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F - ORAL SURGERY > Max Fax Trauma > Flashcards

Max Fax Trauma Flashcards

1
Q

Ways to improve airway in OMFS trauma?

A

Chin lift - issue with fractured mandible

Jaw thrust - where rest hands if zygomas / midface are mobile

Oropharyngeal airway - gudel airway

Nasopharyngeal airway

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2
Q

Adjuncts to prevent bleeding in OMFS?

A

Tranexamic acid - prevent clots breaking down

Interventional radiology - balloons into vessels

Medication impregnated gauze into wound

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3
Q

Key events to a trauma history?

A

Blunt vs sharp injury - blunt = burst and irregular skin

When?

Other injuries to head

Drug, alcohol or smoking involvement?

PMH especially anticoagulants and diabetes

Allergies

Social history - trumpet player etc

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4
Q

What might a bruise under the tongue indicate?

A

Fractured mandible
- very hard to get bruise

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5
Q

How might fractured mandible be identified?

A

Contralateral numbness in mandible

Sublingual hematoma

Vertical two point mobility of mandible

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6
Q

What imaging needed for facial trauma?

A

Decide if they need imaging first

2 view minimum

  • OPG and PA mandible
  • 2 angulation of PA for zygoma or orbit

CT mandated for midface / if surgery indicated

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7
Q

First aid for fracture patients?

A

Analgesia

Antibiotics for open fractures of mandible, or grossly contaminated cases

Discuss with OMFS

Aim for mandible surgery within 24/48hrs

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8
Q

Things to look for on trauma radiograph?

A

Bones in right place

Blood, fluid or gas where it shouldn’t be

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9
Q

Wha are the middle third fractures?

A

Nasal fracture

Unilateral maxillary fracture

Le fort I, II, III

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10
Q

What is a malar fracture and its clinical signs?

A

Displacement inferiorly of the zygomatic arch

  • swelling and bruising peri-orbitally
  • diplopia / visual impairment
  • nosebleed
  • sensory deformity of IO nerve
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11
Q

Clinical signs and symptoms of mandible fracture?

A

Pain, swelling and bruising

Limitation of function

Occlusal derangement, loose / mobile teeth

Lower lip numbness
- contralateral numbness to impact

AOB

Asymmetry

Deviation of mandible
- 2 point vertical mobility

Sublingual hematoma

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12
Q

How classify mandibular fracture?

A

Involvement of surrounding tissue
- simple, compound of comminuted

Number of fractures

Side of fracture

Site of fracture

Direction of fracture line

Specific features

Displacement of fracture

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13
Q

What determines a Le Fort type 1?

A

Anterolateral margin of nasal fossa

  • fractured = type 1
  • not fractured, excludes type 1
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14
Q

What indicated type II le fort?

A

inferior orbital rim

Fractured = type II

Not fractured = excludes type II

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15
Q

What indicates type III le fort?

A

Zygomatic arch involvement

Fractured = Type III

Not fractured = not type III

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16
Q

Essential first aid for someone with mandibular fracture?

A

Fast track patients

  • analgesia
  • antibiotics for open fractures / grossly contaminated
  • discuss with OMFS
17
Q

Clinical features of Le fort 1?

A

Swelling of midface / upper lip

Malocclusion

Mobility of the maxilla

Ecchymosis

18
Q

Clinical features of lefort 2 fracture?

A

Widening of intercanthal space

Mobility of maxilla and nose

Malocclusion

Periorbital bruising

Epistaxis

19
Q

Clinical features le fort type 3?

A

Similar to 2
- mobility of zygoma
- mastoid / zygoma bruising
- epistaxis
- widening of intercanthal space

20
Q

What is ORIF?

A

Open reduction internal fixation

  • displaced bone returned to its original position
  • fixation in position with rods, plates and screws
21
Q

What is intermaxillary fixation?

A

Allows for reduction and stabilisation of maxillary or mandibular fractures

Used with closed reduction

  • screws, interdental wires or arch bars
22
Q

What is closed reduction?

A

Treatment of fractured segment without visualisation through skin or mucous membranes

  • repositioned and fixed or not fixed with IMF
23
Q

How pre assess trauma case?

A

A

B

C

D

24
Q

Signs of mandible fracture?

A

Sublingual hematoma

2 point vertical mobility

Abnormal sensation contralateral side to injury

Numbness can’t be explained

25
Q

Treatment if someone presents with fracture of mandible?

A

FAST

  • analgesia
  • antibiotics if open
  • liquid diet
  • immediate discussion with OMFS
26
Q

Signs of midface fracture, including zygoma

A

Epistaxis without blow to nose

V2 numbness without blow to nerve

Subconjunctival bleed

Mobility of midface

Malocclusion

Swelling after nose blowing

Diplopia

Change of appearance / asymmetry

27
Q

Tx of zygoma fracture?

A

No routine ABs

Call OMFS for follow up arrangement

NO NOSE BLOWING

Soft diet for comfort (masseter pull)

Warning regarding retrobulbar bleed

28
Q

How manage orbit fracture?

A

Ensure diplopia documented

Discuss with OMFS

No ABs

No nose blowing!

Warning re retrobulbar bleed

29
Q

Management of le fort?

A

Antibiotics

Discussion with OMFS

Liquid diet

No nose blowing

Most need assessed same day!

30
Q

How refer to OMFS?

A

Contact DCT on call via switchboard at the QEUH

Have pt details ready

Keep pt fasted until discussed

Don’t tell patient date for their review

No appropriate to send to QE without discussion

999 if patient cannot wait / cannot get access to care

F - ORAL SURGERY (25 decks)

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