principles of trauma management Flashcards
what are the main causes of fractues of the facial bones?
- interpersonal violence
- road traffic accidents
- falls
- industrial accidents
what unique features and functions of the face and maxillofacial region must be considered when there is trauma to the face?
- senses
- sight
- smell
- taste
- hearing
- function
- eating
- drinking
- speech
- communication through facial expression
- look out for these features to aid with diagnosis
what are common features of a fractured mandible?
- mobile and displaced teeth
- deranged occlusion
- sublingual haematoma
what is shown here?
lower anteriors are displaced lingually
swelling
patient unable to occlude
mandible fracture
what is shown here?
deranged occlusion - patient contacting early on left side
lateral and anterior open bite on the right side
-> fracture on ramus or angle is fractured on right side
what is shown here?
sublingual haematoma
bleeding at the floor of the mouth
may raise floor of mouth and interefere with airway
what information should be sought for in the history if fracture is suspected in the mandible
- altered occlusion
- pain sites and step deformity
- able to feel step
- numbness in skin, mucosa, teeth
- mobile teeth in fracture site
- alteration in ability to speak, swallow, chew, limitation of opening mouth
what are features of a zygomatic complex fracture?
- asymmetry
- epistaxis
- haematoma
- periorbital bruising
- neurological deficit
- sensory - infraorbital nerve supplied upper teeth
- diplopia
- extraoral muscles of orbit can be trapped in fracture lines
- bleeding around the eye
- subconjunctival haemorrhage
- bleeding around the globe, under the conjuctiva
- limitation of mandibular movement
- impedes with ocornoid process underneath
- trismus
describe the location of haemorrhage in the orbial area which can occur after fracture
treatment?
- Lid ecchymosis
- Bleeding around the eyelid
- Subperiosteal haematoma
- Bleeding around the sub perio sclera
- Haemorrhage posterior to orbital septum
- Within the core of the orbital muscles
- If bleeding in retrobulbar area - no where for blood to escape
- Pressure build up around optic nerve
- Optic nerve crushed
- Becomes ischemic
- Person will lose sight in an hour
- Treatment : drain bleed - access to retrobulbar haemorrhage
what information should be sought for in the history if fracture is suspected in the maxilla?
- flattening of cheek
- bruising
- altered function or tingly acute pain
- limitation of jaw movement
- epistaxis
- diplopia
- bony tenderness
*
what fractures can occur in the mid face?
draw them
Le Fort I, II, III
in what order should the examination occur and palpating?
Start by considering the scalp
Frontal bones and supraorbital ridges
Orbits and nasoethmoidal region
External auditory meatus, zygomatic arches and infraorbital margins
Zygomatic buttress, alar regions, upper teeth
TMJs, mandible and lower teeth
what are you looking for in an examination of a suspected fracture
- Step defects - bone fractures
- Discontinuity - bone fractures
- Crepitus - air in tissues
- E.g. fractures that breach maxillary sinus
- Tenderness and pain
- Hearing deficit
- If involves external auditory meatus
- Visual acuity
- Orbital injuries
- Zygomatic complex fracture
what are the principles of treatment in the case of a fracture?
-
Reduction
- Reposition fragments of bone to their anatomical positions
-
Fixation
- Making sure fragments remain in place until fractures have healed
- Miniplates and small screws used
-
Immobilisation
- Preventing the broken bone from moving during the healing period
-
Rehabilitation
- Return patient to normal function and appearance is goal
- Chewing, talking, eye sight
- Traumatic stress, PTSD
- Consider psychosocial rehabilitation
