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Facial Trauma

Facial Trauma. Joseph Lang, MD April, 2011. Objectives. Discuss relevant anatomy and physiology Discuss identification and emergent treatment ocular injuries Discuss identification and emergent treatment of maxillo-facial injuries

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Facial Trauma

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  1. Facial Trauma Joseph Lang, MD April, 2011

  2. Objectives • Discuss relevant anatomy and physiology • Discuss identification and emergent treatment ocular injuries • Discuss identification and emergent treatment of maxillo-facial injuries • Discuss identification and emergent treatment of dental and oral injuries

  3. Ocular Injuries • Eye trauma accounts for 1% of visits to ER • Often associated with facial fractures • Approximately 90% of injuries could be prevented with protective lenses

  4. Mechanisms of Injury • Burn • Blunt force • Laceration/abrasion • Penetrating Trauma

  5. Assessment • Determine mechanism of injury • Quick visual acuity • Examine lids and periorbital structures • Neurologic exam

  6. Ocular Burns • Assess what chemical, bring in bottle if possible • Remove contact lens if in place • Irrigate with saline 1000 cc by drip and remove any free foreign bodies

  7. Blunt Force • Fist, ball, heavy object • Direct trauma to globe – subconjunctival hemorrhage, globe injury • Injury to surrounding structures – orbital wall fractures, nerve injury, muscular entrapment or hematoma

  8. Blunt Force Management • Visual acuity • Cardinal movements • Neurologic exam • Do not let pt blow nose • Cover area with saline soaked gauze • Pain management

  9. Laceration/Abrasion • Corneal layer is only 5-6 cells thick • Abrasions heal in 2 days • Possibility of globe rupture • Usually does not require treatment in field except removal of loose foreign bodies, may irrigate in certain situations

  10. Penetrating Trauma • Visual acuity • Do not remove any objects in eye, stabilize area • Do not touch eye • We all want to see pictures…

  11. Maxillo-Facial Trauma • Blunt trauma much more common than penetrating • Airway issues of main concern • Neurologic issues • Hemorrhage • Other trauma

  12. Facial bones

  13. Facial Bone Strength • High impact • Supraorbital rim: 200 g • Symphysis mandible: 100 g • Frontal-glabellar: 100 g • Angle of mandible: 70 g • Low impact • Zygoma: 50 g • Nasal bone: 30 g

  14. Facial Fractures • Nasal bone most common • Look for fluid coming from nose (CSF) • Cover area with gauze, ice if available • Control bleeding with compression

  15. Frontal Bone Fracture • One of the hardest bones to break • Significant trauma • Often associated brain/eye injury • Cover any open areas with saline soaked gauze • Trauma center

  16. Orbital Injuries • Generally refers to structures surrounding globes • Need to assess globe and vision • Check extra ocular motion (EOM) • Do not let pt blow nose

  17. Zygoma Fractures • Refers to “cheekbones” • Zygoma fractures may affect vision, may also cause numbness on cheek due to nerve entrapment • Trismus

  18. Maxillary Fractures • Classified by Le Fort System • I – separates hard palate from bone • II – separates central maxilla and hard palate from rest of face • III – craniofacial disassociation – entire facial skeleton is removed

  19. Maxillary Fractures • If suspected, can use gentle pull on upper incisor area • Often associated with other structures such as blood vessels, nerve, parotid glands • Le Fort III almost always has CSF leak • Difficult airway

  20. Mandible Fractures • After nasal bone, most common fracture of face • Usually 2 fractures • Open or closed • May note malocclusion, numbness, dislocation • Look in preauricular area

  21. Mandible Fractures • Often have dental fractures or subluxed teeth • May have significant intra-oral debris • Airway issues • Screening test is bite stick test

  22. Mandibular Dislocations • Usually occur from motion that opens mouth widely – yawning, vomiting, singing • May occur from seizure or direct trauma • Anterior most common • May be unilateral or bilateral

  23. Pediatrics • Head is larger in proportion to body than in adults • Up to 60% of children with facial fractures have intracranial injury • Children more likely to have serious exsanguination from facial wounds than adults

  24. Oral Injuries • Includes dental and tongue injuries • Penetrating trauma • Airway issues

  25. Dental Avulsion • Primary tooth – implantation not done • Permanent tooth – mechanism, time out of socket, what tooth was lying in • Inspect tooth to see if intact • Inspect site of tooth loss

  26. Dental Avulsion Care • Do not touch root or scrub tooth • May use gentle saline irrigation • If possible, attempt reimplantation in field • If unable to reimplant in field, place tooth in transport medium – Hank’s solution, milk, saline

  27. Dental Fractures • 85% maxillary teeth • According to one medical website, lists the top causes, #6 is ice hockey

  28. Intra-oral Lacerations • May require suction • Can cover with saline dressings • If penetrating trauma, and object still in place, secure object and transport

  29. Facial Gunshot Wounds • High mortality, dependant on angle and bullet • Bullet may travel in unpredictable pattern • Airway nightmares

  30. Questions • ???

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