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

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