MIDFACIAL TRAUMA Flashcards
KEY CONCEPTS
LE FORT I
Transverse fracture along the maxilla
Clinical Features:
Movement of maxilla only with manipulation of the maxillary teeth
Greater palatine foramen ecchymosis (Guerin sign)
Ecchymosis in the buccal vestibule
LE FORT II
Pyramidal fracture through the cental maxilla and hard palate
Involves the suborbital and lateral maxillary buttresses, orbital floor, and nasofrontal junction
Involves the suborbital and lateral maxillary buttresses, orbital floor, and nasofrontal junction
Commonly involves the infraorbital nerve
Clinical Features:
Dish-face deformity (elongation and flattening of the facial structures)
Movement of nasal bridge + maxilla with manipulation of the maxillary teeth
Periorbital ecchymosis
Subconjunctival ecchymosis
Telecanthus (widening of intercanthal space)
Diplopia
LE FORT III
Disruption of all bony attachments between the skull base and maxilla (“craniofacial separation”)
Midface separation at the zygomaticomaxillary complex, orbital floor, and nasofrontal junction
Clinical Features:
Dish-face deformity
Movement of the entire midface with manipulation of the maxillary teeth
Orbital hooding
Enophthalmos
Ecchymosis of the mastoid region (Battle sign)
CSF otorrhea
Hemotympanum
ZYGOMATICOMAXILLARY COMPLEX FRACTURE
Clinical Features:
Swelling
Pain
Ecchymosis
Enophthalmos
Subconjunctival hemorrhage
Trismus
Paresthesias or hyperesthesias of the ipsilateral cheek, inferior eyelid, nose, and upper lip → inferior orbital nerve injury
Diplopia → extraocular muscle entrapment
PALATAL FRACTURE
Disruption of the palatal and gingival mucosa
Change in occlusion
Mobility of alveolar segments
DDx
Intracranial Injury
Frontal Bone Fracture
Orbital Fracture
Globe Injury
Midfacial Fracture: LaFort I-III
Mandibular Fracture
Dental Injury
C-Spine injury
MANAGEMENT
HEMOSTASIS
TXA 500 mg soaked in gauze or cotton inserted into the bleeding nare for 10-30 min
IMAGING
Non contrast CT of facial bones
CTA to evalutate blunt cerebrovascular trauma in patients with LeFort II, LeFort III or complex mandibular fracture
DOCUMENTATION
HISTORY
Ask about:
Mechanism of injury
Timing of injury (of any laceration)
Use of protective gear
Visual change
Facial Numbness
Changes in dental occlusion
LOC
Headache
Nausea / Vomiting
Neck pain
PHYSICAL EXAM
Document:
GCS
Swelling, erythema, bruising, deformity
nasal mucosa (patency, hematoma)
rhinorrhea or otorrhea.
epiphora (overflow of tears onto the face).
Palpate facial structures for instability
Test the patient’s mobility on both sides of the face as well as in the midline because fractures can be found unilaterally.
Halo test: The separation of nasal fluid with a bloody center encircled by a “halo” of clear fluid suggests a CSF leak
ddx: saline, saliva, and other clear fluids.
Hemotympanum
Evaluate Malocclusion
Dental Exam
CN Exam
visual acuity
intercanthal distance.
slit lamp exam with fluorescein.
C-spine
