Facial Trauma

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Facial Trauma http://decode- medicine.blogspot.com/ by sun yaicheng

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http://decode-medicine.blogspot.com/ by sun yaicheng

Transcript of Facial Trauma

  • 1. Facial Traumahttp://decode-medicine.blogspot.com/ by sun yaicheng

2. Look at the orbits carefully, 60 - 70% of allfacial fractures involve the orbit.Exceptions: local nasal bonefracture, zygomatic arch fracture, LeFort Ifracture.Bilateral symmetry can be very helpful.Carefully trace along the lines of Dolanwhen examining the Waters view in a facialseries. 3. Radiographic Signs of Facial Fractures Direct Signs nonanatomic linear lucencies cortical defect or diastatic suture bone fragments overlapping causing a "double- density" asymmetry of face Indirect Signs soft tissue swelling periorbital or intracranial air fluid in a paranasal sinus 4. Emergency Managementand Resuscitation Airway Most urgent complicationl: Airway compromise Simple interventions first No mandible? Intubation Avoid nasotracheal intubation Aviod RSI Benzodiazepines Ketamine Etomidate Be Prepared and Be Creative 5. Emergency Managementand Resuscitation Airway Management OptionsAwake intubationFiberoptic intubationLateral or semi-prone positionPercutaneous transtracheal jet ventilationRetrograde intubationCricothyroidotomy 6. Emergency Managementand Resuscitation Hemorrhage ControlRarely develop shock from facial bleedingaloneDirect PressureLeFort FracturesNasal hemorrhage may require A&P packing 7. Maxillofacial Trauma-History How is your vision? Is any part of your face numb? Are your teeth meeting normally? 8. Maxillofacial Trauma-Physical Exam Inspection Palpation Facial elongationTenderness High grade LeFort(intraoral palpation) Fracture Step offs AsymmetryFacial stability Deformities and cranial nerve injury CrepitusSubcutaneous airCutaneousanesthesia 9. Maxillofacial Trauma-Physical Exam Periorbital and Orbital Exam Perform earlyProfessional Lid Retractor 10. 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 11. Maxillofacial Trauma-Physical Exam Oral and Mandibular Exam Mandible deviation Teeth malocclusion Paresthesia Tongue Blade Test 95% Sensitive 65% Specific 12. Maxillofacial Trauma-Imaging PE detects up to 90% of fractures Plain Films: Waters CT Orbital fractures 3D images available 13. Maxillofacial Trauma-SpecificFractures Orbital Fractures Usually through floor or medial wall Enophthalmos Diplopia Infraorbital stepoff deformity Subcutaneous emphysema 24 % of fractures areBlowout fracture the arrows associated with ocular point to the fracture fragments and injury periorbital tissue which haveherniated into the maxillary sinus 14. TeardropHerniation 15. Maxillofacial Trauma-SpecificFracturesZygomatic FracturesTripod fractureMost seriousLateral subconjunctival hemorrhageNeed ORIF 16. Tripod Fracture 17. Maxillofacial Trauma-SpecificFractures Maxillary Fractures High-energy injury Malocclusion Facial lengthening CSF rhinorrhea Periorbital ecchymosis 18. Lefort Classification Weakest areas of midfacial complex when assaulted from a frontal direction at different levels (Rene Lefort, 1901) Lefort I: above the level of teeth Lefort II: at level of nasal bones Lefort III: at orbital level 19. LeFort Fractures 20. LeFort I Transmaxillary fracture runs between the maxillary floor and the orbital floor. It may involve the medial and lateral walls of the maxillary sinuses and invariably involves the pterygoid processes of the sphenoid. The floating fragment will be the lower maxilla with the maxillary teeth 21. LeFort II Occurs along yet another weak zone in the face, and is sometimes called a pyramidal fracture because of its shape. 22. LeFort III craniofacial disassociation large unstable (floating) fragment is virtually the entire face! 23. Mandibular Fractures Second most common facial fracture Often multiple Mal-occlusion Intra-oral lacerations Sublingual ecchymosis Nerve injury Plain films Panorex CT 24. Clinical Findings Facial distortion Malocclusion of the teeth Abnormal mobility of portions of the mandible or teeth 25. TM Joint Dislocation 26. TM Joint Dislocation 27. Nasal Bone Fracture Common pitfalls in viewing the nasal bone are the normal sutures lining the nasal bone CSF rhinorrhea Halo sign 28. 2511980/50 mmHg120/min32/minA. B. C. 2000mlD. E. cricothyroidotomy96 29. 20BP80/40mmHgHR140/mina.b.c. (Cricothyroidotomy)d.e. A. c,a,b,d,e B. c,d,b,e,a C. a,d,c,b,e D. c,d,a,b,e 95 E. c,d,b,a,e 30. temporo-mandibular jointdislocationA. X (Panoramic view) B. C. D. 95 31. 70 mandibularangleX A. mandibular angleB. extensionC. D. E. 98 32. 25 orbital blowoutfractureA. B. C. D. E. 98