Maxillofacial Trauma-Lecture note with Powerpoint Presentation

Etiology and Incidence

• Multisystem injury 20-50%
• Nasal and mandibular fractures most common in community ED’s
• Midface and zygomatic injuries most common in Trauma centers
• 25% of women with facial trauma result of domestic violence
• Incidence of concomitant cervical spine injuries with facial fractures
• Older age, MVC and TBI-higher incidence
• Facial fractures-a distracting injury?
• Carotid artery injury
• Blindness may occur with facial fractures

(Watch the PowerPoint presentation to See the Images)

Emergency Management and Resuscitation

Airway

Most urgent complication-Airway compromise

Simple interventions first

No mandible?

Intubation

Avoid nasotracheal intubation

May not want RSI

Benzodiazepines

Ketamine

Etomidate

Be Prepared and Be Creative

Emergency Management and Resuscitation

Airway Management Options

• Awake intubation
• Laryngeal Mask Airway
• Fiberoptic intubation
• Lateral or semi-prone position
• Percutaneous transtracheal jet ventilation
• Retrograde intubation
• Cricothyroidotomy

Hemorrhage Control

Rarely develop shock from facial bleeding alone

Direct Pressure

LeFort Fractures

Nasal hemorrhage may require A&P packing

History

Vision

Teeth alignment

Abuse

Maxillofacial Trauma-Physical Exam

Inspection

Facial elongation

High grade LeFort Fracture

Asymmetry

Deformities and cranial nerve injury

Palpation

Tenderness

Step offs

Facial stability

Crepitus

Subcutaneous air

Cutaneous anesthesia

Periorbital and Orbital Exam

Perform early

Periorbital and Orbital Exam

Look for exophthalmos or enophthalmos

Pupil shape

Hyphema

Visual acuity

Entrapment signs

Raccoon sign

Bimanual Palpation Test

Penetrating Injuries

Occult globe penetration

Eyelid lacerations

Nose

Septal hematoma

CSF Rhinorrhea

Ears

Subperichondral hematoma

Hemotympanum

Battle sign

Oral and Mandibular Exam

Mandible deviation

Teeth malocclusion

Paresthesia

Tongue Blade Test

• 95% Sensitive
• 65% Specific

Maxillofacial Trauma-Imaging

Head, chest and abdominal trauma takes precedence

PE detects up to 90% of fractures

Plain Films

CT

• Orbital fractures
• 3D images available

Maxillofacial Trauma-Specific Fractures

Frontal Sinus/Bone Fractures

• Direct blow
• Frequent intracranial injuries
• Mucopyoceles
• Consult with NS for treatment, disposition and antibiotics

Nasoethmoidal-Orbital Injuries

• Lacrimal apparatus disruption
• Bimanual palpation if medial canthus pain
• CT face

Orbital Fractures

• Usually through floor or medial wall
• Enophthalmos
• Anesthesia
• Diplopia
• Infraorbital stepoff deformity
• Subcutaneous emphysema

Orbital Fissure Syndrome

• Fracture of the orbital canal
• Extraocular motor palsies and blindness
• If significant retrobulbar hemorrhage, may need cantholysis to save vision

Zygomatic Fractures

Tripod fracture

• Most serious
• Lateral subconjunctival hemorrhage
• Need ORIF

Arch fracture

• Most common
• Outpatient repair

Maxillary Fractures

• High-energy injury
• 100x gravity
• Malocclusion
• Facial lengthening
• CSF rhinorrhea
• Periorbital ecchymosis

Mandibular Fractures

• Second most common facial fracture
• Often multiple
• Malocclusion
• Intraoral lacerations
• Sublingual ecchymosis
• Nerve injury

Plain films

Panorex

CT

Open Fractures

Pen G or Cleocin

 

Maxillofacial trauma PowerPoint Presentation