Lecture 9C: Facial Trauma Flashcards
What should be your priorities when dealing with facial traumas?
airway maintenance
in-line immobilization spinal control
oro-pharynx bleeding control
LOC management
Shock prevention/treatment
What is the general management of facial trauma?
airway adjunct where possible
suction available
patient position preference (forward lean/ side-lying permits secretions and blood to drain allows mandible/ tongue to fall forward
What are some characteristics of mandible fractures?
Most common fx area of jaw are condyles and body of mandible
10% of sports related facial trauma
2nd most common facial fx (after nasal)
Attached to skull by muscles and TMJ
Prone to injury in collision sports
few muscles/ protection/ sharp contours
What are the s/s of mandibular fractures?
change in bite
jaw mobility swelling, bruising or bleeding
step deformity
increased salivation
malocclusion, awkward movement
pain on mastication
bleeding at gums
ecchymosis floor of mouth
lower lip anesthesia
What are the treatment steps for mandibular fractures?
Bleeding control
prevent swallowing of avulsed teeth
tx for shock, position of comfort
allow for drainage of blood, salivation
transport side-lying: blood/saliva drainage
stabilize/ immobilize: mouth guard+ barton bandage
ice locally
hospital
Characteristics of mandibular dislocations.
involves TMJ, bilateral synovial joint (movement in 3 planes)
inequity between condyle of mandible and mandibular fossa of temporal bone
inequity - prone to dislocations
MOI: usually lateral blow to open mouth mandibular condyle is anterior
List the s/s of mandibular dislocations.
inability to close mouth
pain/deformity anterior to ear
condyles may be palpable
malocclusion
chin deviated to one side
spasm of surrounding musculature
subluxation: audible crepitus from discs
some clicks/pops opening/closing is normal
What is the treatment of mandibular dislocations?
initial immobilization, ice
reduction procedure: MD/DDs/DO
complications: recurrent, malocclusion, TMJ dysfunction
List the S/S of maxillary fractures.
Malocclusion
elongated face
epistaxis
peri-orbital deformity
facial ecchymosis
rhinorrhea (clear CSF)
infra-orbital paresthesia
palpate: increased mobility/crepitus
What is the treatment of maxillary fractures?
airway maintenance
bleeding control
ice application
refer to hospital
List the zygomatic arch fracture s/s.
lateral cheek flatness
unilateral epistaxis: maxillary sinus bleed
anesthesia of cheek
deformity of nose/ upper lip
diplopia (double vision)
trismus (spasm of masseters)
What are the eval and tx steps of zygomatic arch fx?
eval: head injury ax, palpate for deformity, sensation
tx: ice pack locally/gently
patch both eyes, transport supine
hospital for xray/ reduction
edema may delay correction
List the characteristics of nasal injuries.
most common facial bone fracture
prominent/weak structure
function: respiration/olfactory/filtering
physical exam more value than x-ray, should x-ray to R/O max/facial bones
bleed profusely
List the s/s of nasal fractures.
epistaxis, crepitus, pain on palpation
deformity, deviation, depression
swelling, laceration possible, decreased smell
ecchymosis (next day)
septal hematoma
what is the treatment for nasal fx?
control bleeding
patient never supine
airway concerns
do not blow nose
cosmetic important reduce within 5 days
usually some aesthetic effect
What is a permanent deformity of the ear?
cauliflower ear
what is the treatment for auricular hematomas?
ice locally
sterile needle aspiration followed by compression 3-5 days
tight pressure dressing and contouring mold made with flexible collodian and gauze
drain re-accumulations
ear protectors for 4-6 weeks
What are the s/s of tympanic membrane rupture?
severe pain, muffled hearing, bleeding, tinnitus, vertigo
What are the steps to an eye examination?
open the eye, look for foreign body
observe: intra-ocular swelling
inspect: conjunctiva, sclera, pupil, iris
palpate: orbital rim
check: PERRLA
movement
visual acuity
What are the different types of eye injuries?
lids
cornea and conjunctiva
anterior chamber
lens
vitreous
retina
orbit
What kinds of lacerations require expert care?
lacerations involving lid margins and/or naso-lacrimal apparatus
What is subconjunctival hemorrhage?
bleeding under the conjunctiva
often spontaneous
asymptomatic: no pain or change in vision
no treatment required, clears spontaneously
may return to play if cleared
What is hyphema?
bleeding in anterior chamber (most common injury in sport)
MOI: blunt trauma to eye
What are the s/s of hyphema and what is its treatment?
s/s: blurred vision
loss of field of vision
may see loss of iris detail
rarely see a blood fluid level
clears spontaneously may rebleed day 4-6
tx: immediate non-urgent referral for tx and meds
List the MOI, S/S and Tx of iris injuries.
MOI: usually blunt trauma
S/S: light sensitivity, double vision, irregular pupil
Tx: immediate referral to ophthalmologist
List the MOI, S/S and Tx of lens trauma.
MOI: usually blunt trauma
Lens can dislocate
lens can opacify (cataract)
S/s: blurred vision, double vision, darkening of vision
Tx: immediate referral to ophthalmologist
List the MOI, S/S and Tx of conjunctival foreign body .
description: dirt or other extraneous material on conjunctival membrane
s/s: foreign body sensation
first response: rinse eye with sterile water, evert lid and use wet Q-tip if necessary
May RTP if fully cleared
List the MOI, S/S and Tx of corneal foreign body.
Corneal foreign body
material embedded in clear window of eye
s/s: reduced visual acuity, foreign body sensation, photophobic
first response: immediate referral to ophthalmologist for surgical removal
List the MOI, S/S and Tx of corneal abrasion.
scratch, scrape, erosion of clear window
s/s: decreased visual acuity, foreign body sensation, photophobia
heals in 24-48h with patch and/or drugs
tx: irrigate with sterile saline solution
patch eye
refer for ophthalmic exam
List the MOI, S/S and Tx of corneal laceration.
MOI: blunt or sharp or trauma, previous laser eye surgery increases risks
S/S: decrease vision, increased light sensitivity, irregular pupil
tx: urgent referral to opth
List the MOI, S/S and Tx of vitreous hemorrhage.
Bleeding into the vitreous jelly in the posterior chamber of the eye
MOI: blunt or sharp trauma
S/S: decreased vision, floaters
Tx: immediate referral to ophthalmologist
resolves spontaneously (may take weeks)
List the MOI, S/S and Tx of detached retina.
separation of very thin retina from underlying structures, usually painless
More common with athletes with myopia
S/S: flashing lights, floaters, blurred vision, visual field defect, as detachment progress ==> curtain is falling
Tx: True ocular emergency, immediate referral
List the MOI, S/S and Tx of macular injury.
macula is central part of retina, required for central vision acuity
MOI: blunt trauma
S/S: blurred central vision
Tx: immediate referral to ophthalmologist
damage to vision often permanent due to scarring
List the MOI, S/S and Tx of orbital blowout fracture.
fracture of thin bones of orbit
MOI: blunt trauma
s/s: double vision, orbital bruising/air bubbles, numbness below eye
Tx: immediate referral, may require surgery
What is the treatment for an extruded eye?
tx associated injuries first
control bleeding, calm patient
wet saline notched dressing below/above
cover with notched cup with loose padding inside
secure cup with transpore tape
cover both eyes, TLC
transport supine
What symptoms prevent an athlete from RTP?
visual blurring
double vision
flashers or floaters
Light sensitivity
abnormal penlight exam
Problems with: lid margin, pupil changes, loss of iris detail, abnormal extra-ocular movements
When is it a 911 versus an urgent referral to the ophthalmologist?
911: ruptured globe/ embedded sharp object, associated injuries
urgent referral: visual field loss with flashers/floaters, visual acuity loss, photophobia, diploplia
How many teeth do we have?
32, 8 per quadrants ==> 2 incisors, 1 canine, 2 premolars, 3 molars
What are the three layers of teeth?
enamel: hard outer layer
cementum: coats root surface, attaches tooth to periodontal lig of socket
dentin: forms bulk of tooth/walls for pulp
pulp chamber: space in middle contains nerve, blood for tooth viability
What are the 4 types of tooth luxations?
concussion: no breakage, loosening or displacement
subluxation: mobile but undisplaced
luxation: displacement of tooth, blood supply fully compromised
avulsion: tooth is out of socket
How can you tell if its an alveolar fracture versus a tooth luxation?
alveolar fractures will show mobility for a group of teeth no tooth independently mobile
What is one of the best ways to protect teeth?
wearing a mouth guard
What is the management of a crown fracture?
need to cover fx part ASAP
need urgent dental tx to prevent infection and prevent need for root canal
locate missing pieces of teeth. Out of mouth, in soft tissue, swallowed, inhaled
What is the management of a tooth avulsion?
replace tooth in socket ASAP (within 3 min)
rinse debris off tooth, don’t scrub tooth
handle tooth by crown, not root
clean a blood clot out of socket with light gentle irrigation
if can’t be re-implanted immediately, store tooth in appropriate medium, (egg white, coconut water, milk)
don’t let tooth dry out
don’t re-implant a baby tooth
