Trauma (Deeb) Flashcards
What is life threatening with facial trauma injuries: the fractures themselves or occult injuries?
occult injuries
What is the sequence for examining pt with facial and systemic injuries?
ATLS = Advance Trauma Life Support
What is the ATLS sequence?
ABCDE A-Airway B-Breathing C-Circulation/bleeding D-Disability/neural E-Exposure to look for other injuries
What is assessed on the Airway?
Patency, can pt maintain airway themself
What is assessed on Breathing?
Respiratory effort, can they ventilate and exchange air
What is assessed in Circulatory status?
Whether there is bleeding or difficulty maintaining blood pressure
What is the most common cause for not being able to maintain blood pressure?
Blood loss
What is assessed in Disability?
Neurologic status including cervical spine
Eye response: open spontaneously, or non-responsive
Verbal: do they talk or slur
Motor: do they respond to painful stimuli or give a thumbs up
What can the surgeon give after assessing pts Neuorologic status?
GCS score (Glasgow Comma Score)
What is done during Exposure?
Roll patient around to look at entire body to assess any hidden injuries
Why are the events surrounding traumatic accident important to know?
Determine extent of injuries to pt
Aide in determining method of general anesthesia if req
Help police determine cause of accident
How do you classify facial fractures?
- Location (upperface, midface, mandible)
- Severity
- Displacment or displaceability
Nose, orbit, zygoma, maxillary complex are contained in what zone of the face?
Midface
What is the term for horizontal fracture of maxilla, below the nose?
Leforte I
What is the term for a triangular shaped fracture of skull from maxilla up between eyes, and back down to contralateral maxilla(?
Leforte II
What is a horizontal fracture separating the mid face from the forehead?
Leforte III
A mandibular body fracture occurs near what teeth?
2nd premolar to 1st molar region
What are 5 fracture types?
- Simple
- Greenstick
- Comminuted
- Compound
- Comminuted compound
What is a fracture that communicates with the environment either intraorally or extra orally?
Compound fracture
What are 2 other ways to classify a facial fracture?
- Displaced
2. Nondisplaced
What are 2 causes of displacement of fractures?
- Angulation of fracture
2. Muscle pull at fracture site
In a fracture of the body of the mandible what muscles pull in the vertical plane to cause displacement of the fracture vertically?
Masseter and Maedial pterygoid muscles
In a fracture of the body of the mandible, what muscles pull in the horizontal plane to displace the fracture laterally?
Mylohyoid
Which radiographic view is good for seeing Zygomatic arch fractures?
Submental vertex view (“Waters View”)
What is an imaging modality ideal for fractures, especially of the mid face?
CT scan
What are common signs and symptoms of facial fractures?
- Pain (all fractures)
- Swelling (some fractures)
- Limited range of motion
Eccymosis involving the orbit is commonly seen in what fracture types?
- Zygoma
- Leforte II (triangular)
- Leforte III (Face from forehead)
Will malocclusion be seen if the nose or orbit is fractured?
No. Only if the mandible, maxilla, or sometimes the zygoma are fractured
If the patient has an anterior open bite, what fractures are considered?
- Billateral condyle fracture
2. Leforte fracture
If the patient has a unilateral open bite, what fracture is considered?
Unliateral mandibular fracture
To which side will a mandible deviate when a condyle is fractured?
Towards the fractured side
What nerve can be injured in a maxillae fracture, an orbit fracture or a trimaler fracture?
V2
What nerve can be injured in mandibular body fracture?
V3
Is there a concern for nerve injury with a condyle or rams fracture?
No
What are the top ten signs and symptom of facial fractures?
1. Pain 2 Swelling 3. Limited range of motion 4. Laceration 5. Bleeding 6. Ecchymosis 7. Malocclusion 8. Nerve dysfunction (numbness) 9. Step deformity 10. Tenderness
What is the treatment of fracture that restores anatomical integrity and alignment, including occlusion?
Reduction
What is the treatment of a fracture that holds and immobilizes fracture segments in place so that bone can heal (usual in 4-6 weeks)
Fixation / Stabilization
What are 2 types of reduction and fixation?
- Open
2. Closed
Midface fractures are treated how?
Internal rigid fixation
If a mandible fracture is comminuted (bag of bones) what treatment is indicated?
External pin fixation to avoid opening up the site with multiple bone pieces
What cranial nerve runs through the temporal bone?
VII. You will see paralysis of the face on that side.
What indicates an orbital fracture?
Unable to move the eye up indicates a problem with the orbit
