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Facial Trauma
This document provides guidance on assessing and treating facial trauma. It outlines the standard clinical assessment process, including taking a history, performing a general external and neurologic examination, and examining specific areas like the orbit, nose, ears, and occlusion. It then describes common facial bone injuries like nasal, orbital floor, zygomatic, and mandibular fractures. The document concludes with information on classifying facial fractures, local anesthetics used in facial procedures, and guidelines for referring patients with facial fractures to the emergency department for CT imaging and follow-up care.
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Facial Trauma
- 1. Facial Trauma Plastic andReconstructive Surgery Department SCGH Dr Sepehr Lajevardi Dr Qadir Khan Dr Mike O’Hallaren Dr Guy Watts
- 9. Standard Clinical Assessment History Modeof injury, loss of consciousness, symptoms at examination, medications, alcohol or drugs and fasting status General Examination External Examination for Hard / Soft injury Inspection looking for oedema, ecchymosis and lacerations. Palpate for bony deformity. Orbital rims, zygomatic arches, nasal bones, mandibular body and condyles.
- 10. Neurologic Examination Cranial NervesV and VII Intra-oral Examination Intra-oral examination in good lighting. Inspect for ecchymosis in buccal or lingual sulci. Mucosal haematoma over underlying fractures Dentition and Occlusion examination New deformity indicates discrepant maxillary and/or mandibular position. Standard Clinical Assessment
- 11. Orbital Examination Ocular movements,ocular position. Intra- ocular pathology. Close observation essential in zygoma fractures. Nasal Examination Septal haematoma, deviation, patency, CSF Rhinorrhoea Ear Examination Blood in EA canal, behind membrane, mastoid Standard Clinical Assessment
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- 13. Bony Injuries • CommonPresentation – Nasal – Orbital Floor – Zygoma • Zygomatic Arch – Infra-orbital rim – Mandibular • Less common – Frontal sinus – Nasoorbitoethmoidal NOE – Le Forte Fracture Patterns
- 14. CLASSIFICATION OF FACIAL FRACTURES 1.Upper ⅓ 2. Middle ⅓ 3. Lower ⅓ Frontal Bone Maxilla Mandible Nasal Naso-ethmoids Orbitozygomatic “Pure” blowout 4. Panfacial Craniofacial Upper, middle, lower thirds
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- 17. Orbital Floor • Tetheringvs entrapment • Diplopia, enopthalmos
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- 20. Local Anaesthetics inthe Face • Infra-orbital nerve • Supra-orbital nerve • Mental nerve • Dorsal nasal nerves
- 21. ED referral forFacial #s • On CT ensure facial bones and mandible included + 3D reconstruction views • Call Plastics registrar post imaging • Opthal review for orbital floor fractures • Most patients can be reviewed as outpatient in PDC the next day (eReferral) • Advise on no nose blowing • Oral Augmentin Duo Forte • Sleep with head elevated