1 / 28

Maxillofacial Trauma

Etiology and Incidence . Multisystem injury 20-50%Nasal and mandibular fractures most common in community ED'sMidface and zygomatic injuries most common in Trauma centers25% of women with facial trauma result of domestic violenceIncidence of concomitant cervical spine injuries with facial fractures.

bert
Download Presentation

Maxillofacial Trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Maxillofacial Trauma Anthony G. Hillier, D.O. St. John West Shore Emergency Medicine Resident

    2. Etiology and Incidence Multisystem injury 20-50% Nasal and mandibular fractures most common in community EDs 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

    3. Etiology and Incidence Older age, MVC and TBI-higher incidence Facial fractures-a distracting injury? Carotid artery injury Blindness may occur with facial fractures

    4. Maxillofacial Trauma

    5. 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

    7. 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

    8. Emergency Management and Resuscitation 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

    9. 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

    10. Maxillofacial Trauma-Physical Exam Periorbital and Orbital Exam Perform early

    11. Maxillofacial Trauma-Physical Exam Periorbital and Orbital Exam Look for exophthalmos or enophthalmos Pupil shape Hyphema Visual acuity Entrapment signs Raccoon sign Bimanual Palpation Test

    12. Maxillofacial Trauma-Physical Exam Penetrating Injuries Occult globe penetration Eyelid lacerations Nose Septal hematoma CSF Rhinorrhea Ears Subperichondral hematoma Hemotympanum Battle sign

    13. Maxillofacial Trauma-Physical Exam Oral and Mandibular Exam Mandible deviation Teeth malocclusion Paresthesia Tongue Blade Test 95% Sensitive 65% Specific

    14. 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

    15. 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

    16. Maxillofacial Trauma-Specific Fractures Orbital Fractures Usually through floor or medial wall Enophthalmos Anesthesia Diplopia Infraorbital stepoff deformity Subcutaneous emphysema

    17. Maxillofacial Trauma-Specific Fractures 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

    18. Tripod Fracture

    19. Maxillofacial Trauma-Specific Fractures Maxillary Fractures High-energy injury 100x gravity Malocclusion Facial lengthening CSF rhinorrhea Periorbital ecchymosis

    20. LeFort Fractures

    22. Maxillofacial Trauma-Specific Facial Fractures 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

    24. Questions? Thank You!

    25. Lecture Questions What portion of the mandible is most commonly fractured? Ramus Coronoid process Body Angle Symphysis

    26. Orbital fractures can cause all of the following except: Blindness Motor palsies Facial anesthesia Enophthalmos Hyphema

    27. Which of the following is/are true regarding maxillary fractures? Only minimal force necessary Rarely cause CSF rhinorrhea May cause facial lengthening Usually the only sustained injury All of the above are true

    28. The best modality for diagnosing an orbital or facial fractures is Plain films MRI CT Ultrasound Osteopathic palpation

    29. Which statement below is correct? Midface fractures usually have minimal morbidity The tongue blade test is quite sensitive in assessing need for mandibular xrays The bimanual nasal exam is crucial in possible medial orbital wall fracture Midface fracture is an indication for nasotracheal intubation and RSI is often needed in these patients c, e, c, c, b

More Related