OMFS Trauma Flashcards
What are the principles for assessing the trauma case?
Airway
Breathing
Circulation
Disability
What the presenting features of a mandible fracture?
Sublingual heamatoma
2 point mobility vertically
Abnormal sensation/ numbness contra lateral to side of injury
Pain contra lateral
What is the treatment for mandibular fracture (as GDP)?
Tell pt to fast anf grove analgesia
Antibiotics given for open fractures (through dentate mandible or mucosal breach)
Liquid diet
Immediate discussion with OMFS team (urgent referral)
What are some presenting features of a mid face trauma?
Le fort fractures- top jaw is mobile in all
Epistaxis without blow to the nose
V2 numbness without direct blow to nerve
Subconjunctival bleed
Midface mobility
Malocclusion
Surgical emphysema around eye
What is the management for zygomatic fracture as gdp?
No indication for routine antibiotics
Call OMFS - follow up in 7-10 days
No nose blowing
Soft diet (for their comfort)
Warn pt of retrobulbar bleed risk (can go blind)
What is Le fort?
Describes the way in which mid face breaks (transverse fractures in 3 distinct patterns). All fractures in this class extend in to pterygoid columns and plates.
Le fort 1 - palatal fracture (only top jaw moves)
Le fort 2 - teeth and nose come forward
Le fort 3 - teeth and nose come forward, rest of face stays in same place.
What is the management of an orbit fracture as gdp?
Ensure visual acuity (can they see) and Diplopoda (double vision) are recorded.
Discuss with OMFS team - suitable for outpatient follow up
No nose blowing
No antibiotics
Give warning of retrobulbar bleed
What is the management of maxilla fracture as GDP?
Fast pt
Give antibiotics and advise liquid diet
No nose blowing
Referral to OMFS that day
what is the referral pathway to OMFS?
Page OMFS through contacting QEUH
Give patients CHI, phone number, important MH
Keep patient fasted until discussed with OMFS
Allow OMFS for further communication w patient
What is Diplopia?
Double vision
What is sublingual haematoma?
Bruise under tongue, suggestive of fractured mandible
What are the features of a zygomatic fracture?
Unilateral epistaxis (without nose injury)
Eyebrow sign
Paraesthesia when trauma was distant to the extraosseus infra orbital nerve
Buttress tenderness/ FZ/ IOR/ arch tender
What are the features of a Naso maxillary fracture?
Tender IOR/ pyriform
Buttress intact
Often numb
Unilateral epistaxis without blow to nose
What are the features of Naso orbital fractures?
Retropositioned nose
Buttress not tender
Hyperteloric (eyes drift apart)
Often numb
Epistaxis
What are the primary and secondary surveys in OMFS?
Primary - airway, bleeding
Secondary - sight, bony injury, soft tissue injury
What are some factors which make the airway difficult to asses?
Uncleared neck eg hard collar
Poor mouth opening
Intoxicated/ abnormal GCS
Beards
Overweight
Arthritic neck
Maxillofacial trauma
Which are the most risky injuries for protecting airway?
Bilateral mandible body/ angle fractures
Midface/ pan face fractures
Neck injuries
What are signs of acute airway obstruction?
Stridor - caused by closed glottis, not moving any air
Stertor - sounds like snoring
Funny noises on inspiration
Which is the best way to achieve a safe airway in maxillofacial injuries?
Oral intubation - safest option for risky airways, have a surgeon nearby if doesn’t go to plan
How much of CO goes to head and neck?
1 litre per min
How are bleeding emergencies managed?
Reduce fractures and pack cavities
What are some adjuncts used in bleeding emergencies?
Tranexamic acid
Intraventional radiology
Medication impregnated gauze/ packing
What is the most common sight loss emergency?
Retrobulbar bleed - bleed and build up of pressure behind eye
How is a retro bulbar bleed managed?
Surgical intervention to relieve pressure - clip eye at the lateral border.
What is assessed for sight loss emergencies?
Pupils - blown pupils can be many things so must rule out intercranial bleed
Eye movements
Pain
Chemosis (globby conjunctiva)
Proptosis
Visual acuity
Numbness (V1 and V2)
What are you assessing for bony injuries?
Numbness
Mobility
Visual acuity
Pupils
Symmetry
CSF
