This document discusses various types of maxillofacial, ophthalmic, dental, and neck trauma. It covers the anatomy and physiology of these areas, common injuries including fractures, lacerations, and foreign bodies. Management priorities include airway control, bleeding control, spinal motion restriction, and rapid transport to a trauma center. Facial fractures include mandibular, maxillary, and LeFort patterns. Eye injuries require careful examination and irrigation. Dental trauma emphasizes finding and stabilizing avulsed teeth. Neck trauma zones and signs of vascular or airway injury are outlined.

1. Maxillofacial, Ophthalmic & Dental Trauma www.hi-dentfinishingschool.blogspot.com

2. Morbidity & Mortality Mortality Primarily associated with brain and spine injury Severe Facial fractures may interfere with airway and breathing Morbidity Disability concerns Cosmetic concerns

3. Maxillofacial Trauma Causes MVC, home accidents, athletic injuries, animal bites, violence, industrial accidents Soft tissue lacerations, abrasions, avulsions vascular area supplied by internal and external carotids Management - Seldom life-threatening unless in the airway consider spinal precautions have suction available and in control of conscious patients control bleeding

4. Anatomy & Physiology Review Arteries temporal artery mandibular artery maxillary artery Nerves trigeminal (cranial nerve V) facial (cranial nerve VII)

5. Anatomy & Physiology Review Bones nasal zygoma / zygomatic arch maxilla mandible

6. Facial Fractures Fx to the mandible, maxilla, nasal bones, zygoma & rarely the frontal bone S/S - pain, swelling, deep lacerations, limited ocular movement, facial asymmetry, crepitus, deviated nasal septum, bleeding, depression on palpation, malocclusion, blurred vision, diplopia, broken or missing teeth

7. Facial Fractures Mandibular Fx - numbness, inability to open or close the mouth, excessive salivation, malocclusion Anterior dislocation may be caused by extensive dental work, yawning Condylar heads move forward and muscles spasm

8. LeFort Fractures Specially named facial fractures Usually requires significant forces especially for LeFort II and III LeFort I - Maxillary fracture with “free-floating” maxilla LeFort II - Maxilla, zygoma, floor of orbit and nose LeFort III - Lower 2/3 of the face

9. LeFort Fractures I II III

10. Signs and Symptoms Often associated with orbital fractures risk of serious airway compromise (bleeding & edema) contraindication to NG tube or nasotracheal intubation Present with: Edema, Epistaxis, Numb upper teeth Unstable maxilla, CSF rhinorrhea Unusual facial appearance “ donkey face” (lengthening) “ pumpkin face” (edema) nasal flattening

11. Management Spinal motion restriction Airway is the most difficult and most critical priority Consider Early Intubation Surgical Airway may be the only alternative but NEVER the first consideration Suction & Control Bleeding Critical trauma patient - Transport accordingly

12. Facial Fractures Caution NG tube or Endotracheal tube placement may be HAZARDOUS!!!

13. Ear Trauma External injuries lacerations, avulsions, amputations, frostbite Control bleeding with direct pressure Internal injuries Spontaneous rupture of eardrum will usually heal spontaneously penetrating objects should be stabilized, not removed! Removal may cause deafness or facial paralysis Hearing loss may be result of otic nerve damage in basilar skull fracture

14. Anatomy & Physiology Review Ear Outer Ear (Pinna) Cartilage little blood supply External Ear canal mucous membrane that secretes wax for protection Middle Ear separated from external canal by ear drum delicate structure needed for hearing

15. Ear Injuries Separation of ear cartilage treat as an avulsion dress and bandage consider disability and cosmetic concerns Bleeding from ear canal cover with loose dressing only

16. Barotitis Changes in pressure cause pressure buildup and/or rupture of tympanic membrane Boyle’s Law, at constant temperature, the volume of gas is inversely proportionate to the pressure s/s - pain, blocked feeling in ears, severe pain equalize pressure by yawning, chewing, moving mandible, swallowing (open Eustachian tubes allowing gas to release)

17. Eye Anatomy Bony orbit Eyelid Lacrimal apparatus Sclera Cornea Conjunctiva Iris Pupil Lens Retina Optic nerve

18. Eye Injuries Penetrating Abrasions Foreign bodies (deep, superficial, impaled) Lacerations (deep or superficial, eyelid) Burns flash acid/alkali Blunt Swelling Conjunctival hemorrhage Hyphema Ruptured globe Blow-out fracture of orbit Retinal detachment

19. Blow-out Orbital Fracture Usually result of a direct blow to the eye S/S - flatness, numbness epistaxis, altered vision periorbital swelling diplopia inophthalmos impaired ocular movement

20. Foreign Bodies S/S - sensation of something in eye, excessive tearing, burning Inspect inner surface of upper lid as well as sclera Flush with copious normal saline away from opposite eye

21. Corneal Abrasion Caused by foreign body objects, eye rubbing, contact lenses S/S - pain, feeling of something in eye, photophobia, tearing, decreased visual acuity irrigate, patch both eyes Usually heals in 24 to 48 hours if not infected or toxic from antibiotics

22. Other Globe Injuries Contusion, laceration, hyphema, globe or scleral rupture S/S - Loss of visual acuity, blood in anterior chamber, dilation or constriction of pupil, pain, soft eye, pupil irregularity Management Consider C-spine precautions due to forces required for injury No pressure to globe for dressing, cover both eyes Avoid activities that increase intra-ocular pressure

23. Mouth Injuries Usually result from MVCs Blunt injury to the mouth or chin Penetrating injury due to GSW, lacerations, or punctures

24. Anatomy & Physiology Review Muscles Tongue Masseter muscles Nerves Hypoglossal Glossopharyngeal Trigeminal Facial Bones Mandible Maxilla Hyoid Palate Teeth

25. Mouth Injuries Primary concerns Airway compromise secondary to bleeding FBAO secondary to broken or avulsed teeth Impaled object Management ABCs Suction prn Stabilize impaled object Collect tissue: tongue or tooth

26. Dental Trauma 32 teeth in normal adult Associated with facial fractures May aspirate broken tooth Avulsed teeth can be replaced so find them! Early hospital notification to find dentist < 15 minutes, may be asked to replace the tooth in socket do not rinse or scrub (removes periodontal membrane and ligament) preserve in fresh whole milk Saline OK for less than 1 hour

27. Nasal Injuries Variety of mechanisms including blunt or penetrating trauma Most common injury Adults - Epistaxis Children - Foreign bodies

28. Anatomy & Physiology Review Nasal bone between the eyes Nasal cartilage provides shape to nose Internal septum turbinates sinuses

29. Nasal Injuries Epistaxis anterior bleeding from septum usually venous posterior bleeding often drains to airway may be associated with sphenoid and/or ethmoid fractures basilar skull fracture

30. Nasal Injuries Often looks worse than it is! A little patience and direct pressure work wonders!

31. Nasal Injuries Foreign Bodies Variety of objects food toys Often can be left alone and removed later

32. Nasal Injury Management Epistaxis Direct pressure over septum Upright position, leaning forward or in lateral recumbent position If CSF present, do not apply direct pressure allow to drain

33. Neck Trauma Neck - 3 zones 1 = sternal notch to top of clavicles (highest mortality) 2 = clavicles or cricoid cartilage to angle of the mandible (contains major vasculature and airway) 3 = above angle of mandible (distal carotid, salivary, pharynx)

34. Neck Trauma Transected Trachea Larynx separated from trachea or fractured vocal cord swelling altered airway landmarks soft tissue edema Vessel lacerated or torn severe bleeding (large vessels) airway compromise risk of air emboli, hypoxia, or ischemia

35. Neck Trauma Signs & Symptoms pale or cyanotic face obvious external injury frothy blood or sputum from wound SQ air voice change feeling of fullness in throat Signs of stroke with air emboli

36. Esophageal Injury Especially common in penetrating trauma S/S may include subcutaneous emphysema neck hematoma, blood in the NG tube or posterior nasopharynx high mortality rate from mediastinal infection secondary to gastric reflux through the perforation Consider Semi-fowler’s vs. supine position unless contraindicated by MOI.

37. Neck Trauma Management ABCs Suction Intubate EARLY!!! May require cricothyrotomy stop bleeding as best as possible Occlude large blood vessel quickly Left lateral position with occlusive dressing to wound Consider spinal motion restriction Stabilize impaled objects Transport to trauma center

38. Cranial Nerve Hints May not be helpful in unconscious patients, but if they happen to wake up: Cranial nerve I - loss of smell, taste (basilar skull fracture hallmark) Cranial nerve II - blindness, visual defects Cranial nerve III - Ipsilateral, dilated fixed pupil Cranial nerve VII - immediate or delayed facial paralysis (basilar skull or LeFort) Cranial nerve VIII - deafness (basilar skull fx)