Maxillofacial Edema is caused due to RTA fall. treatment is more concentrated on preventing infection and pain management.

1. A case study on
maxillofacial trauma:
J. Anisha Ebens
Pharm D IV yr

2. Introduction:
• Facial trauma, also called maxillofacial trauma, is any
physical trauma to the face. Facial trauma can involve
soft tissue injuries such as burns, lacerations and bruises,
or fractures of the facial bones such as nasal fractures
and fractures of the jaw, as well as trauma such as eye
injuries. Symptoms are specific to the type of injury; for
example, fractures may involve pain, swelling, loss of
function, or changes in the shape of facial structures.

3. • Facial injuries have the potential to cause disfigurement and loss of
function; for example, blindness or difficulty moving the jaw can result.
Although it is seldom life-threatening, facial trauma can also be deadly,
because it can cause severe bleeding or interference with the airway; thus a
primary concern in treatment is ensuring that the airway is open and not
threatened so that the patient can breathe. Depending on the type of facial
injury, treatment may include bandaging and suturing of open wounds,
administration of ice, antibiotics and pain killers, moving bones back into
place, and surgery. When fractures are suspected, radiography is used for
diagnosis. Treatment may also be necessary for other injuries such as
traumatic brain injury, which commonly accompany severe facial trauma.

4. Case study:
• Mrs V, a 50yr old female patient was admitted in the
hospital for,
C/O : Lt orbital edema after accident.
Pain in nose and head.
Came with alleged H/O RTA fall from 2 wheeler
on 19/10, in padur @ 12;00 pm and sustained injury
to face.
H/O : LOC 2 mins, nose bleed+ , No
vomiting/seizures/ear bleed. No other ENT
complaints.

5. O/E: Patient was conscious and oriented.
Anterior segmant was normal.
Periorbital edema+ , orbital rim tenderness+, lens clear,
fundus media clear, disc and vesicles normal, periphery
normal.
Nose : Tenderness + , abrasian + root of nose, laceration +
involving ala of nose on both DNS (deviated nasal septum) to
L.
Oral cavity : Normal
Ear : Normal, no swelling.
Fore head : Swelling in size of 5 x 4 cm.
Foot : Rt abrasion +.
Wrist : Laceration of size 2 x 3 cm.

6. Lab investigations:
Test: Report values Normal values
BP on 19th- 140/90
on 20th- 140/100
on 21st- 150/90
120/80 mmHg
RDW 12.8 11.5 – 14.5 %
HB 13.8 12 – 16 g/dl
RBC 4.91 4.10 - 5.10 million cells/mcL
TLC 11300 Cells/mm³
Platelets 2.36 1.5 – 4.5 lakhs/mm³
PCV 42.8 36 – 46 %
MCH 28.2 25.0 – 35.0 pg/cell
MCHC 32.3 31.0 – 37.0 g/dl
DC N-77.4, L-16.1, E-0.4, M-5.9, B-0.2 N: 45-75, L: 16-46, E: 0-8, M: 4-11, B: 0-3
RBS 133 80 – 120 mg/dl
BUN 8 8 – 25mg/dl
Cr 0.56 0.6 – 1.5 mg/dl
Sodium 135 135 – 145 mmol/l
Potassium 4.2 3.4 – 4.8 mmol/l

7. GCS : E3 V5 M6 14/15
Other tests: Ultra sound- Rt kidney- 9x4.5cm sub pentametric
cortical cyst.
CT scan brain- No significant intracranial
abnormalities.
Critical analysis:
• With the physical examination it was found to be Maxillary
trauma and with imaging study he was found to have cortical
cyst.
• Treatment was appropriate according to the evidence based
medicine followed in ESI hospital.
Diagnosis : Maxillary trauma with # L maxillary sinus with
cortical cyst.
Plan : For Rhinoplastic surgery.

8. Drug chart:
S.No Drug name Dose ROA Freq. No. of days
1 T. Zenodol SP (Aceclofenac 100mg,
Paracetamol 325mg,
Serratiopeptidase 15mg)
1 tab P/O 1-0-1 1 2 3
2 T. Ranitidine 150mg P/O 1-0-1 1 2 3
3 Inj. TT ½ cc IM STAT 1
4 Inj. Diclofenac 3 cc IM STAT 1
5 T. Vertin 8mg P/O TDS 2 3
6 Moxigram KT eye drops Two drops 2 3
7 Inj. Taxim 1g IV BD 1 2 3
8 Inj. Para 1g IV BD 1 2 3
9 Inj. Rantac 50mg IV BD 1 2 3
10 Inj. Metro 500mg IV TDS 1 2
11 Inj. Emeset 4mg IV SOS 1 2 3
12 Inj. Tramadol 100mg IV BD 1 2 3
13 T. Chymorol forte P/O TDS 1 2 3
14 T. Etoshine 90mg P/O OD 3
15 Usen DR 1 tab P/O BD 3

9. T bact ointment and Inj. Leveteracetam are given if required
according to patient condition.
FARM notes:
Findings:
• Possible drug-drug interaction with
1. Aceclofenac and Diclofenac
2. Metronidazole and Ondansetron
• Drug duplication of Rantac was found.
Assesment:
• Aceclofenac and Diclofenac : Concurrent use of
DICLOFENAC and NSAIDS AND SALICYLATES may
result in increased risk of bleeding.

10. Metronidazole and Ondansetron : Concurrent use of
METRONIDAZOLE and QT INTERVAL PROLONGING
DRUGS may result in increased risk of QT-interval
prolongation and arrhythmias.
Resolution:
• Concurrent administration should be stoped.
• Required dose adjustments can be made.
Monitoring:
• Check for QT prolongation.
• Monitor further bleeding or pain at the site of injury.