Maxillofacial trauma

Diagnosis

Always ask about vision
Evaluate for:
- Facial numbness
- Misalignment of teeth
- Diploplia (monocular vs binocular)

Anesthesia of upper lip and/or maxillary teeth may be 2/2 infraorbital nerve injury from orbital blowout or orbital rim fx

Physical Exam
- Jaw deviation - chin will point away from dislocation and towards a fracture
- Best way to palpate the mandibular condyles is to place a finger in the external auditory canal and press down while pt opens and closes mouth.

Imaging

Suspect midface fx > facial CT
Suspect orbital floor fx > orbital CT
Suspect mandibular Fx
- Mandibular series
- Body fx > oblique view
- Angle/symphysis fx > PA view
- Condyle fx > AP axial (Towne's) view
Plain Films
- Water's view
  - Orbital rims/floors, zygmatic arch, maxillary sinus, maxilla
- Bucket handle view
  - zygomatic arches

Frontal sinus fractures
- If ant wall Fx need CT to evaluate posterior wall (75% have both walls Fx)
- Need neurosurg or ENT for posterior wall fx since many need surgery and IVABx
Naso-ethmoid fractures
- Diffuse tearing and increased intercanthal distance are suggestive
- Intranasal palpation w/ hemostat while palpating along bony rim for crepitus
- Complications include:
  - Lacrimal disruption
  - Medial canthal ligament rupture
  - Dural tears
  - Intracranial injury seen in up to 70%
Nasal Fx
- Clincal diagnosis (does NOT require xrays)
- Drain septal hematomas and f/u with ENT in 7-10 days
Zygomatic arch fracture
- Unlikely isolated
Tripod Fracture
- Fx through:
  - 1. Inf orbital rim
  - 2. lateral orbital wall
  - 3. Fx/dislocation of zygomatic arch
- Must r/o associated ocular injuries
- Usually requires admission and surgical repair