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Clinical Medicine Lecture - Professor Kramer > Facial Trauma > Flashcards

Facial Trauma Flashcards

1
Q

Kramer story ?

A

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 ??

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2
Q

Fractures ?

A

LeFort I

LeFort II

LeFort III

Mandibular

Nasal

orbital floor

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3
Q

Types of facial injury ?

A

Fractures

Globe rupture

Retrobulbar hematoma

Hyphema

Septal hematoma

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4
Q

44% of patients with severe maxillofacial trauma require __________________ due to mechanical disruption or massive hemorrhage into the airway

A

endotracheal intubation

facial fractures complications - AIRWAY DISATERS!, dont miss loss of vision

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5
Q

6% of patients with maxillofacial trauma will develop ___________ , a detailed eye examination is essential,

A

vision loss

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6
Q

Facial trauma MC causes ?

A

Assaults

motor vehicle crashes

Falls

Sports

gunshot wounds

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7
Q

Facial trauma MC fracture ?

A

nasal bone

orbital floor - blowout , inferior orbit

Zygomaticomaxillary

maxillary sinuses

mandibular ramus

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8
Q

Facial trauma Hx. ?

A

Mechanism, how did you get injured ?

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9
Q

Facial trauma Hx. important Questions ?

A

How is your vision?

Do any parts of your face
feel numb?

Does your bite feel normal?

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10
Q

Facial trauma PE, inspection ?

A

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.

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11
Q

Lateral view for _______ with Le Fort III fractures.

A

dish face

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12
Q

Frontal view for______ with Le Fort II or III fractures.

A

donkey face

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13
Q

Bird’s eye view for ____________.

A

exophthalmos

with retrobulbar hematoma

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14
Q

Worm’s view for _____________.

A

endophthalmos

with blow-out fractures or flattening of malar prominence

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15
Q

_________ and _________ typically develop over several hours, suggesting basilar skull fracture.

A

Raccoon eyes (bilateral orbital ecchymosis) and

Battle sign (mastoid ecchymosis)

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16
Q

Facial trauma PE: palpation ?

A

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.

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17
Q

Palpating the ________ will detect the majority of fractures.

A

entire face

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18
Q

______ palpation of the zygomatic arch, palpating lateral to posterior maxillary molars to distinguish bony from soft tissue injury.

A

Intraoral

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19
Q

Assess for Le Fort fractures by gently_____________ with one hand while stabilizing the forehead with the other.

A

rocking the hard palate

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20
Q

Facial trauma: PE - eye ?

A

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)

21
Q

Facial trauma: PE - Nose ?

A

Crepitus over any facial sinus suggests sinus fracture.

Septal hematoma appears as blue, boggy swelling on nasal septum.

22
Q

Facial trauma: PE - Ears ?

A

Auricular hematoma.

Cerebrospinal fluid leak.

Hemotympanum.

23
Q

Facial trauma: PE - Oral ?

A

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

24
Q

Frontal bone: low suspicion ?

A

Head CT

  • *FB - plain film is not helpful - cause bones overlap
  • *
25
Q

Frontal bone: significant clinical findings imaging ?

A

Head CT (skull windows)

26
Q

Frontal bone: Additional considerations ?

A

Facial CT w/ orbital involvement

C-spine CT w/ significant clinical findings

27
Q

Midface: low suspicion imaging ?

A

Waters view

28
Q

Midface: Significant clinical findings imaging ?

A

Face CT w/ coronal and axial sections

** midface - and donkey or dish face then get a CT cause there is more suspicion of fracture **

29
Q

Midface: Additional considerations ?

A

Coronal face sections require C-spine clearance for positioning

Computer-generated, 3D reconstructions w/ complex injuries

30
Q

Mandible: low suspicion imaging ?

A

Panorex

31
Q

Mandible: Significant clinical findings imaging ?

A

Mandible CT

32
Q

Mandible: Additional considerations ?

A

Head CT can replace waters view

Facial CT detects mandible fx.

33
Q

Good initial study for low suspicion mandible, imaging ?

A

Panorex

34
Q

Panorex facts ?

A

Often not available in emergency department

35
Q

Panorex: May not identify mandibular ________.

A

condyle fracture

36
Q

Can identify midface fractures ?

A

Waters view

37
Q

Waters view facts ?

A

Considered for low suspicion

Facial CT has better sensitivity

38
Q

Best for frontal bone fracture imaging ?

A

CT head

39
Q

Best for midface and orbit injury imaging ?

A

CT facial bones

40
Q

Best for mandibular fracture

imaging ?

A

CT mandible

May not identify dental root fracture

41
Q

LeFort fracture tx. ?

A

Airway protection

Oral packing

IV antibiotics

42
Q

Mandibular fx tx. ?

A

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)

43
Q

nasal fx. tx. ?

A

Amoxicillin-clavulanate

Decongestants

Education not to blow nose

Follow up with otolaryngology

44
Q

Orbital floor fx. tx. ?

A

Amoxicillin-clavulanate

Decongestants

Education not to blow nose

Consult with maxillofacial surgery before discharge

45
Q

Globe rupture tx. ?

A

Emergent ophthalmology consultation

enucleated - pull eye ball out

46
Q

Retrobulbar hematoma tx. ?

A

Emergent ophthalmology consultation

47
Q

Hyphema tx. ?

A

Emergent ophthalmology consultation

48
Q

Septal hematoma tx. ?

A

Incision and evacuation

Amoxicillin-clavulanate

Clinical Medicine Lecture - Professor Kramer (28 decks)

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