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Maxillofacial trauma
 

Maxillofacial trauma

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Maxillofacial trauma

Maxillofacial trauma

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    Maxillofacial trauma Maxillofacial trauma Presentation Transcript

    • Maxillofacial Trauma
    • Etiology and Incidence
      • Multisystem injury 20-50%
      • Nasal and mandibular fractures most common in community ED’s
      • 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
    • Etiology and Incidence
      • Older age, MVC and TBI-higher incidence
      • Facial fractures-a distracting injury?
      • Carotid artery injury
      • Blindness may occur with facial fractures
    • Maxillofacial Trauma
    • 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
    •  
    • 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
    • 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
    • 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
    • Maxillofacial Trauma-Physical Exam
      • Periorbital and Orbital Exam
        • Perform early
      Professional Lid Retractor
    • 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
    • Maxillofacial Trauma-Physical Exam
      • Penetrating Injuries
        • Occult globe penetration
        • Eyelid lacerations
      • Nose
        • Septal hematoma
        • CSF Rhinorrhea
      • Ears
        • Subperichondral hematoma
        • Hemotympanum
        • Battle sign
    • Maxillofacial Trauma-Physical Exam
      • Oral and Mandibular Exam
        • Mandible deviation
        • Teeth malocclusion
        • Paresthesia
        • Tongue Blade Test
          • 95% Sensitive
          • 65% Specific
    • 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
    • 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
    • Maxillofacial Trauma-Specific Fractures
      • Orbital Fractures
        • Usually through floor or medial wall
        • Enophthalmos
        • Anesthesia
        • Diplopia
        • Infraorbital stepoff deformity
        • Subcutaneous emphysema
    • 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
    • Tripod Fracture
    • Maxillofacial Trauma-Specific Fractures
      • Maxillary Fractures
        • High-energy injury
        • 100x gravity
        • Malocclusion
        • Facial lengthening
        • CSF rhinorrhea
        • Periorbital ecchymosis
    • LeFort Fractures
    •  
    • 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
    • Body 30-40 % Angle 25-30 % Condyle 15-17 % Symphysis 7-15 % Ramus 3-9 % Alveolar 2-4 % Coronoid Process 1-2 %
    • Questions?
      • Thank You!
    • Lecture Questions
      • What portion of the mandible is most commonly fractured?
        • Ramus
        • Coronoid process
        • Body
        • Angle
        • Symphysis
      • Orbital fractures can cause all of the following except:
        • Blindness
        • Motor palsies
        • Facial anesthesia
        • Enophthalmos
        • Hyphema
      • 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
      • The best modality for diagnosing an orbital or facial fractures is
        • Plain films
        • MRI
        • CT
        • Ultrasound
        • Osteopathic palpation
      • 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