Facial Trauma Flashcards
Kramer story ?
hit in face with frying pan and actual damage that happened, now there is a LF III fx.
and there is a donkey face so when he stands up his faces just falls down and droops
he can loose his airway,,, when is surgery indicated ??
Fractures ?
LeFort I
LeFort II
LeFort III
Mandibular
Nasal
orbital floor
Types of facial injury ?
Fractures
Globe rupture
Retrobulbar hematoma
Hyphema
Septal hematoma
44% of patients with severe maxillofacial trauma require __________________ due to mechanical disruption or massive hemorrhage into the airway
endotracheal intubation
facial fractures complications - AIRWAY DISATERS!, dont miss loss of vision
6% of patients with maxillofacial trauma will develop ___________ , a detailed eye examination is essential,
vision loss
Facial trauma MC causes ?
Assaults
motor vehicle crashes
Falls
Sports
gunshot wounds
Facial trauma MC fracture ?
nasal bone
orbital floor - blowout , inferior orbit
Zygomaticomaxillary
maxillary sinuses
mandibular ramus
Facial trauma Hx. ?
Mechanism, how did you get injured ?
Facial trauma Hx. important Questions ?
How is your vision?
Do any parts of your face
feel numb?
Does your bite feel normal?
Facial trauma PE, inspection ?
Lateral view for dish face with Le Fort III fractures.
- *everything is sunken in
- *
Frontal view for donkey face with Le Fort II or III fractures.
** bug eye type look **
Bird’s eye view for exophthalmos
-with retrobulbar hematoma
Worm’s view for endophthalmos
-with blow-out fractures or flattening of malar prominence
Raccoon eyes (bilateral orbital ecchymosis) and Battle sign (mastoid ecchymosis) typically develop over several hours, suggesting basilar skull fracture.
Lateral view for _______ with Le Fort III fractures.
dish face
Frontal view for______ with Le Fort II or III fractures.
donkey face
Bird’s eye view for ____________.
exophthalmos
with retrobulbar hematoma
Worm’s view for _____________.
endophthalmos
with blow-out fractures or flattening of malar prominence
_________ and _________ typically develop over several hours, suggesting basilar skull fracture.
Raccoon eyes (bilateral orbital ecchymosis) and
Battle sign (mastoid ecchymosis)
Facial trauma PE: palpation ?
Palpating the entire face will detect the majority of fractures.
Intraoral palpation of the zygomatic arch, palpating lateral to posterior maxillary molars to distinguish bony from soft tissue injury.
Assess for Le Fort fractures by gently rocking the hard palate with one hand while stabilizing the forehead with the other.
Palpating the ________ will detect the majority of fractures.
entire face
______ palpation of the zygomatic arch, palpating lateral to posterior maxillary molars to distinguish bony from soft tissue injury.
Intraoral
Assess for Le Fort fractures by gently_____________ with one hand while stabilizing the forehead with the other.
rocking the hard palate
Facial trauma: PE - eye ?
Examine early before swelling
visual acuity
teardrop sign– globe rupture
Hyphema
flashlight test– afferent papillary defect
Fat– septal perforation
intraocular pressure— orbital compartment syndrome (if no rupture)
Facial trauma: PE - Nose ?
Crepitus over any facial sinus suggests sinus fracture.
Septal hematoma appears as blue, boggy swelling on nasal septum.
Facial trauma: PE - Ears ?
Auricular hematoma.
Cerebrospinal fluid leak.
Hemotympanum.
Facial trauma: PE - Oral ?
Jaw deviation – mandible dislocation or condyle fracture
Malocclusion
Missing or injured tooth.
Lacerations and mucosal ecchymosis suggest mandible fracture
Place finger in external ear – condyle fractures
Tongue blade test: without fracture can bite down on a tongue blade enough to break blade twisted
—it should be able to break and if they cant handle that then it is a higher suspicion there is an injury there
Frontal bone: low suspicion ?
Head CT
- *FB - plain film is not helpful - cause bones overlap
- *
Frontal bone: significant clinical findings imaging ?
Head CT (skull windows)
Frontal bone: Additional considerations ?
Facial CT w/ orbital involvement
C-spine CT w/ significant clinical findings
Midface: low suspicion imaging ?
Waters view
Midface: Significant clinical findings imaging ?
Face CT w/ coronal and axial sections
** midface - and donkey or dish face then get a CT cause there is more suspicion of fracture **
Midface: Additional considerations ?
Coronal face sections require C-spine clearance for positioning
Computer-generated, 3D reconstructions w/ complex injuries
Mandible: low suspicion imaging ?
Panorex
Mandible: Significant clinical findings imaging ?
Mandible CT
Mandible: Additional considerations ?
Head CT can replace waters view
Facial CT detects mandible fx.
Good initial study for low suspicion mandible, imaging ?
Panorex
Panorex facts ?
Often not available in emergency department
Panorex: May not identify mandibular ________.
condyle fracture
Can identify midface fractures ?
Waters view
Waters view facts ?
Considered for low suspicion
Facial CT has better sensitivity
Best for frontal bone fracture imaging ?
CT head
Best for midface and orbit injury imaging ?
CT facial bones
Best for mandibular fracture
imaging ?
CT mandible
May not identify dental root fracture
LeFort fracture tx. ?
Airway protection
Oral packing
IV antibiotics
Mandibular fx tx. ?
Airway as needed
Barton’s bandage - ACE around head to keep jaw closed
Penicillin G (or clindamycin)
Surgery must be done soon - cause it can heal wrong and bite can be off
–(immediately if open)
nasal fx. tx. ?
Amoxicillin-clavulanate
Decongestants
Education not to blow nose
Follow up with otolaryngology
Orbital floor fx. tx. ?
Amoxicillin-clavulanate
Decongestants
Education not to blow nose
Consult with maxillofacial surgery before discharge
Globe rupture tx. ?
Emergent ophthalmology consultation
enucleated - pull eye ball out
Retrobulbar hematoma tx. ?
Emergent ophthalmology consultation
Hyphema tx. ?
Emergent ophthalmology consultation
Septal hematoma tx. ?
Incision and evacuation
Amoxicillin-clavulanate
