Maxillofacial and Ocular Emergencies Flashcards
1. Explain concepts related to the assessment of emergency department patients experiencing maxillofacial and ocular emergencies. 2. Describe various patient presentations related to maxillofacial and ocular emergencies. 3. List interventions necessary for patients presenting with maxillofacial and ocular emergencies.
ophthalmic branch VI
sensation to:
scalp, forehead
upper eyelid
conjunctive, cornea
nose
maxillary branch V2
infraorbital nerve (maxillary fracture)
sensation to upper lip, lower eyelid, cheek
mandibular branch V3
inferior alveolar nerve (mandibular fracture)
sensation to lower lip, chin, jaw
define Bell’s Palsy
unilateral facial paralysis due to CN VII damage
often d/t herpes simplex
sx Bell’s Palsy
facial droop can't blink/close affected eye postauricular pain change to tear production ipsilateral loss of taste HA hyperacusis: increased sensitivity to sound frequencies and volume ranges
assessing Bell’s Palsy
diagnosis of exclusion
r/o stroke, meningitis, facial nerve tumor
intervene for Bell’s Palsy
antivirals, steroids analgesics sunglasses artificial tears lubricants at night moist heat facial massage to prevent contractures/paralysis
define trigeminal neuralgia
sudden onset unilateral severe, brief, stabbing, recurrent pain along one or more branches of CN V
branches of CN V
ophthalmic (V1)
maxillary (V2)
mandibular (V3)
overview of trigeminal neuralgia
aka tic doloureux
usually w/ facial tic
worse w/ brushing teeth, chewing
fall/spring exacerbations
causes of trigeminal neuralgia
compression of CN V d/t: MS tumor trauma AV malformation
sx trigeminal neuralgia
shock-like stabbing pain for seconds or minutes
unilateral
affects: lips, cheeks, jaw, eyes, forehead, scalp, nose
intervene for trigeminal neuralgia
carbamazepine to diagnose or be therapeutic
educate about triggers
pharm management of trigeminal neuralgia
carbamazepine/baclofen phenytoin clonazepam lamotrigine valproic acid gabapentin
define temporal arteritis
inflammation of temporal artery
aka giant cell arteritis or cranial arteritis
cause of temporal arteritis
immune system issues
linked to severe infections and high dose abx
sx temporal arteritis
severe stabbing pain in temporal area
redness, swelling to temple w/ tenderness
signs of systemic infection
reduction in vision
intervene for temporal arteritis
steroids x 2 years
analgesics
biopsy
complications of temporal arteritis
if untreated:
blindness or death d/t MI or aortic dissections
define temperomandibular joint (TMJ) dislocation
anterior/superior displacement of jaw
unilateral or bilateral
causes of TMJ dislocation
trauma
yawning
grinding teeth
sx TMJ dislocation
malocclusion head/ear/neck ache pain with jaw movement pop, click, snap sensation limited ROM pain on TMJ palpation palpable depression
assessing TMJ dislocation
open/closed mouth xray
post-reduction view
MRI is image of choice
intervene for TMJ dislocation
IV for sedation
suction
manual reduction
analgesia
dc education for TMJ dislocation
soft diet for 3-4 days
awareness of habits
education on triggers
define zygomatic fractures
loss of malar eminence
2nd most common facial fracture
associated with orbital wall fractures and ocular trauma
sx zygomatic fractures
TIDES: trismus infraorbital hypesthesia diplopia epistaxis symmetrical abnormality (assymmetry)
trismus
reduced ability to open jaw r/t muscle spasm
infraorbital hypesthesia
abnormal loss of sensation to pain, heat, cold, touch
intervene for zygomatic fractures
cold pack elevate HOB ophtho consult avoid: -valsalva maneuver -sleep on affected side -straining/blowing nose
function or orbit
holds eye in correct position
two types of orbital wall fractures
blow in
blow out
blow in orbital fracture
bone fracture into orbit towards eye
eye bugling (exophthalmos) d/t baseball hitting side of face
blow out orbital fracture
bone fracture outward from eye
eye suck into socket (enophthalmos)
direct force to eye socket
sx orbital fractures
ocular entrapment diplopia edema ecchymosis subconjunctival hemorrhage infraorbital hypesthesia
intervene for orbital fractures
cold pack
ophthalmology consult
dc teaching for orbital fractures
avoid:
valsalva maneuvers
straining
blowing nose
ocular entrapement
eye unable to rotate within orbit
overview of maxillary fractures
requires tremendous force
intracranial/spinal trauma
do not always follow Le Fort classifications
complications of maxillary fractures
airway compromise loss of bony stability difficulty swallowing edema blood traumatic debris
assessing maxillary fractures
facial, head CT
facial XR
chest XR if missing teeth
intervene maxillary fractures
airway suctioning elevate HOB ice ophthalmology, neuro, ESS consults for Le Fort II, III fractures
Le Fort I
transverse detachment of entire maxilla above teeth at level of nasal floor
malocclusion, lip lac, fractured teeth, maxillary swelling
aka free-floating maxilla
Le Fort II
pyramidal-shaped fracture with:
transverse detachment of maxilla at base
fracture of bridge of nose at top
fractures through lacrimal and ethmoid bones into median portion of both orbits
massive edema, nasal bone fracture, epistaxis, face lengthening, paresthesia to cheeks, malocclusion
Le Fort III
craniofacial disjunction that creates a free-floating segment of mid-face (complete separation of cranial attachments from facial bones)
involves maxilla, zygona, orbits, bones of cranial base
massive swelling, severe intrafacial hemorrhage, diplopia, malocclusion
tip to remember Le Fort fractures
A man with a Mustache goes to the Pyramids and takes of his Mask
mandibular fractures
blunt trauma
concern when malocclusion: most common fracture sites at canine or third molar sites, angel of mandible and condyles
sx mandibular fractures
malocclusion trismus edema ecchymosis signs of trauma point tenderness numbness to lower lip
dc teaching for mandibular fractures
jaw rest
soft diet
avoid talking/using jaw
avoid strenuous exertion
define peritonsillar abscess
collection of purulent material around tonsils that may lead to deep tissue infection
often follows pharyngitis, tonsillitis
sx peritonsillar abscess
uvula deviation drooling/difficulty swallowing fever halitosis muffled voice pain in throat that radiates to ear swollen soft palate cervical lymphadenitis erythematic tonsils with exudate trismus
intervene peritonsillar abscess
airway throat cultures fluids, abx, steroids, pain needle aspiration, I&D ENT
Ludwig’s angina
bacterial cellulitis of floor of mouth
fast moving - lethal
causes of Ludwig’s angina
untreated dental abscess
abx resistant abscess
sx Ludwig’s angina
resp distress submandibular, sublingual swelling pain, tenderness dysphagia, drooling muffled voice, trismus fever
intervene Ludwig’s angina
airway labs, blood cultures fluids, abx, pain xray, CT if stable admission, surgery
dental subluxation
loose toolth
intervene for dental subluxation
mild: soft diet
moderate: dental consult
avulsed tooth
tooth out of socket
intervene avulsed tooth
preserve tooth:
replace in socket
put in cheek/gum, under tongue
put in glass of milk
put in Hank’s balanced electrolyte solution
replace max 6 hours, ideally 30 min
anterior epistaxis
more common that posterior
front of nasal cavity
hemorrhage bright red
drips from nostrils
causes of anterior epistaxis
nose picking
dry mucosa
intranasal meds or inhalant use
posterior epistaxis
more profuse
hemorrhage dark red
drips down throat
causes of posterior epistaxis
elevate HOB, suction fluids pinch nostrils 10 min cauterization nasal packing
types of cauterization for posterior epistaxis
silver nitrate sticks
diathermy
electrocautery
nasal packing for posterior epistaxis
nasal sponge
epistaxis balloon
pledget soaked with 4% cocaine, phenylephrine, lidocaine with epi
nasal foreign body
most common in peds
monitor for potential aspiration
