Max Fax Trauma Flashcards
Ways to improve airway in OMFS trauma?
Chin lift - issue with fractured mandible
Jaw thrust - where rest hands if zygomas / midface are mobile
Oropharyngeal airway - gudel airway
Nasopharyngeal airway
Adjuncts to prevent bleeding in OMFS?
Tranexamic acid - prevent clots breaking down
Interventional radiology - balloons into vessels
Medication impregnated gauze into wound
Key events to a trauma history?
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
What might a bruise under the tongue indicate?
Fractured mandible
- very hard to get bruise
How might fractured mandible be identified?
Contralateral numbness in mandible
Sublingual hematoma
Vertical two point mobility of mandible
What imaging needed for facial trauma?
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
First aid for fracture patients?
Analgesia
Antibiotics for open fractures of mandible, or grossly contaminated cases
Discuss with OMFS
Aim for mandible surgery within 24/48hrs
Things to look for on trauma radiograph?
Bones in right place
Blood, fluid or gas where it shouldn’t be
Wha are the middle third fractures?
Nasal fracture
Unilateral maxillary fracture
Le fort I, II, III
What is a malar fracture and its clinical signs?
Displacement inferiorly of the zygomatic arch
- swelling and bruising peri-orbitally
- diplopia / visual impairment
- nosebleed
- sensory deformity of IO nerve
Clinical signs and symptoms of mandible fracture?
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
How classify mandibular fracture?
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
What determines a Le Fort type 1?
Anterolateral margin of nasal fossa
- fractured = type 1
- not fractured, excludes type 1
What indicated type II le fort?
inferior orbital rim
Fractured = type II
Not fractured = excludes type II
What indicates type III le fort?
Zygomatic arch involvement
Fractured = Type III
Not fractured = not type III
Essential first aid for someone with mandibular fracture?
Fast track patients
- analgesia
- antibiotics for open fractures / grossly contaminated
- discuss with OMFS
Clinical features of Le fort 1?
Swelling of midface / upper lip
Malocclusion
Mobility of the maxilla
Ecchymosis
Clinical features of lefort 2 fracture?
Widening of intercanthal space
Mobility of maxilla and nose
Malocclusion
Periorbital bruising
Epistaxis
Clinical features le fort type 3?
Similar to 2
- mobility of zygoma
- mastoid / zygoma bruising
- epistaxis
- widening of intercanthal space
What is ORIF?
Open reduction internal fixation
- displaced bone returned to its original position
- fixation in position with rods, plates and screws
What is intermaxillary fixation?
Allows for reduction and stabilisation of maxillary or mandibular fractures
Used with closed reduction
- screws, interdental wires or arch bars
What is closed reduction?
Treatment of fractured segment without visualisation through skin or mucous membranes
- repositioned and fixed or not fixed with IMF
How pre assess trauma case?
A
B
C
D
Signs of mandible fracture?
Sublingual hematoma
2 point vertical mobility
Abnormal sensation contralateral side to injury
Numbness can’t be explained
Treatment if someone presents with fracture of mandible?
FAST
- analgesia
- antibiotics if open
- liquid diet
- immediate discussion with OMFS
Signs of midface fracture, including zygoma
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
Tx of zygoma fracture?
No routine ABs
Call OMFS for follow up arrangement
NO NOSE BLOWING
Soft diet for comfort (masseter pull)
Warning regarding retrobulbar bleed
How manage orbit fracture?
Ensure diplopia documented
Discuss with OMFS
No ABs
No nose blowing!
Warning re retrobulbar bleed
Management of le fort?
Antibiotics
Discussion with OMFS
Liquid diet
No nose blowing
Most need assessed same day!
How refer to OMFS?
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
