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Medicine II: Emergency Medicine > Head and Facial Injuries > Flashcards

Head and Facial Injuries Flashcards

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1
Q

What is the most common cause of facial injuries?

A

Domestic violence

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2
Q

What is the most common cause of facial injuries in children < 6 yo?

A

Animal attacks

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3
Q

What are the two main portions of the teeth?

A

crown and root

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4
Q

ELLIS Classification 1:

A

Only the enamel is fractured

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5
Q

ELLIS Classification 2:

A

Enamel with dentin exposure

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6
Q

ELLIS Classification 3:

A

Enamel fracture with dentin and pulp exposed

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7
Q

What is the treatment for a dental fracture, ELLIS type I?

A

No pain or hot/cold sensitivity. Elective dental follow up visit.

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8
Q

What is the treatment for a dental fracture, ELLIS type II?

A

Hot/cold sensitivity present. 12yo dressing on the tooth for comfort.

24hr follow up with dentist

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9
Q

What is the treatment for a dental fracture, ELLIS type III?

A

Severe pain (maybe absent if NV bundle is disrupted). TRUE DENTAL EMERGENCY. Immediate dental referral. If not available, place moist cotton over the exposed pulp and cover with tin foil.

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10
Q

What determines a tooths viability?

A

The integrity of the periodontal ligament and the length of time removed from the socket

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11
Q

Treatment of avulsed teeth: Permanent tooth:

A

Hold the tooth by the crown, rinse with saline and immediately replace the tooth in the socket. DO NOT brush or rub the tooth.

Immediate referral

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12
Q

Treatment of avulsed teeth: Deciduous/Primary tooth:

A

DO NOT replace the tooth, may result in alveolar ankylosis. Dental referral

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13
Q

What is the best storage medium for an avulsed tooth?

A

Hank’s solution, integrity can be maintained for 4-6hrs

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14
Q

The mandible is the _______ most commonly fractured facial bone

A

second

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15
Q

How do mandible fractures usually present? Why?

A

Due to its ring like structure, the mandible fractures into 2 or more places in 50 percent to cases

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16
Q

What is the most commonly fractured area of the mandible?

A

the body

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17
Q

What is the most common mechanism of injury for a mandible fracture?

A

MVA, Assault

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18
Q

What are the hallmarks of mandibular dysfunction?

A

Limited opening, deviation on opening mouth, malocclusion, trismus and pain

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19
Q

What is trismus associated with?

A

tetanus

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20
Q

What is the best study for the diagnosis of a mandibular fracture?

A

PANOREX

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21
Q

Classification of Alveolar Fractures:

A

Class 1: fracture of the edentulous segment
Class 2: fracture of the edentulous segment with mild displacement
Class 3: fracture with moderate to severe displacement
Class 4: severe displacement and other fracture lines thru dental skeleton

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22
Q

Mandibular Treatment:

A

ABC’s, Reestablish occlusion, reduction and fixation

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23
Q

Indications for Open Reduction of Mandibular Fractures

A

Multiple Facial Fractures.
Displaced unfavorable fractures: angle, body, symphysis, parasymphysis.
Bilateral Condylar fractures.
Displaced Edentulous fractures of the maxilla and mandible.

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24
Q

Zygomatic Arch Fractures Clinical Clues:

A

FLATTENED CHEEK, Painful/limited opening of the mouth, lower eyelid swelling

XR: Subsegmental vertex

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25
Q

What is the treatment for a zygomatic arch fracture?

A

1st control the bleeding, then abx and surgical elevation and wiring (after facial swelling resolves)

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26
Q

Pathophysiology and Presentation of a Zygomatic Maxillary Complex “Tripod Fractures”

A

Result from a blow to the cheek

Clinically: Flattening of the cheek, Periorbital swelling, Diploplia, Palpable stepoff deformity of the inferior orbital rim, Anesthesia of the cheek, upper teeth, lip, and gum.

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27
Q

Tripod Fractures involve fractures at 3 sites:

A

Zygomatic Arch, Zygomaticofrontal suture, Infraorbital foramen

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28
Q

Tripod Fractures can cause…

A

Entrapment of extraocular muscles (inferior rectus).

Disruption of the intraorbital artery or intraorbital division of CN V

Visual disturbances secondary to loss of integrity of the normal ligamentous structures that hold the globe in place

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29
Q

Tripod Fractures Treatment:

A

Control the bleeding, Broad Spectrum ABX, Analgesia

Open reduction/wire fixation for open and displaced fractures

30
Q

Maxillary Fractures

A

(6-25% of all facial fractures). Result from massive, direct facial trauma.

ALWAYS AIRWAY FIRST!!! (high potential for airway compromise)

31
Q

What are the clinical clues of a maxillary fracture?

A

Massive soft tissue swelling, Midfacial Mobility, Malocclusion, CSF rhinorrhea

32
Q

LeFort I Classification

A

Horizontal fx of the maxilla at the level of the nasal floor

33
Q

LeFort II Classification

A

Fx through the nasal bones, maxilla, and infraorbital rim

34
Q

Lefort III Classification

A

Fractures through the zygomaticofrontal suture and frontal bone above the nose

35
Q

Clincal Clue of a Lefort I Classification:

A

Malocclusion

36
Q

Clincal Clue of a Lefort II Classification:

A

Mobility of the nose into the dental arch

37
Q

Clincal Clue of a Lefort III Classification:

A

Global posterior retrusion; “Dish Face”

38
Q

What is the treatment for Le Fort Fractures?

A

AIRWAY.. Face may be impacted posterio-inferiorly, thus dismimpaction may be attempted first.

Prepare for cricothyrotomy or tracheotomy

39
Q

Le Fort _________ is the most common type of fracture and is also known as ___________.

A

I; Guerin’s fracture.

40
Q

Orbital Blowout Fractures

A

Most commonly occur through the orbital floor. May occur medially in the region of the lamina papyracea of the ethmoid bone.

41
Q

What are the XR/CT findings of an Orbital Blowout fracture?

A

Air fluid level in the maxillary sinus
Bony disruption of the orbital floor
Clouding of the maxillary sinus
Orbital Emphysema

42
Q

What are the Signs/Symptoms of Orbital Floor Fractures?

A

Pain/Diploplia on UPWARD GAZE
Enopthalmos
Hypoesthesia of the ipsilateral cheek and lip (infraorbital n.)
Subcutaneous Emphysema
LIMITATION OF UPWARD GAZE (secondary to entrapment of the inferior rectus/oblique muscles)

43
Q

Medial Wall Fractures Signs/Symptoms:

A

Epistaxis
Lid/Conjunctival Emphysema
LIMITATION OF LATERAL GAZE (entrapment of medial rectus)

XR: Clouding of the ethmoid sinus, orbital emphysema

44
Q

What are Trapdoor Fractures?

A

Small orbital floor fractures with clinically significant muscle entrapment. Common in pediatrics

Similar findings to orbital floor fracture with NO supraduction, nausea, vomiting, or intense pain

45
Q

Orbital Fracture Treatment:

A

RULE OUT OCULAR INJURY (30%) . Opthomology referral

Broad Spectrum ABX, Decongestants, Avoid Valsalva including nose blowing

Broad spectrum antibiotics are given as a standard treatment in orbital trauma in order to prevent Orbital Cellulitis.

46
Q

Orbital Roof Fracture

A

LIFE THREATENTING INJURY!!! IMMEDIATE Neurosurgical intervention. Secondary to communication between the orbit and anterior cranial fossa.

47
Q

How do we evaluate and treat a closed skull fracture?

A

Get a CT to rule out other injuries.

No specific treatment. Close observation is needed to detect development of epidural hematoma if the CT was initially negative

48
Q

What is the plan for a patient with a closed skull fracture?

A

Patients with closed skull fractures, with no evidence of brain injury should be admitted for at least 24 hrs.

49
Q

What is the most common orbital fracture?

A

orbital floor fracture

50
Q

How do we treat orbital fracture?

A

first rule out ocular injury, then refer and give abx to prevent cellulitis.

avoid valsalva/nose blowing

51
Q

How do we diagnose depressed skull fractures?

A

inspection and palpation with CT

52
Q

How do we treat depressed fractures?

A

cosmetic, open depressed is at high risk of infection

53
Q

What are the signs and symptoms of a temporal bone fracture?

A
  • Hearing loss, facial nerve injury, intracranial injury
  • External clinical sings CAN BE ABSENT
  • CT scan of face and head
54
Q

What are the types of basillar skull fractures?

A

mastoid ecchymosis “battle’s sign, periorbital ecchymosis “raccoon eyes”, hemotympanum, TM torn, conductive hearing loss

55
Q

What is a subdural hematoma?

A

Lesion lies in space btwn dura and arachnoid. Conforms to convexity of underlying cereberal cortex.

CONCAVE! CROSSES SUTURE LINES!

56
Q

What are the signs and symptoms of a subdural hematoma?

A

Pt have min neuro deficits. Chronic hematoma will lead to neuro deterioration.

57
Q

How do we diagnose and treat a subdural hematoma?

A

Dx with CT.

Tx: Prompt neurosurg evaluation, poss. drainage

58
Q

What is the cause of a subdural hematoma?

A

shearing of the bridging veins

59
Q

What is an epidural hematoma?

A

EPIDURAL HEMATOMA
Collection of blood and clot btwn dura and bones of skull.

Have biconvex shape. DOES NOT CROSSES SUTURE LINES!

60
Q

What are the signs and symptoms of a epidural hematoma?

A

Brief loss of consciousness with lucid segment. Can lead to herniation of brain content.

61
Q

What is the cause of a epidural hematoma?

A

Sources of bleeding: meningeal artery, or dural venous sinus.

62
Q

How do we diagnose and treat a epidural hematoma?

A

DX made w/ CT

Rapid intervention by surgeon. Pts outcome is determine by their level of consciousness upon presentation. And the length of time before decompression.

63
Q

What part of the brain is at highest risk in a SAH?

A

3rd and 4th ventricles

64
Q

How do we dx a Diffuse Axonal Injury?

A

Dx via noncontrast CT scan: blurring of gray to white matter margin, punctuate cerebral hemorrhages, cerebral edema

Posttraumatic coma

65
Q

What causes a diffuse axonal injury?

A

Shearing forces from sudden deceleration during blunt trauma

66
Q

What are the most common findings in a minor head injury?

A

Soft tissue injuries: abrasion, contusion, laceration

67
Q

Which le fort fracture has airway compromise?

A

III

68
Q

Most common facial fracture?

A

nasal bone

69
Q

What is a contrecoup injury?

A

occurs on the side opposite the area that was impacted.

70
Q

Signs and symptoms of a nasal fracture:

A

Pain in nose, epistaxis, deformity of nose

71
Q

How do we diagnose a nasal fracture?

A

No imaging needed, clinical dx

72
Q

How do we treat a nasal fracture?

A

Assess for airway, control epistaxis, reduce fractures, drain septal hematomas.

Give oral analgesics, nasal decongestants

Medicine II: Emergency Medicine (11 decks)

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