Facial Trauma Etiology and Concomitant Injuries Etiology and
16
5/1/2010 1 Facial Trauma Jason Pomerantz, MD Assistant Professor, UCSF 4/31/2010 Topics Covered • Etiology / Concomitant injuries • Facial Trauma Emergencies • Diagnosis / Approaches to specific injuries Facial Trauma Etiology and Concomitant Injuries • Motor vehicle collision > assault, bicycle, home, industrial, athletic – of 7000+ ER patients over 11 years; Lee, et al Sem. Plast. Surg 2002 • male : female 2:1 • Mortality 5.9% overall, 17% if head injury – of 73,000 patients admitted with craniofacial injuries; Lee, et al J Craniofac Trauma 2000 Facial Trauma Etiology and Concomitant Injuries • 11% of facial trauma patients have concomitant injuries – 8% extremities – 5% neurosurgical – 4% eye – 1% spine • Motor Vehicle Collisions – > 50% head, face and c- spine Lim et al, Br J Plastic Surgery, 1993
Transcript of Facial Trauma Etiology and Concomitant Injuries Etiology and
5/1/2010
1
Facial Trauma
Jason Pomerantz, MD
Assistant Professor, UCSF
4/31/2010
Topics Covered
• Etiology / Concomitant injuries
• Facial Trauma Emergencies
• Diagnosis / Approaches to specific injuries
Facial TraumaEtiology and Concomitant Injuries
• Motor vehicle collision > assault, bicycle, home, industrial, athletic– of 7000+ ER patients over 11 years; Lee, et al
Sem. Plast. Surg 2002
• male : female 2:1• Mortality 5.9% overall, 17% if head injury
– of 73,000 patients admitted with craniofacial injuries; Lee, et al J Craniofac Trauma 2000
Facial TraumaEtiology and Concomitant
Injuries• 11% of facial trauma
patients have concomitant injuries– 8% extremities– 5% neurosurgical– 4% eye– 1% spine
• Motor Vehicle Collisions– > 50% head, face and c-
spine
Lim et al, Br J Plastic Surgery, 1993
5/1/2010
2
Facial Trauma: Emergencies / Life Threatening Injuries
• Airway
• Hemorrhage
• Occult– eye– brain– c-spine
Facial Trauma: Emergencies / Life Threatening Injuries
• Airway– oral intubation– nasal intubation– tracheostomy
Facial Trauma: Emergencies / Life Threatening Injuries
• Hemorrhage
Facial Trauma: Emergencies / Life Threatening Injuries
• Hemorrhage
5/1/2010
3
Facial Trauma: Emergencies / Life Threatening Injuries
• Hemorrhage
Facial Trauma: Emergencies / Life Threatening Injuries
Ho et al., JPRAS, 2006
Facial Trauma: Diagnosis
• History / Physical
• CT scan
Facial Trauma: Soft Tissue
• Facial Nerve
• Parotid Duct
5/1/2010
4
• Diagnose bone and soft tissue injuries
• Judicious debridement
• Repair nerve / duct when indicated
Dog Mauling
5/1/2010
5
Facial Nerve Injuries
5/1/2010
6
Laceration / Avulsion
Parotid Duct Injury Parotid Duct Injury
5/1/2010
7
Parotid Duct Repair
Facial Fracture Management: General Principles
• Diagnosis / Plan • Timing
– Adults 2 weeks– Children 1 week
• Exposure• Anatomic reduction / Occlusion• Immediate bone grafting when indicated• Rigid fixation with plates and screws• Proper soft tissue repositioning
Incisions
5/1/2010
8
Upper Face / Frontal Sinus
Anterior Table Only
5/1/2010
9
Frontal Sinus / NOE Anterior and Posterior Table
• CSF Leak?
• Nasofrontal Duct Transected?
5/1/2010
10
Maxillary Fractures
Le Fort I Le Fort II Le Fort III
5/1/2010
11
Facial Buttresses Assault
Zygoma, Le Fort I, Mandible
5/1/2010
12
5/1/2010
13
Hemi Le Fort I, II, III
5/1/2010
14
Gunshot Injuries
5/1/2010
15
GSW Face
GSW Face – 4 weeks post injury
5/1/2010
16
Summary
• Motor Vehicle Accident
• Recognize and address life threatening injuries
• Accurate Diagnosis of soft tissue and bone injury
• Early, definitive treatment
