examining a patient with facial trauma?

Answer 1

Airway, Breathing, Circulation

Question 2

When carrying out an extra-oral clinical examination, what do we INSPECT?

Answer 2

1) Circumorbital ecchymosis (bruising)
2) Subconjunctival haematoma (blood shot eye)
3) Bleeding
4) Swelling
5) Flattening
6) Eye movements
7) Check for double vision

Question 3

When carrying out an extra-oral clinical examination, how do we PALPATE?

Answer 3

We check for skin sensation by asking the patient if they have numbness.
We palpate with a light touch on the Ophthalmic, maxillary and mandibular divisions.
We compare the left and right sides.

Question 4

What nerve is affected and thus where is numbness experienced with a mandible fracture?

Answer 4

The ID nerve is affected.
Numbness in lower lip and chin.

Question 5

What nerve is affected and thus where is numbness experienced with a zygoma fracture?

Answer 5

The infraorbital nerve is affected.
Numbness in cheek, nose and upper lip.

Question 6

Where would numbness be experienced in a craniofacial fracture in the ophthalmic division?

Answer 6

Numbness in the forehead.

Question 7

What do we check when examining intraorally?

Answer 7

1) Gap or step in occlusion
2) Gingival tear
3) Malocclusion
4) Bleeding
5) Bruising

Question 8

What fracture often leads to anterior open bite?

Answer 8

Bilateral fracture of mandibular condyles

Question 9

At least how many radiographs should be taken when examining a patient with facial injuries?

Answer 9

At least 2 radiographs at different angles.

Question 10

Why do we need to take radiographs at different angles?

Answer 10

Because:
1) Fractures might be missed
2) To assess displacement
3) To assess angulation

Question 11

What type of radiographs are taken to view mandible?

Answer 11

-OPT
-PA mandible
-Towne’s view

Question 12

What type of radiographs are taken to view mid-face?

Answer 12

-Occipitomental view
-Submental vertex (just for zygomatic arch)

Question 13

What type of radiograph is the gold standard?

Answer 13

CT scan

Question 14

Occipitomental view is taken to view the mid-face. What features can be identified using this radiograph?

Answer 14

-Fluid level
-Infraorbital margin
-Zygomatic buttress
-Zygomatic arch

Question 15

What are the two types of subconjunctival haematoma and explain them

Answer 15

1) with posterior limit: direct trauma to the eyeball
2) with no posterior limit: a fracture in the orbital floor/walls has led to bleeding which has leaked underneath the conjunctiva