Plastic Surgery: Facial Injuries Flashcards
Describe emergency assessment including exam and investigations for a facial injuries.
Etiology: if traumatic, then ensure pt stable then deal with craniofacial injury (secondary).
ABC and C spine precautions: high likelihood of C spine injury with bad facial injury. Do C spine XR/CT, look for posterior neck pain on palpation, limited ROM, paresthesias.
Bleeding: check for bleeding from internal maxillary artery or branches. Suture superficial wounds, do anterior-posterior packing, angio-embolization, ligation.
If frontal impact, look for Le Fort I/II, if lateral impact Le Fort III.
PEx:
Examine both sides to assess symmetry and deformity.
CN exam, especially CN V sensation.
Check for midface stability.
Soft tissue: contour deformities, crepitus, scalp/facial lacerations, contusions.
Zygoma exam:
SS: double vision, V2 paresthesias, trismus, malocclusion. Periorbital ecchymosis, lateral subconjunctival hemorrhage, loss of malar prominence, uniequal height of pupils (orbital dystopia), intraoral ecchymosis.
Mandible exam:
SS: malocclusion, injured dentition, numb V3, pain on opening. laceration of ear canal, deviation of jaw. Open vs closed– # extends into mouth where teeth are. If open, provide abx as there is a high risk of infection.
Maxillary exam:
Irritated nerves –> numbness of teeth. Anterior superior dental alveolar nerve supplies anterior maxillary teeth, posterior superior dental alveolar nerve supplies middle/posterior maxillary teeth. Facial edema (panda faces), increased midfacial length, periorbital ecchymosis, subconjunctival hemorrhage, epistaxis, CSF rhinorrhea, malocclusion.
Midface crepitus. Le Fort classification, maxillary mobility (hallmark of diagnosis).
Orbit exam: Frontal, maxilla, zygoma, sphenoid, ethmoid, lacrimal and palatine bone exams. SS diplopia, enophthalmos, vertical dystopia, numb V2, periorbital ecchymosis, conjunctival hemorrhage, corneal abrasion, visual acuity/fields.
Nasal exam: SS difficulty breathing, swelling, deviation, periorbital ecchymosis, conjunctival hemorrhage, asymmetry, epistaxis, CSF rhinorrhea, VA/fields, rule otu septal hematoma.
Ear exam: hemotympanum, CSF otorrhea.
Principles of tx of lacerations and other soft tissue injuries.
T shaped distribution (midline/brow) –> midface is the most susceptible to fracture so have high suspicion.
ABC/stabilize –> trauma pt first.
Mgmt of soft tissue injury: Local anesthetic blocks, irrigate and debride, remove foreign bodies, remove non-viable tissue, approximate areas, give tetanus shots and abx.
Important structures to check: facial nerve, parotid duct.
Principles of tx of # of facial bones.
Airway mgmt, occlusion (align properly), exposure, fixation.
Describe Le Fort I, II, III fractures
Classification system for maxillary fractures, must exit through the pterygoid plates (posterior component).
Le Fort I: through the maxilla so get mobility of upper teeth in lateral plane.
Le Fort II: triangular piece of maxilla including nasal root. Mobility in anterior-posterior direction of upper teeth and nose.
Le Fort III: across the orbits. Whole midface to upper teeth mobile.
