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

Head and Facial Injuries Flashcards

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
What is the treatment for a zygomatic arch fracture?
1st control the bleeding, then abx and surgical elevation and wiring (after facial swelling resolves)
26
Pathophysiology and Presentation of a Zygomatic Maxillary Complex “Tripod Fractures”
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.
27
Tripod Fractures involve fractures at 3 sites:
Zygomatic Arch, Zygomaticofrontal suture, Infraorbital foramen
28
Tripod Fractures can cause…
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
29
Tripod Fractures Treatment:
Control the bleeding, Broad Spectrum ABX, Analgesia Open reduction/wire fixation for open and displaced fractures
30
Maxillary Fractures
(6-25% of all facial fractures). Result from massive, direct facial trauma. ALWAYS AIRWAY FIRST!!! (high potential for airway compromise)
31
What are the clinical clues of a maxillary fracture?
Massive soft tissue swelling, Midfacial Mobility, Malocclusion, CSF rhinorrhea
32
LeFort I Classification
Horizontal fx of the maxilla at the level of the nasal floor
33
LeFort II Classification
Fx through the nasal bones, maxilla, and infraorbital rim
34
Lefort III Classification
Fractures through the zygomaticofrontal suture and frontal bone above the nose
35
Clincal Clue of a Lefort I Classification:
Malocclusion
36
Clincal Clue of a Lefort II Classification:
Mobility of the nose into the dental arch
37
Clincal Clue of a Lefort III Classification:
Global posterior retrusion; "Dish Face"
38
What is the treatment for Le Fort Fractures?
AIRWAY.. Face may be impacted posterio-inferiorly, thus dismimpaction may be attempted first. Prepare for cricothyrotomy or tracheotomy
39
Le Fort _________ is the most common type of fracture and is also known as ___________.
I; Guerin’s fracture.
40
Orbital Blowout Fractures
Most commonly occur through the orbital floor. May occur medially in the region of the lamina papyracea of the ethmoid bone.
41
What are the XR/CT findings of an Orbital Blowout fracture?
Air fluid level in the maxillary sinus Bony disruption of the orbital floor Clouding of the maxillary sinus Orbital Emphysema
42
What are the Signs/Symptoms of Orbital Floor Fractures?
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
Medial Wall Fractures Signs/Symptoms:
Epistaxis Lid/Conjunctival Emphysema LIMITATION OF LATERAL GAZE (entrapment of medial rectus) XR: Clouding of the ethmoid sinus, orbital emphysema
44
What are Trapdoor Fractures?
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
Orbital Fracture Treatment:
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
Orbital Roof Fracture
LIFE THREATENTING INJURY!!! IMMEDIATE Neurosurgical intervention. Secondary to communication between the orbit and anterior cranial fossa.
47
How do we evaluate and treat a closed skull fracture?
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
What is the plan for a patient with a closed skull fracture?
Patients with closed skull fractures, with no evidence of brain injury should be admitted for at least 24 hrs.
49
What is the most common orbital fracture?
orbital floor fracture
50
How do we treat orbital fracture?
first rule out ocular injury, then refer and give abx to prevent cellulitis. avoid valsalva/nose blowing
51
How do we diagnose depressed skull fractures?
inspection and palpation with CT
52
How do we treat depressed fractures?
cosmetic, open depressed is at high risk of infection
53
What are the signs and symptoms of a temporal bone fracture?
* Hearing loss, facial nerve injury, intracranial injury * External clinical sings CAN BE ABSENT * CT scan of face and head
54
What are the types of basillar skull fractures?
mastoid ecchymosis “battle’s sign, periorbital ecchymosis “raccoon eyes”, hemotympanum, TM torn, conductive hearing loss
55
What is a subdural hematoma?
Lesion lies in space btwn dura and arachnoid. Conforms to convexity of underlying cereberal cortex. CONCAVE! CROSSES SUTURE LINES!
56
What are the signs and symptoms of a subdural hematoma?
Pt have min neuro deficits. Chronic hematoma will lead to neuro deterioration.
57
How do we diagnose and treat a subdural hematoma?
Dx with CT. Tx: Prompt neurosurg evaluation, poss. drainage
58
What is the cause of a subdural hematoma?
shearing of the bridging veins
59
What is an epidural hematoma?
EPIDURAL HEMATOMA Collection of blood and clot btwn dura and bones of skull. Have biconvex shape. DOES NOT CROSSES SUTURE LINES!
60
What are the signs and symptoms of a epidural hematoma?
Brief loss of consciousness with lucid segment. Can lead to herniation of brain content.
61
What is the cause of a epidural hematoma?
Sources of bleeding: meningeal artery, or dural venous sinus.
62
How do we diagnose and treat a epidural hematoma?
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
What part of the brain is at highest risk in a SAH?
3rd and 4th ventricles
64
How do we dx a Diffuse Axonal Injury?
Dx via noncontrast CT scan: blurring of gray to white matter margin, punctuate cerebral hemorrhages, cerebral edema Posttraumatic coma
65
What causes a diffuse axonal injury?
Shearing forces from sudden deceleration during blunt trauma
66
What are the most common findings in a minor head injury?
Soft tissue injuries: abrasion, contusion, laceration
67
Which le fort fracture has airway compromise?
III
68
Most common facial fracture?
nasal bone
69
What is a contrecoup injury?
occurs on the side opposite the area that was impacted.
70
Signs and symptoms of a nasal fracture:
Pain in nose, epistaxis, deformity of nose
71
How do we diagnose a nasal fracture?
No imaging needed, clinical dx
72
How do we treat a nasal fracture?
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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