Trauma Flashcards
What is the most common trauma? What is the most prone group to trauma?
Approx 2300 injuries/yr w/bottles pacifiers sippy cups
<3 yo
Mouth lacerations most common
Anticipatory trauma guidance for infants? Toddlers? Children? Teens? Atheletes?
Infants: pacifier safety, danger of ‘walkers’
Toddlers: dont let babies run with scissors, ambulatory skills
Kids/Teens: bike helmets
Athletes: sports activities
Aspects of neurological exam
III-Occulomotor Penlight PERRLA
III, IV, VI Occulomotor tochlear and abducens- track movements
VII: Facial ask pt to close eyes, smile, frown. No asymmetry of movement
Injuries to which cranial nerves are more common after trauma?
III (occulomotor), IV-trochlear, VI-abducens, VII-facial
Post op instructions for observation post trauma?
Parents should watch out for:
Pt persistently sleepy, vomiting, severe headache, or abnormal behaviors
Comminuted fracture? Simple, compound?
Comminuted- bone is splintered. Simple overlying soft tissue are intact; compound bone exposed to skin or mucosa
Causes of craniofaction trauma in descending order?
Distribution of Craniofacial trauma?
How often do concomitant injuries occur? What kind of injury?
Causes: Falls 64% Traffic 22%, Sports 9%, Violence 5% Distribution: skull vault 54% Upper/middle facial third 37%
Concomitant injuries occur 1/3 of the time-usually a concussion
What facial bones are most likely to fracture? (midface fractures)
Nasal bone and zygoma
Describe LeFort fractures in children?
Least common midface fracture in children due to prominent calvaria
Many LeFort 1 tx, no fixation. Class II and III req open reduction w/caution for developing teeth.
From least (30G) to most (200G) force, order the following facial bones:
Zygoma, angle of the mandible, nasal, supraorbital rim, midline maxilla, frontal glabellar region, symphysis of mandible
Nasal 30 Zygoma 50 Angle of mandible 70 Frontal-glabellar region 80 Midline maxilla 100 Symphysis of mandible 100 Supraorbital rim 200
Diagnostic aid for facial fractures?
CT scan
pt with limited upward gaze, periorbital swelling suspect?
Zygomatic fracture:
hx of blow to the cheek, periorbital swelling, ecchymosis, hematoma, conjunctival hemorrhage, palpable step deformity, paresthesia in dist of 2nd division of trigeminal nerve, limited upward gaze
What is the most common facial skeletal injury in hospitalized pediatric trauma patients? What is the incidence, causes, and characterstics?
Mandibular fracture
Boys 2xgirls
Younger patients : condylar/subcondylar fractures
Adolescents: fracture of angle of the mandible-think developing 3rd molars
Causes: bicycles, steps, swings
What are signs and charactersitcs of a subcondylar/condylar fracture?
Blunt injury to chin
Bite is “off” (retrognathic when they werent before) or deviated
Unilater vs bilateral (deviated chin)
Palpate external auditory meatus
Which fractures carry the greatest risk of growth disturbance?
How is it treated?
And what are possible complications of the injury?
Likely outcomes?
Condylar fractures- ramus height may not be maintained and may cause a huge asymmetry
tx: not rigid fixation, elastic
- Possible complications: ankylosis of the jaw, asymmetry, development of malocclusion
- condylar head resorbs, and the ramus remodels to maintain height
Describe an intracapsular condylar fracture in mandibular fractures. Risks? and Treatment?
Ankylosis risk in children less than 3 years old
Crushing injury
Treatment mandibular exercises and jaw stretching
Fracture of the body of the mandible: age group, best tx? dx by? Signs/Symptoms
Older patients
Closed reduction better than open
Pano
Signs: bruising in the floor of the mouth, hematoma in buccal vestibule, mobility along fracture site on palpation, possible paresthesia
Radiographs for soft tissue lacerations?
1/4 usual exposure for intraoral xray and 1/2 usual exposure of an extraoral xray
Electric Burns: age? type of injury? and clinical course?
2-4 yo
Coagulation tissue necrosis
Immediately post injury- paresthesia or anesthesia and no hemorrhage.
W/in a few hours: edema that may last 7-10 days, drooling (lost sensation), after several days center of lesion becomes gray/yellow w/erythema
Spontaneous hemorrhage w/in first 3 weeks after born
fibrous tissue forms can result in microstomia
WHO classification of dental trauma Class 1, 2, 3
Class 1: injury to dental structures and pulp (enamel fracture, enamel/dentin frac, uncomplicated; enamel/dentin/complicated w/pulp exposure)
Class 2: injury to dental structures, pulp & alveolar process (crown root fracture, root fracture, alveolar fracture)
Class 3: injury to periodontal tissues (concussion, sublux, lux, avulsion)
Primary tooth root fractures require extractions T/F.
F: If the coronal section is not displaced, no occlusal interference, can allow tooth to remain.
Treatment for:
Extrusive luxation in primary teeth?
If interfering with occlusion, likely ext.
Intrusion in primary dentition:
Percent of which are intruded in which direction?
Duration and prognosis?
Later findings?
Intrusion if no movement after 6-8 weeks : EXT
80% of intruded teeth are pushed labially (away from permanent successor); majority re-erupt and survive >36mo
-PCO is a common finding as is ectopic position (rotation) following re-eruption.
What are the most common findings in primary teeth post trauma? Relative percentages?
Color changes 53% Premature tooth loss 46% Pulp canal obliteration 36% Pulp necrosis 25%' Gingival retraction 6% Disturbances in physiologic resorption 4%
