Maxillofacial trauma

Question 1

What do you need to do when pre assessing a trauma case?

Answer 1

• ATLS principles - Advanced trauma life support
  A (airway Plus C-spine control)
  B (Breathing)
  C (Circulation plus haemorrhage control)
  D (Disability GCS are they head injured)
• Then assess if any fractures
• Full history

Question 2

What might be an indication the mandible has fractured?

Answer 2

• Sublingual haematoma
• 2 point mobility vertically
• Abnormal sensation contralateral to side of injury
• Pain contralateral to side of injury
• Numbness that can’t be explained by direct injury to the nerve

Question 3

What is the immediate management of Mandible fracture?

Answer 3

• Fast pt
• Analgesia
• AB for open fractures (through dentate mandible or mucosal breach)
• Liquid diet
• Immediate discussion with OMFS team

Question 4

What is indicative of midface fracture (including zygoma)?

Answer 4

• Epistaxis （nosebleed） without a blow to the nose (nosebleed)
• CN V2 (maxillary branch of trigeminal nerve) numbness without direct blow to the nerve
• Subconjunctival bleed
• Midface mobility
• Malocclsuion
• Surgical emphysema around eye
• Swelling after nose blowing
• Diplopia (double vision)
• Change of appearance
• CSF from nose

Question 5

reason for epistaxis after midface trauma

with no direct trauma to nose

Answer 5

• bleeding from maxillary sinus can travel to nasal cavity through semilunar hiatus

Question 6

What is the immediate management of midface fracture including zygoma?

Answer 6

• No indication for routine AB
• Call OMFS (vast majority followed up in 7-10days)
• No nose blowing
• Soft diet for their comfort (masseter pull)
• Give warning re retrobulbar haemorrhage (pain, bruising, bulging around eye - seek medical attention immediately)

Question 7

What is the immediate tx protocal for Orbital fractures?

Answer 7

• Ensure visual acuity and diplopia (double vision) documented
• Discuss with OMFS
• No need routine ABS
• No nose blowing
• Give warning re retrobulbar haemorrhage

Question 8

What is the txt protocol for maxilla (lefort type) fractures?

Answer 8

• Fast
• ABS
• Discussion with OMFS immediately
• Liquid diet
• No nose blowing
• Most be will be assessed on the day

Question 9

What do you need to know on how to refer to OMFS for fractures or injuries of the face?

Answer 9

• Contact QEUH OMFS on call via switchboard at QEUH - page them, don’t get put through to the ward
• Have pt details ready including CHI, phone numbers etc
• Keep pt fasted until discussed
• Don’t tell pt date of review
• Don’t send to QE without discussion

Question 10

What would you do if you were unhappy with a discussion with OMFS or failure to reach DCT? (direct consultant)

Answer 10

• Speak to Mr Laraways secretary who knows the consultant covering trauma that week’
• Discuss with consultant directly if not happy with management or pt is too injured to wait / needs 999

Question 11

general points in management

Answer 11

• take 2 x-rays
• keep them fasted until being seen