Trauma Flashcards
WoS - aetiology for Trauma
-how many have alcohol in their system?
- Assault: 65%
- Fall: 15%
- Sports: 9%
- RTA: 9%
- Industrial
- Iatrogenic
-2/3rds have alcohol in system
Examination aspects - Observe (E/O)
- asymmetry
- laceration
- swelling
- haematoma
- mouth opening
- cranial N: facial / trigeminal
Examination: palpate for..? (E/O)
- tenderness
- bony step deformities
- numbness
- crepitation
Examination aspects: Observe (I/O)
- asymmetry
- bleeding
- occlusion
- swelling
- haematoma
- teeth: missing/damaged
Symps of Mandible # (8)
- pain / loss of function / swelling
- AOB
- numb lip/chin
- bleeding
- occlusal derangement
- loose/mobile teeth
- facial asymmetry
- deviation of mandible to opposite side
Classifcation of mandibular #
A-F
A: invovement of surrounding tissue -simple / compound / comminuted B: No. of #'s -single / double / multiple C: side of # -unilateral / bilateral D: site of # -body / subcondylar / parasymphseal / angle / coronoid / ramus / alveolar process / condylar (intra/extracapsular) E: Direction of fracture line -favourable / unfavourable F: Specific #'s -Greenstick # / pathological #
Factors that cause displacement of # (6)
- magnitude of force
- direction of # line
- surrounding soft tissue intact
- opposing occlusion
- mechanism of injury
- other associated #’s
Sp Inv for Mandibular #
Rg:
a) 2 radiographs at right angles to each other - OPT / PA mandible
b) other views: occlusal / lateral oblique / CT scan
Treatment aims/priorities for Mandibular#
- Control of pain/infection
- Reduction / Fixation
Treatment for Mandibular #’s
- displaced
- undisplaced
- Displaced: ORIF- Open reduction / Internal Fixation, closed reduction / fixation
- Undisplaced: No treatment
Name some surgical approaches for Mandibular #’s
- retro-mandibular approach
- Raisdon approach
- preauricular approach
- bi-coronal flap
- endoscopic reduction / fixation
Other names for ZO #’s
- ZOC
- cheekbone
- zygoma
- malar
- tripod
- tetrapoid
Name some arteries surounding the eye - ZO #’s
- supraorbital A
- infraorbital A
- lacrimal A
- facial A
- supratrochlear A
- angular A
- medial palpebral A
- zygomaticofacial A
- superficial temporal A
- transverse facial A
Name some nerves surrounding the eye - ZO #’s
- lacrimal N
- supraorbital N
- infraorbital N
- infratrochlear N
- supratrochlear N
- zygomaticofacial N
- zygomaticotemporal N
Symps of ZO #
- asymmetry / deformity
- altered sensation: cheek numbness (infraorbital N)
- visual disturbance: decreased acuity / diplopia / swelling / motility / position
- pain on eye movement
Name of classification of ZO #’
-significant ones to remember
Henderson’s Classification
- type 5: orbital blowout
- type 6: orbital rim #
Clinical signs of ZO #’s
- periorbital ecchymosis
- swelling then flatness
- lacerations / excoriations
- sunconjuctival haemorrhage
- numb cheek
Sp Inv for ZO #’s
- OM views 15/30 degrees (facial views)
- CT scan - blowout / complex #’s
Examination of ZO # - important details
- palpate cheek: bone margins/crepitus/altered sensation
- visual acuity: eye movement/position/reaction to light/diplopia
Indications for treatment of ZO #
- Symps: diplopia/asymmetry/numbness/enopthalmos
- Asymp: defect on Rg = significant deformity
Indications for NO treatment of mand #
ASYMP
- co-morbidities
- fracture is > 1mth old
- defect on Rg - no displacement
- patient refuses treatment
Treatment for ZO #
ORIF
- GIllies lift
- Malar hook
Post op instructions given to patients with a ZO#
- don’t blow nose
- post op steroids: dexamethasone 4-8mg
- eye observations overnight
What MAJOR complication must be observed for ZO # cases
-symps/signs
RETROBULBAR HAEMORRHAGE
- decreasing visual acuity
- severe pain
- proptosis
- opthomoplegia
Medical management of retrobulbar haemorrhage
- drugs
- surgical
- IV acetazolamide 500mg
- IV hydrocortisone 100mg
-Lateral canthotomy: emergency decompression of orbital compartment syndrome
Aetiology of Maxillary #’s
- blunt force trauma
- iatrognenic: intentional/unintentional
- pathological
Initial assessment of maxillary #
- Airway & C spine
- Breathing & oxygenation
- Circulation & haemorrhage control
- Disability - GCS etc
- other injuries
Symps of Maxillary #
- malocclusion
- altered sensation
- diplopia
- facial asymmetry
- decreased air entry
- nose bleeds
Signs of Maxillary #
- swelling/bruising
- hypoaesthesia
- restricted eye movement
- noe bleeds
- malocclusion
- ‘cracked cup’ - perc note
- mobility: palatal split
Sp Inv for Maxillary #
- plain Rg
- CT scan
- study models
Complications of Maxillary #
- malunion
- nonunion
- infection
- haemorrhage
- persistent hypoaesthesia
- late enopthalmos
Explain the extent of:
- Le Fort I #
- what structures separate from rest of skull
- fracture line extends over apices of maxillary teeth to pterygoid processes
- teeth / alveolar processes / palate
Explain the extent of:
- Le Fort II #
- what structures separate from rest of skull
Fracture line extends:
- posterolateral wall of max sinus
- medial wall of orbit
- lacrimal bone onto bridge of nose
- through floor of orbit
- along infraorbital canal
- through zygomatic process of maxilla
Displaced: entire anterior portion / central portion of face / palate / alveolar process
Explain the extent of:
- Le Fort III #
- what structures separate from rest of skull
Fracture line passes bilaterally through:
- zygomaticomaxillary suture
- across the greater wing of the sphenoid,
- through the superior orbital fissure,
- ethmoid bone, lacrimal bone
- maxilla at bridge of nose.
Displaced: almost entire face
