KIN 191B – Advanced Assessment of Upper  Extremity Injuries Face and Eye Anatomy, Evaluation  and Injuries
Anatomy <ul><li>Facial anatomy </li></ul><ul><ul><li>Bony anatomy </li></ul></ul><ul><ul><li>Temporomandibular joint </li>...
Facial Anatomy
Bony Anatomy <ul><li>Frontal bone </li></ul><ul><li>Maxillary bone </li></ul><ul><ul><li>Inferior orbit, nasal cavity, ora...
Face – Bony Anatomy
Temporomandibular Joint (TMJ) <ul><li>Synovial joint between temporal bone and mandible (condyle) </li></ul><ul><li>Articu...
TMJ Anatomy
Ear Anatomy <ul><li>External ear </li></ul><ul><ul><li>Auricle (pinna) – cartilaginous funnel of sounds </li></ul></ul><ul...
Ear Anatomy
Nasal Anatomy <ul><li>Proximal 1/3 of nose is bone </li></ul><ul><li>Distal 2/3 comprised of cartilage </li></ul><ul><ul><...
Nasal Anatomy
Mouth, Throat and Teeth <ul><li>Mouth </li></ul><ul><ul><li>Oral vestibule (between lips and teeth) and oral cavity (betwe...
Mouth Anatomy
Throat Anatomy
Muscular Anatomy <ul><li>Muscles of mastication </li></ul><ul><ul><li>Masseter – primary muscle for clenching jaw or chewi...
Facial Muscles
Eye Anatomy
Eye Anatomy <ul><li>Bony anatomy </li></ul><ul><li>Globe </li></ul><ul><li>Muscular anatomy </li></ul>
Bony Anatomy <ul><li>Superior – frontal bone </li></ul><ul><li>Lateral – zygomatic, frontal and spehnoid bones </li></ul><...
Bony Anatomy
Globe <ul><li>Sclera </li></ul><ul><ul><li>Visible white layer of the eye </li></ul></ul><ul><li>Pupil </li></ul><ul><ul><...
Globe <ul><li>Cornea </li></ul><ul><ul><li>Transparent anterior covering of eye </li></ul></ul><ul><ul><li>Focuses light a...
Globe Anatomy
Muscular Anatomy <ul><li>6 total muscles control eye movements </li></ul><ul><li>Rectus muscles rotate eye toward contract...
Eye Muscles
Visual Acuity
Visual Acuity <ul><li>Utilization of Snellen eye chart </li></ul><ul><li>20/20 vision is “normal” (emmetropia) </li></ul><...
Snellen Eye Chart
Evaluation of Facial Injuries
Facial Evaluation <ul><li>History </li></ul><ul><ul><li>Anatomy specificity </li></ul></ul><ul><li>Inspection </li></ul><u...
History - Ear <ul><li>Location of pain </li></ul><ul><ul><li>Internal pain indicative of infection and/or tympanic membran...
History - Nose <ul><li>Location of pain </li></ul><ul><ul><li>Generally localized, may involve other facial structures, es...
History - Throat <ul><li>Location of pain </li></ul><ul><ul><li>External is generally trauma related </li></ul></ul><ul><u...
History - Maxillofacial <ul><li>Location of pain </li></ul><ul><ul><li>Generally at site of injury due to etiology </li></...
Inspection
Inspection - Ear <ul><li>Auricle </li></ul><ul><ul><li>Contusion, laceration, avulsion </li></ul></ul><ul><ul><li>Auricula...
Tympanic Membrane
Inspection - Nose <ul><li>Alignment </li></ul><ul><ul><li>Asymmetry may be due to fracture and/or swelling  </li></ul></ul...
Insepction - Throat <ul><li>Thyroid and cricoid cartilages </li></ul><ul><ul><li>Appreciate normal location and appearance...
Inspection – Face/Jaw <ul><li>Bleeding </li></ul><ul><ul><li>Facial lacerations tend to bleed significantly </li></ul></ul...
Inspection - Mouth <ul><li>Lips </li></ul><ul><ul><li>Often lacerated with dental injuries </li></ul></ul><ul><li>Teeth </...
Palpation
Primary Palpable Structures <ul><li>Nasal bone/cartilage </li></ul><ul><li>Zygomatic arch </li></ul><ul><li>Maxilla </li><...
Special Tests
Special Tests <ul><li>Specific tests discussed with pathologies </li></ul><ul><li>Neurological function generally associat...
Facial Pathologies
Facial Injuries <ul><li>Ear </li></ul><ul><li>Nose </li></ul><ul><li>Throat </li></ul><ul><li>Facial fractures </li></ul><...
Ear Injuries <ul><li>Auricular hematoma </li></ul><ul><li>Tympanic membrane injury </li></ul><ul><li>Otitis externa </li><...
Auricular Hematoma <ul><li>Often referred to as cauliflower ear </li></ul><ul><li>Associated with blunt force trauma </li>...
Auricular Hematoma
Tympanic Membrane Injury <ul><li>Most common mechanisms are penetration with foreign object, blunt force trauma or systemi...
Cerumen
Perforated Tympanic Membrane
Otitis Externa <ul><li>Commonly referred to as “swimmer’s ear” – outer ear infection (meatus) </li></ul><ul><li>Ear pain a...
Otitis Externa
Otitis Media <ul><li>Middle ear infection – eustachian tubes become blocked and increase pressure on inner ear </li></ul><...
Otitis Media
Nasal Injuries <ul><li>Nasal fracture </li></ul><ul><ul><li>Most commonly fractured facial bones </li></ul></ul><ul><ul><l...
Nasal Fracture/Deviated Septum
Throat Injuries <ul><li>May present with dyspnea, anxiety, dysphagia, laryngitis </li></ul><ul><li>Must identify obvious d...
Facial Fractures <ul><li>Mandibular fracture </li></ul><ul><ul><li>Second most commonly fractured facial bone – tongue bla...
Mandible Fractures
 
Facial Fractures <ul><li>Maxillary fracture </li></ul><ul><ul><li>Often associated with nasal fracture </li></ul></ul><ul>...
LeFort Fractures
Dental Injuries <ul><li>Tooth fractures </li></ul><ul><ul><li>Ellis class I – chip fracture to tooth surface </li></ul></u...
Tooth Fractures
Dental Injuries <ul><li>Tooth luxations </li></ul><ul><ul><li>Subluxation/extrusion </li></ul></ul><ul><ul><ul><li>Often h...
Tooth Luxations
Temporomandibular Joint Injuries <ul><li>May include sprain, disc injury, subluxation or dislocation </li></ul><ul><li>Dis...
Lacerations <ul><li>Must stop bleeding and rule out underlying pathologies </li></ul><ul><li>Want to refer for repair as s...
Evaluation of Eye Injuries
Eye Evaluation <ul><li>History </li></ul><ul><li>Inspection </li></ul><ul><ul><li>Periorbital area </li></ul></ul><ul><ul>...
History <ul><li>Location of symptoms </li></ul><ul><ul><li>Photophobia is common </li></ul></ul><ul><ul><li>“ Feels like f...
Inspection <ul><li>Periorbital area </li></ul><ul><ul><li>Gross deformity (“blowout fracture”) or bleeding require immedia...
Inspection <ul><li>Globe </li></ul><ul><ul><li>Eyelids – swelling, laceration, ecchymosis </li></ul></ul><ul><ul><li>Corne...
Eyelid Laceration
Corneal Abrasion
Hyphema
Conjunctivitis
Iris
Teardrop Pupil
Palpation
Primary Palpable Structures <ul><li>Orbital margin/rim </li></ul><ul><li>Associated bony areas </li></ul><ul><ul><li>Front...
Special Tests <ul><li>Vision assessment </li></ul><ul><ul><li>Snellen chart vs. available reading material </li></ul></ul>...
Eye Movements
Eye Pathologies
Eye Injuries and Conditions <ul><li>Orbital fractures </li></ul><ul><li>Corneal abrasions and lacerations </li></ul><ul><l...
Orbital Fractures <ul><li>Blunt force trauma, typically from object larger than orbit, may fracture it </li></ul><ul><li>M...
Corneal Abrasion and Laceration <ul><li>Occurs either from foreign object beneath eyelid or from direct insult </li></ul><...
Iritis <ul><li>Typically caused by trauma to eye resulting in inflammatory response in iris </li></ul><ul><li>Most common ...
Detached Retina <ul><li>Typically associated with jarring movement of head but may be secondary to sneeze </li></ul><ul><l...
Detached Retina
Ruptured Globe <ul><li>Almost always associated with direct trauma to globe </li></ul><ul><li>Severe pain and complete los...
Ruptured Globe
Conjunctivitis <ul><li>Viral or bacterial infection </li></ul><ul><li>Often presents with discharge, eyelids stuck togethe...
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Kin 191 B – Face And Eye Anatomy, Evaluation And Injuries

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Kin 191 B – Face And Eye Anatomy, Evaluation And Injuries

  1. 1. KIN 191B – Advanced Assessment of Upper Extremity Injuries Face and Eye Anatomy, Evaluation and Injuries
  2. 2. Anatomy <ul><li>Facial anatomy </li></ul><ul><ul><li>Bony anatomy </li></ul></ul><ul><ul><li>Temporomandibular joint </li></ul></ul><ul><ul><li>Ear </li></ul></ul><ul><ul><li>Nose </li></ul></ul><ul><ul><li>Mouth, teeth and throat </li></ul></ul><ul><ul><li>Muscular anatomy </li></ul></ul><ul><li>Eye anatomy </li></ul><ul><ul><li>Bony anatomy </li></ul></ul><ul><ul><li>Globe </li></ul></ul><ul><ul><li>Muscular anatomy </li></ul></ul>
  3. 3. Facial Anatomy
  4. 4. Bony Anatomy <ul><li>Frontal bone </li></ul><ul><li>Maxillary bone </li></ul><ul><ul><li>Inferior orbit, nasal cavity, oral cavity </li></ul></ul><ul><ul><li>Upper row of teeth </li></ul></ul><ul><li>Nasal bone </li></ul><ul><li>Zygomatic bone/arch/process </li></ul><ul><ul><li>Gives shape to cheeks </li></ul></ul><ul><li>Mandible </li></ul><ul><ul><li>Moveable portion of jaw, TMJ articulation </li></ul></ul><ul><ul><li>Lower row of teeth </li></ul></ul>
  5. 5. Face – Bony Anatomy
  6. 6. Temporomandibular Joint (TMJ) <ul><li>Synovial joint between temporal bone and mandible (condyle) </li></ul><ul><li>Articular disc at joint enhances nature of articulation </li></ul><ul><li>Movement at joint necessary for communication and mastication </li></ul><ul><li>Injury often presents with malocculsion of teeth </li></ul>
  7. 7. TMJ Anatomy
  8. 8. Ear Anatomy <ul><li>External ear </li></ul><ul><ul><li>Auricle (pinna) – cartilaginous funnel of sounds </li></ul></ul><ul><ul><li>External auditory meatus (canal – transmits sounds to middle ear) </li></ul></ul><ul><li>Middle ear </li></ul><ul><ul><li>Tympanic membrane (ear drum) </li></ul></ul><ul><ul><li>Ossicles – malleus, incus, stapes (vibration) </li></ul></ul><ul><ul><li>Eustachian tube – connects middle ear to nasal passage (pressure regulation, illness) </li></ul></ul><ul><li>Inner ear </li></ul><ul><ul><li>Cochlea – propagates sounds to brain via CN VIII </li></ul></ul><ul><ul><li>Semicircular canals – filled with fluid, process body and head movements to brain, maintains balance </li></ul></ul>
  9. 9. Ear Anatomy
  10. 10. Nasal Anatomy <ul><li>Proximal 1/3 of nose is bone </li></ul><ul><li>Distal 2/3 comprised of cartilage </li></ul><ul><ul><li>Nasal septum separates nostrils </li></ul></ul><ul><li>Nostrils allow passage of air into pharynx and ultimately to trachea </li></ul><ul><ul><li>Mucosal cells warm and humidify air </li></ul></ul><ul><ul><li>Nasal hairs trap foreign particles </li></ul></ul>
  11. 11. Nasal Anatomy
  12. 12. Mouth, Throat and Teeth <ul><li>Mouth </li></ul><ul><ul><li>Oral vestibule (between lips and teeth) and oral cavity (between teeth and throat) </li></ul></ul><ul><ul><li>Tongue – skeletal muscle, sense of taste </li></ul></ul><ul><li>Throat (larynx) </li></ul><ul><ul><li>Thyroid and cricoid cartilages </li></ul></ul><ul><ul><li>Hyoid bone </li></ul></ul><ul><li>Teeth </li></ul><ul><ul><li>32 permanent teeth (pulp, dentin, enamel) </li></ul></ul><ul><ul><li>Root, neck and crown per tooth </li></ul></ul>
  13. 13. Mouth Anatomy
  14. 14. Throat Anatomy
  15. 15. Muscular Anatomy <ul><li>Muscles of mastication </li></ul><ul><ul><li>Masseter – primary muscle for clenching jaw or chewing </li></ul></ul><ul><ul><li>Multiple muscles responsible for mouth opening </li></ul></ul><ul><li>Muscles of expression </li></ul><ul><ul><li>Responsible for movement of lips, cheeks, nose, eyebrows and forehead </li></ul></ul><ul><ul><li>Lack of symmetrical movement indicative of Bell’s palsy (cranial nerve deficit) </li></ul></ul>
  16. 16. Facial Muscles
  17. 17. Eye Anatomy
  18. 18. Eye Anatomy <ul><li>Bony anatomy </li></ul><ul><li>Globe </li></ul><ul><li>Muscular anatomy </li></ul>
  19. 19. Bony Anatomy <ul><li>Superior – frontal bone </li></ul><ul><li>Lateral – zygomatic, frontal and spehnoid bones </li></ul><ul><li>Inferior – zygomatic and maxillary bones </li></ul><ul><ul><li>Floor – add palatine bone </li></ul></ul><ul><li>Medial – lacrimal, ethmoid, maxillary and sphenoid bones </li></ul><ul><li>Posterior – sphenoid bone </li></ul>
  20. 20. Bony Anatomy
  21. 21. Globe <ul><li>Sclera </li></ul><ul><ul><li>Visible white layer of the eye </li></ul></ul><ul><li>Pupil </li></ul><ul><ul><li>Dark, central aperture </li></ul></ul><ul><ul><li>Separates anterior from posterior chamber </li></ul></ul><ul><li>Iris </li></ul><ul><ul><li>Pigmented contractile tissue controlling pupil size </li></ul></ul><ul><li>Conjunctiva </li></ul><ul><ul><li>Mucous membrane lining globe, eyelids and socket </li></ul></ul>
  22. 22. Globe <ul><li>Cornea </li></ul><ul><ul><li>Transparent anterior covering of eye </li></ul></ul><ul><ul><li>Focuses light as it enters eye </li></ul></ul><ul><li>Lens </li></ul><ul><ul><li>Focuses light onto retina at back of eye </li></ul></ul><ul><ul><li>Suspended by ligaments from ciliary body </li></ul></ul><ul><li>Retina </li></ul><ul><ul><li>Rods/cones are photoreceptors </li></ul></ul><ul><ul><li>Optic nerve transmits impulses to brain </li></ul></ul>
  23. 23. Globe Anatomy
  24. 24. Muscular Anatomy <ul><li>6 total muscles control eye movements </li></ul><ul><li>Rectus muscles rotate eye toward contracting muscle </li></ul><ul><ul><li>Inferior, superior, medial and lateral </li></ul></ul><ul><li>Inferior and superior oblique muscles allow for torsion/rotation of the eye </li></ul>
  25. 25. Eye Muscles
  26. 26. Visual Acuity
  27. 27. Visual Acuity <ul><li>Utilization of Snellen eye chart </li></ul><ul><li>20/20 vision is “normal” (emmetropia) </li></ul><ul><li>Myopia </li></ul><ul><ul><li>Nearsightedness, light focused anterior to retina </li></ul></ul><ul><li>Hypermetropia </li></ul><ul><ul><li>Farsightedness, light focused posterior to retina </li></ul></ul>
  28. 28. Snellen Eye Chart
  29. 29. Evaluation of Facial Injuries
  30. 30. Facial Evaluation <ul><li>History </li></ul><ul><ul><li>Anatomy specificity </li></ul></ul><ul><li>Inspection </li></ul><ul><ul><li>Anatomy specificity </li></ul></ul><ul><li>Palpation </li></ul><ul><li>Special tests </li></ul><ul><ul><li>Discussed with pathologies </li></ul></ul>
  31. 31. History - Ear <ul><li>Location of pain </li></ul><ul><ul><li>Internal pain indicative of infection and/or tympanic membrane injury </li></ul></ul><ul><ul><li>External pain typically due to trauma </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Typically blunt force trauma </li></ul></ul><ul><ul><li>Tympanic membrane more susceptible secondary to infection, foreign objects or pressure changes </li></ul></ul><ul><li>Related symptoms </li></ul><ul><ul><li>Tinnitus, dizziness, congestion </li></ul></ul>
  32. 32. History - Nose <ul><li>Location of pain </li></ul><ul><ul><li>Generally localized, may involve other facial structures, esp. eyes </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Typically blunt force trauma </li></ul></ul><ul><ul><li>May be secondary to illness and/or environment </li></ul></ul><ul><li>Typical symptoms </li></ul><ul><ul><li>Pain, bleeding (epistaxis), associated head injury </li></ul></ul><ul><li>Relevant medical history </li></ul><ul><ul><li>Prior injuries/conditions which may affect anatomy or symptom presentation </li></ul></ul>
  33. 33. History - Throat <ul><li>Location of pain </li></ul><ul><ul><li>External is generally trauma related </li></ul></ul><ul><ul><li>Internal is generally systemic in nature </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Typically blunt force trauma </li></ul></ul><ul><li>Related symptoms </li></ul><ul><ul><li>Dyspnea, respiratory distress </li></ul></ul><ul><ul><li>Difficulty speaking </li></ul></ul>
  34. 34. History - Maxillofacial <ul><li>Location of pain </li></ul><ul><ul><li>Generally at site of injury due to etiology </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Typically blunt force trauma </li></ul></ul><ul><li>Related symptoms </li></ul><ul><ul><li>Visual impairment </li></ul></ul><ul><ul><li>Difficulty with eye movements </li></ul></ul><ul><ul><li>Malocclusion of teeth/TMJ injuries </li></ul></ul>
  35. 35. Inspection
  36. 36. Inspection - Ear <ul><li>Auricle </li></ul><ul><ul><li>Contusion, laceration, avulsion </li></ul></ul><ul><ul><li>Auricular hematoma (cauliflower ear) </li></ul></ul><ul><li>Tympanic membrane </li></ul><ul><ul><li>Utilize otoscope, also inspect meatus </li></ul></ul><ul><ul><li>Should be shiny, translucent and smooth </li></ul></ul><ul><li>Periauricular area </li></ul><ul><ul><li>Battle’s sign (basilar skull fracture) </li></ul></ul>
  37. 37. Tympanic Membrane
  38. 38. Inspection - Nose <ul><li>Alignment </li></ul><ul><ul><li>Asymmetry may be due to fracture and/or swelling </li></ul></ul><ul><li>Epistaxis </li></ul><ul><ul><li>May or may not be associated with fracture or trauma </li></ul></ul><ul><li>Septum </li></ul><ul><ul><li>Deviation indicative of septal injury </li></ul></ul><ul><li>Eyes/face </li></ul><ul><ul><li>“ Raccoon’s eyes” often associated with nasal fracture </li></ul></ul>
  39. 39. Insepction - Throat <ul><li>Thyroid and cricoid cartilages </li></ul><ul><ul><li>Appreciate normal location and appearance </li></ul></ul><ul><ul><li>May be compromised with swelling </li></ul></ul><ul><ul><li>Can compromise airway – must be treated as medical emergency </li></ul></ul>
  40. 40. Inspection – Face/Jaw <ul><li>Bleeding </li></ul><ul><ul><li>Facial lacerations tend to bleed significantly </li></ul></ul><ul><li>Ecchymosis </li></ul><ul><ul><li>Around eyes from contusion and/or fracture </li></ul></ul><ul><ul><li>Around tooth “socket” with contusion/fracture </li></ul></ul><ul><li>Symmetry </li></ul><ul><ul><li>Identify bony prominences and compare bilaterally </li></ul></ul><ul><li>Muscle tone </li></ul><ul><ul><li>Ability to move jaw and create facial expressions </li></ul></ul>
  41. 41. Inspection - Mouth <ul><li>Lips </li></ul><ul><ul><li>Often lacerated with dental injuries </li></ul></ul><ul><li>Teeth </li></ul><ul><ul><li>Inspect for fractures/avulsion/subluxation </li></ul></ul><ul><li>Tongue </li></ul><ul><ul><li>Often lacerated with dental injuries or head trauma </li></ul></ul><ul><li>Gums </li></ul><ul><ul><li>Inspect for lacerations, ecchymosis, abcess </li></ul></ul>
  42. 42. Palpation
  43. 43. Primary Palpable Structures <ul><li>Nasal bone/cartilage </li></ul><ul><li>Zygomatic arch </li></ul><ul><li>Maxilla </li></ul><ul><li>Temporomandibular joint </li></ul><ul><li>Periauricular area (mastoid processes) </li></ul><ul><li>Auricle </li></ul><ul><li>Teeth </li></ul><ul><li>Mandible </li></ul><ul><li>Hyoid bone </li></ul><ul><li>Cricoid cartilage </li></ul><ul><li>Thyroid cartilages </li></ul>
  44. 44. Special Tests
  45. 45. Special Tests <ul><li>Specific tests discussed with pathologies </li></ul><ul><li>Neurological function generally associated with cranial nerve evaluation </li></ul><ul><li>Vascular assessment generally performed via skin color and temperature </li></ul>
  46. 46. Facial Pathologies
  47. 47. Facial Injuries <ul><li>Ear </li></ul><ul><li>Nose </li></ul><ul><li>Throat </li></ul><ul><li>Facial fractures </li></ul><ul><li>Dental injuries </li></ul><ul><li>Temporomandibular joint injuries </li></ul><ul><li>Lacerations </li></ul>
  48. 48. Ear Injuries <ul><li>Auricular hematoma </li></ul><ul><li>Tympanic membrane injury </li></ul><ul><li>Otitis externa </li></ul><ul><li>Otitis media </li></ul>
  49. 49. Auricular Hematoma <ul><li>Often referred to as cauliflower ear </li></ul><ul><li>Associated with blunt force trauma </li></ul><ul><li>Bleeding between skin and underlying cartilage – if left untreated, will scar </li></ul><ul><li>Often drained and casted for optimal resolution </li></ul><ul><li>Must rule out associated head injury </li></ul>
  50. 50. Auricular Hematoma
  51. 51. Tympanic Membrane Injury <ul><li>Most common mechanisms are penetration with foreign object, blunt force trauma or systemic infection </li></ul><ul><li>Evaluate with otoscope – pull up on ear to straighten canal for easier viewing </li></ul><ul><li>Excessive ear wax (cerumen) can obscure view of tympanic membrane </li></ul><ul><li>Must be referred if obvious hole, bleeding or swelling/fluid accumulation on/near tympanic membrane </li></ul>
  52. 52. Cerumen
  53. 53. Perforated Tympanic Membrane
  54. 54. Otitis Externa <ul><li>Commonly referred to as “swimmer’s ear” – outer ear infection (meatus) </li></ul><ul><li>Ear pain and pressure </li></ul><ul><li>May complain of dizziness and/or tinnitus </li></ul><ul><li>Area is red and inflamed </li></ul><ul><li>Must keep dry, often prescribed antibiotic ear drops for treatment </li></ul>
  55. 55. Otitis Externa
  56. 56. Otitis Media <ul><li>Middle ear infection – eustachian tubes become blocked and increase pressure on inner ear </li></ul><ul><li>Often secondary to URI, air travel, environmental allergies </li></ul><ul><li>Tympanic membrane may be red, opaque, demonstrate fluid and/or bulge </li></ul><ul><li>Typically treat with antibiotics and may use decongestants or antihistamines for symptom relief </li></ul>
  57. 57. Otitis Media
  58. 58. Nasal Injuries <ul><li>Nasal fracture </li></ul><ul><ul><li>Most commonly fractured facial bones </li></ul></ul><ul><ul><li>Often presents with deformity but not requisite – may have crepitus </li></ul></ul><ul><ul><li>Typically has associated epistaxis </li></ul></ul><ul><li>Septal deviation </li></ul><ul><ul><li>Viewed from inside nostrils with otoscope or penlight </li></ul></ul>
  59. 59. Nasal Fracture/Deviated Septum
  60. 60. Throat Injuries <ul><li>May present with dyspnea, anxiety, dysphagia, laryngitis </li></ul><ul><li>Must identify obvious deformity and refer immediately to avoid respiratory complications associated with swelling </li></ul>
  61. 61. Facial Fractures <ul><li>Mandibular fracture </li></ul><ul><ul><li>Second most commonly fractured facial bone – tongue blade test </li></ul></ul><ul><ul><li>Usually present with malocclusion </li></ul></ul><ul><ul><li>May have difficulty opening and/or closing mouth </li></ul></ul><ul><li>Zygomatic arch fracture </li></ul><ul><ul><li>May present with step-off deformity or “blow-out” fracture (globe “sinks”) </li></ul></ul><ul><ul><li>Eye movements may be compromised, especially upward rotation </li></ul></ul><ul><ul><li>Usually periorbital swelling and globe irritation </li></ul></ul>
  62. 62. Mandible Fractures
  63. 64. Facial Fractures <ul><li>Maxillary fracture </li></ul><ul><ul><li>Often associated with nasal fracture </li></ul></ul><ul><ul><li>Look for ecchymosis along gums/alveolar processes </li></ul></ul><ul><li>LeFort fracture classifications </li></ul><ul><ul><li>Type I – only maxilla fracture </li></ul></ul><ul><ul><li>Type II – maxilla, nasal and suborbital fractures </li></ul></ul><ul><ul><li>Type III – complete craniomaxillofacial separation </li></ul></ul>
  64. 65. LeFort Fractures
  65. 66. Dental Injuries <ul><li>Tooth fractures </li></ul><ul><ul><li>Ellis class I – chip fracture to tooth surface </li></ul></ul><ul><ul><li>Ellis class II – fracture through enamel and dentin </li></ul></ul><ul><ul><li>Ellis class III – fracture to pulp level </li></ul></ul><ul><ul><li>Ellis class IV – fracture through pulp level at gum level </li></ul></ul><ul><ul><li>Must refer to DDS for eval and treatment </li></ul></ul>
  66. 67. Tooth Fractures
  67. 68. Dental Injuries <ul><li>Tooth luxations </li></ul><ul><ul><li>Subluxation/extrusion </li></ul></ul><ul><ul><ul><li>Often heal well if stabilized in place </li></ul></ul></ul><ul><ul><ul><li>Use mouthguard until evaluated by DDS </li></ul></ul></ul><ul><ul><li>Avulsion/dislocation </li></ul></ul><ul><ul><ul><li>Attempt to reimplant if whole – high success rate if done early on </li></ul></ul></ul><ul><ul><ul><li>Rinse with saline if possible/necessary </li></ul></ul></ul><ul><ul><ul><li>If can’t reimplant, store in milk, saline, saliva or emergency tooth kit and refer immediately </li></ul></ul></ul>
  68. 69. Tooth Luxations
  69. 70. Temporomandibular Joint Injuries <ul><li>May include sprain, disc injury, subluxation or dislocation </li></ul><ul><li>Dislocations obvious due to deformity </li></ul><ul><li>Other conditions may present with pain and/or clicking on jaw movements or asymmetrical jaw movements </li></ul><ul><li>Must differentiate from mandible fracture </li></ul><ul><li>Tongue blade test </li></ul>
  70. 71. Lacerations <ul><li>Must stop bleeding and rule out underlying pathologies </li></ul><ul><li>Want to refer for repair as soon as possible for best results </li></ul><ul><li>Consider DDS, OMS or plastic surgeon for severe facial/oral laceration suturing </li></ul>
  71. 72. Evaluation of Eye Injuries
  72. 73. Eye Evaluation <ul><li>History </li></ul><ul><li>Inspection </li></ul><ul><ul><li>Periorbital area </li></ul></ul><ul><ul><li>Globe </li></ul></ul><ul><li>Palpation </li></ul><ul><li>Special tests </li></ul><ul><ul><li>Vision assessment </li></ul></ul><ul><ul><li>Pupillary reaction </li></ul></ul><ul><ul><li>Eye movements </li></ul></ul><ul><ul><li>Neurological evaluation </li></ul></ul>
  73. 74. History <ul><li>Location of symptoms </li></ul><ul><ul><li>Photophobia is common </li></ul></ul><ul><ul><li>“ Feels like foreign object” – corneal abrasion </li></ul></ul><ul><ul><li>Itching – conjunctivitis and/or allergies </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Direct trauma to orbit and/or eye </li></ul></ul><ul><ul><li>Foreign objects (dirt, sand, chlorine, etc.) </li></ul></ul><ul><li>Visual history </li></ul><ul><ul><li>Visual acuity, use of glasses/contact lenses </li></ul></ul>
  74. 75. Inspection <ul><li>Periorbital area </li></ul><ul><ul><li>Gross deformity (“blowout fracture”) or bleeding require immediate referral </li></ul></ul><ul><ul><li>Periorbital hematoma (“raccoon’s eyes”) may indicate contusion, eye injury or fracture </li></ul></ul>
  75. 76. Inspection <ul><li>Globe </li></ul><ul><ul><li>Eyelids – swelling, laceration, ecchymosis </li></ul></ul><ul><ul><li>Cornea – best evaluated with flourescein and cobalt blue light </li></ul></ul><ul><ul><ul><li>Hyphema – blood in anterior chamber of eye </li></ul></ul></ul><ul><ul><li>Conjunctiva – irritation (allergies or foreign object) vs. subconjunctival hemorrhage </li></ul></ul><ul><ul><li>Sclera – bleeding secondary to contusion </li></ul></ul><ul><ul><li>Iris – should be symmetrical </li></ul></ul><ul><ul><li>Pupil – PEARL, anisicoria, teardrop indicative of corneal laceration or ruptured globe </li></ul></ul>
  76. 77. Eyelid Laceration
  77. 78. Corneal Abrasion
  78. 79. Hyphema
  79. 80. Conjunctivitis
  80. 81. Iris
  81. 82. Teardrop Pupil
  82. 83. Palpation
  83. 84. Primary Palpable Structures <ul><li>Orbital margin/rim </li></ul><ul><li>Associated bony areas </li></ul><ul><ul><li>Frontal, temporal, nasal, zygoma </li></ul></ul><ul><li>Soft tissue and globe (through lids) </li></ul>
  84. 85. Special Tests <ul><li>Vision assessment </li></ul><ul><ul><li>Snellen chart vs. available reading material </li></ul></ul><ul><li>Pupillary reaction </li></ul><ul><ul><li>PEARL – cranial nerve relevance </li></ul></ul><ul><li>Eye movements </li></ul><ul><ul><li>Cranial nerve relevance </li></ul></ul><ul><ul><li>Potential for associated fracture </li></ul></ul><ul><li>Neurological evaluation </li></ul><ul><ul><li>Cranial nerve assessment </li></ul></ul>
  85. 86. Eye Movements
  86. 87. Eye Pathologies
  87. 88. Eye Injuries and Conditions <ul><li>Orbital fractures </li></ul><ul><li>Corneal abrasions and lacerations </li></ul><ul><li>Iritis </li></ul><ul><li>Detached retina </li></ul><ul><li>Ruptured globe </li></ul><ul><li>Conjunctivitis </li></ul>
  88. 89. Orbital Fractures <ul><li>Blunt force trauma, typically from object larger than orbit, may fracture it </li></ul><ul><li>Most common is “blow out” fracture </li></ul><ul><ul><li>Inferior displacement due to fracture of floor of orbit </li></ul></ul><ul><li>May present with numbness due to neurological entrapment </li></ul><ul><li>May present with inability to look upward due to entrapment of inferior rectus muscle </li></ul>
  89. 90. Corneal Abrasion and Laceration <ul><li>Occurs either from foreign object beneath eyelid or from direct insult </li></ul><ul><li>Often not grossly visible </li></ul><ul><li>Complaints of “something in eye”, excessive tearing, etc. </li></ul><ul><li>Treat with antibiotic drops, anesthetic drops and may patch </li></ul><ul><li>Corneal lacerations often visible grossly – teardrop pupil is classic presentation </li></ul>
  90. 91. Iritis <ul><li>Typically caused by trauma to eye resulting in inflammatory response in iris </li></ul><ul><li>Most common symptoms are photophobia, abnormal/sluggish pupillary reaction </li></ul><ul><li>May cause permanent pupil deformity </li></ul>
  91. 92. Detached Retina <ul><li>Typically associated with jarring movement of head but may be secondary to sneeze </li></ul><ul><li>Rupture of communication between retina and optic nerve </li></ul><ul><li>May present with blind spots or halos and often note “curtain” falling over field of vision </li></ul><ul><li>Typically requires surgical intervention </li></ul>
  92. 93. Detached Retina
  93. 94. Ruptured Globe <ul><li>Almost always associated with direct trauma to globe </li></ul><ul><li>Severe pain and complete loss of vision </li></ul><ul><li>Most common location of rupture is posterior so often hard to appreciate – look for black spots on sclera which are indicative of globe contents spilling outwardly </li></ul>
  94. 95. Ruptured Globe
  95. 96. Conjunctivitis <ul><li>Viral or bacterial infection </li></ul><ul><li>Often presents with discharge, eyelids stuck together in AM, itching and redness/swelling of conjunctiva </li></ul><ul><li>Highly contagious – avoid touching eye </li></ul><ul><li>Generally treated with antibiotics prophylactically </li></ul>

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