Maxillofacial trauma: Difference between revisions
No edit summary |
|||
| Line 60: | Line 60: | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Suspect midface fracture > facial CT | *Suspect midface fracture > facial CT | ||
*Suspect orbital floor fracture > orbital CT | *Suspect orbital floor fracture > orbital CT | ||
*Suspect mandibular fracture > CT face | *Suspect mandibular fracture > CT face | ||
===Diagnosis=== | |||
*Frequently on CT | |||
===Example Images=== | |||
<gallery mode="packed"> | |||
File:LeFort109M.jpg|thumb|[[Le Fort]] type 1 fracture | |||
File:NoDisManFracMark.png|thumb|[[Mandibular fracture]] | |||
File:PMC4311579 eplasty15ic05 fig1.png|thumb|[[Zygomatic arch fracture]] | |||
File:PMC4145677 eplasty14ic27 fig1.png|thumb|[[Zygomaticomaxillary complex fracture]] | |||
File:PMC4772575 AMS-5-262-g001.png|thumb|[[Zygomaticomaxillary complex fracture]] | |||
</gallery> | |||
==Management== | ==Management== | ||
Revision as of 20:02, 26 October 2021
Background
Prehospital Care
- Assess patients ability to speak and protect the airway before and frequently during transport
- Hematomas can significantly distort pharyngeal and facial anatomy making intubation or cricothyroidotomy difficult
- Increased jaw mobility from a mid face fracture may help with intubation
- Penetrating trauma to the lower third of the face frequently requires intubation or a surgical airway[1]
- Place a protective shield over an eye suspected to have a ruptured globe
- Patients should remain upright or reverse trendelenburg if there is oropharyngeal and nasal bleeding to avoid aspiration especially if placed in cervical protection
- Temporizing hemostasis with oral and nasal packing in an intubated patient may help with persistent bleeding
- Transport all avulsed pieces of the face including ears and nose
Pediatric Considerations
- Cricothyrotomy is contraindicated in patients <8yr old
- Maxillary sinuses do not develop until 6 yr old (reduces midfacial fracture)
- Pediatric orbital floor is more pliable, more likely to lead to entrapment
- Mandible fracture requires prompt referral (1-2d) due to rapid bone remodeling
Clinical Features
Ears
- Auricular Hematoma
- Signs of basilar skull fracture
- CSF leak
- Hemotympanum
- Battle Sign
Nose
- Crepitus over any facial sinus suggests sinus fracture
- Septal Hematoma
- Make sure simple nasal fracture isn't a complex naso-orbito-ethmoid injury
Oral
- Intraoral palpation of zygomatic arch to distinguish bony from soft tissue injury
- Mandible Fracture
- Place finger in auditory canal while patient opens and closes jaw to detect condyle fracture
- Tongue blade test
- 95% Sn for no fracture if can bite down hard enough to break it when twisted by examiner
- Jaw deviation due to mandible dislocation or condyle fracture
- Chin will point away from dislocation, towards a fracture
- Malocclusion occurs in mandible, zygomatic, and Le Fort fractures
- Lacerations and mucosal ecchymosis suggests mandible fracture
Other Face
- Numbness
- Check supraorbital, infraorbital, and mental nerves
- Assess Le Fort by rocking hard palate with one hand while stabilizing forehead with other
Eye
- See Orbital trauma
Visual Diagnosis
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
Workup
- Suspect midface fracture > facial CT
- Suspect orbital floor fracture > orbital CT
- Suspect mandibular fracture > CT face
Diagnosis
- Frequently on CT
Example Images
Le Fort type 1 fracture
Management
- Treat underlying process/diagnosis
Disposition
- Bedside consult is necessary for:
- Decreased vision
- Tripod Fracture
- Le Fort Fracture
- Open Mandibular Fracture
- Frontal Sinus Fractures with intracranial involvement
See Also
References
- ↑ Hollier L. et al. Facial gunshot wounds: A 4-year experience. Journal of Oral and Maxillofacial Surgery. 2011: 59:277-282