Maxfax: Initial Management and Referrals

Question 1

What is involved in pre assessing a trauma case?

Answer 1

ATLS principles
Airway
Breathing
Circulation
Disability

Question 2

What can be seen if there is a suspected mandible fracture?

Answer 2

A malocclusion present
Sublingual haematoma (blood clot under mucosa under tongue)
– 2 point mobility vertically
–Abnormal sensation contralateral to the side of the injury
–Numbness that cannot be explained by direct injury to the nerve
2 X-rays needed - NO OPT’S

Question 3

What is the initial treatment for a suspected fracture?

Answer 3

Fast the patient
Analgesics
Antibiotics for open fractures (through dentate mandible or mucosal breach)
Liquid diet
Immediate discussion with OMFS team

Question 4

What are the signs and symptoms of a midface fracture?

Answer 4

Epistaxis (nose bleed) without a blow to the nose
V2 numbness without a direct blow to the nose
Subconjunctival bleed (blood red on white of eyes)
Midface mobility (hold forehead and maxillary hard palate and move)
Malocclusion
Surgical emphysema around the eye
Swelling after nose blowing
Diplopia (double vision)
Change of appearance
CSF fluid leaking out of the nose or ears (skull injury)