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Head and Face InjuriesHead and Face Injuries

Anatomy and Select Facial Injuries

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Many times the blood masks what the Many times the blood masks what the “problem” is…..have gloves handy!“problem” is…..have gloves handy!

Diving Example

http://www.youtube.com/watch?v=i5RqhiGdP0c

Ice Hockey Example

http://www.youtube.com/watch?v=cIVAUo1CL2g&feature=PlayList&p=29D8DEB14BDCC1D6&playnext=1&playnext_from=PL&index=25

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Protection of the CNSProtection of the CNS1. Cerebrospinal fluid2. Blood brain barrier3. Meninges

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Location of the CSFLocation of the CSF

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Vascular SupplyVascular Supply

Carotid arteriesVertebral arteries

Jugular veins

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Soft Tissue Injuries - LacerationsSoft Tissue Injuries - Lacerations

Causes?

Rule out head injury

Use of steri-strips

Sutures

Why wouldn’t you shave the eyebrow?

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Skull FracturesSkull Fractures

Forceful blow to head

Rule out C-spine injury

SignsHA

NauseaDeformity

Raccoon eyesBattle’s sign

Blood or CSF drainage from ears (ottorhea) or

nose (rhinorhea)

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Blood from ear (Ottorhea)Blood from ear (Ottorhea)

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Skull Fractures con’tSkull Fractures con’t

Immediate referral!!

Skull fracture itself is not the most

serious problem….

ComplicationsIntracranial injury

Subdural or epidural hemorrhage

Infections (meningitis)

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Mandible FractureMandible Fracture

2nd most common fracture (nose is 1st)

Direct blow to mandible

SignsDeformity (step defect)

MalocclusionPain biting down

Bleeding around teethLower lip anesthesia

Ecchymosis on floor of mouth

Treatment

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Mandibular Dislocation

MOI:Side blow to the jaw◦subluate or complete dislocation

S&S: Locked open jaw◦movement of jaw?◦how to reduce dislocation?

Recovery time?Complications

◦Recurrent dislocations◦TMJ dysfunction

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Temporomandubular joint (TMJ) Temporomandubular joint (TMJ) dislocationdislocation

Direct blow to side of jaw

SignsLock jaw

Malocculsion

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Maxillary FractureMaxillary Fracture

Direct blow

SignsMalocclusion

PainEpistaxis (nose bleed)Diplopia (dbl. vision)

Numbness in lip and cheek

LeFort Fracture types I - III(red indicates fracture

location; III worse!)

Admission 3 days post surgery

Le Fort Type II

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Zygoma Fracture Zygoma Fracture

Direct blow

SignsDeformity (flatness of cheek,

step defect)Numbness in cheek, nose,

and upper ipLimited TMJ movement

Restricted eye movementDiplopiaEpistaxis

Edema/ecchymosis

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Blow Out Fracture – Orbital FloorBlow Out Fracture – Orbital Floor

Direct blow

SignsEdema

EcchymosisSubconjunctival

hemorrhage

Don’t allow pt. to sneeze or blow

nose

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““Quiz”Quiz”

1. Mandible fracture2. Blow-out fracture3. Maxillary fracture4. Skull fracture5. Laceration6. Ottorhea7. Rhinorrhea8. Epistaxis9. Diplopia

A. Double visionB. Steri-stripsC. Orbital floorD. Battle’s sign,

racoon eyesE. Fluid from noseF. MalocclusionG. Le Fort typesH. Fluid from earsI. Nosebleed

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““Quiz” AnswersQuiz” Answers

1. Mandible fracture2. Blow-out fracture3. Maxillary fracture4. Skull fracture5. Laceration6. Ottorhea7. Rhinorrhea8. Epistaxis9. Diplopia

A. Double visionB. Steri-stripsC. Orbital floorD. Battle’s sign,

racoon eyesE. Fluid from noseF. MalocclusionG. Le Fort typesH. Fluid from earsI. nosebleed

FCGDBHEIA

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Dental, Nasal, Ear and Eye Dental, Nasal, Ear and Eye Injuries on Wednesday!Injuries on Wednesday!