Types of Facial Injuries and Their indications for referrals

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Types of Facial Injuries and Their indications for referrals

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Types of Facial Injuries and Their indications for referrals

  1. 1. Maxillary Fractures <ul><li>LeFort Fractures </li></ul><ul><li>I – Transverse </li></ul><ul><li>II – Pyramidal </li></ul><ul><li>III – Craniofacial Dysjunction </li></ul><ul><li>Signs </li></ul><ul><ul><li>Facial Swelling, malocclusion, midface instability, V 2 numbness, facial elongation/flattening, bleeding/epistaxis </li></ul></ul>
  2. 2. Mandible Fractures <ul><li>Multiple # patterns </li></ul><ul><li>All tooth bearing #s are “open” </li></ul><ul><li>Assc. Dental injuries / C-spine injuries </li></ul><ul><li>Signs </li></ul><ul><ul><li>Facial Swelling </li></ul></ul><ul><ul><li>Malocclusion </li></ul></ul><ul><ul><li>Intraoral lac’ns </li></ul></ul><ul><ul><li>V 3 numbness, </li></ul></ul>
  3. 3. Mandible Fractures <ul><li>All “open” fractures should be treated in 48 hrs </li></ul><ul><li>Perioperative Abx </li></ul><ul><li>Goal is to restore normal occlusion </li></ul>
  4. 4. Frontal Sinus Fractures <ul><li>Uncommon Injury </li></ul><ul><li>Assc. with Intracranial & Orbital injury </li></ul><ul><li>Signs </li></ul><ul><ul><li>Facial Swelling </li></ul></ul><ul><ul><li>CSF Rhinorrhea </li></ul></ul><ul><ul><li>V 1 numbness </li></ul></ul>
  5. 5. Indications for Referral <ul><li>Intracranial, C-Spine or Ocular Injuries </li></ul><ul><li>Complex soft-tissue injuries (Lip, Eyelid/Eyebrow, Nose, Ear, other) </li></ul><ul><li>Facial nerve lac’n (prox. to lat. canthus) </li></ul><ul><li>Parotid duct or Lacrimal injuries </li></ul><ul><li>Dental Injuries </li></ul>
  6. 6. <ul><li>Nasal fractures = reduce or early phone contact to plan for closed reduction </li></ul><ul><li>Open fractures = clean, close and refer as per closed facial fractures </li></ul><ul><li>Blowout fractures and zygoma fractures = within one week for appropriate management plans </li></ul>Indications for Referral
  7. 7. <ul><li>Open mandible fractures = antibiotics and early referral </li></ul><ul><li>Closed mandible fractures = early phone referral in order to plan for treatment </li></ul>Indications for Referral
  8. 8. Summary <ul><li>Stabilize patient & rule out life- or limb-threatening injuries </li></ul><ul><li>Methodical Clinical Exam, Hx & Imaging </li></ul><ul><li>Manage soft-tissue Injuries as appropriate </li></ul><ul><li>Refer for treatment of complex injuries </li></ul>

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