Maxillofacial trauma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:PMC2700599 JETS-02-89-g005.png|thumb|Patient with poly maxillofacial trauma: (a) Bilateral black eyes. (b) X-ray skull: AP view showing multiple fractures of facial bone including mandible. (c) X-ray skull: lateral view showing multiple fractures of facial bone including mandible. (d) CT scan showing details of facial bone fractures.]] | |||
===Ears=== | ===Ears=== | ||
*[[Auricular Hematoma]] | *[[Auricular Hematoma]] | ||
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**Hemotympanum | **Hemotympanum | ||
**Battle Sign | **Battle Sign | ||
===Nose=== | |||
*Crepitus over any facial sinus suggests sinus fracture | |||
*[[Septal Hematoma]] | |||
*Make sure simple [[nasal fracture]] isn't a complex naso-orbito-ethmoid injury | |||
===Oral=== | ===Oral=== | ||
*Intraoral palpation of zygomatic arch to distinguish [[zygomatic arch fracture|bony]] from soft tissue injury | *Intraoral palpation of zygomatic arch to distinguish [[zygomatic arch fracture|bony]] from soft tissue injury | ||
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*Malocclusion occurs in [[mandible fracture|mandible]], [[zygomatic arch fracture|zygomatic]], and [[Le Fort]] fractures | *Malocclusion occurs in [[mandible fracture|mandible]], [[zygomatic arch fracture|zygomatic]], and [[Le Fort]] fractures | ||
*Lacerations and mucosal ecchymosis suggests [[mandible fracture]] | *Lacerations and mucosal ecchymosis suggests [[mandible fracture]] | ||
===Other Face=== | |||
*[[Numbness]] | |||
**Check supraorbital, infraorbital, and mental nerves | |||
*Assess [[Le Fort]] by rocking hard palate with one hand while stabilizing forehead with other | |||
===Eye=== | |||
*''See [[Orbital trauma]]'' | |||
===Visual Diagnosis=== | |||
<gallery mode="packed"> | |||
File:Black eye 2.jpg|Periorbital ecchymosis | |||
File:Cauliflower ear by dr vikram yadav.jpg|[[Auricular hematoma]] | |||
File:PMC5042625 OAMJMS-4-413-g001.png|[[Septal hematoma]] | |||
File:BrokenNose.jpg|[[Nasal fracture]] | |||
</gallery> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Suspect orbital floor fracture > orbital CT | *Suspect orbital floor fracture > orbital CT | ||
*Suspect mandibular fracture > CT face | *Suspect mandibular fracture > CT face | ||
===Diagnosis=== | |||
*Frequently on CT | |||
===Example Images=== | |||
<gallery mode="packed"> | |||
File:LeFort109M.jpg|thumb|[[Le Fort]] type 1 fracture | |||
File:NoDisManFracMark.png|thumb|[[Mandibular fracture]] | |||
File:PMC4311579 eplasty15ic05 fig1.png|thumb|[[Zygomatic arch fracture]] | |||
File:PMC4145677 eplasty14ic27 fig1.png|thumb|[[Zygomaticomaxillary complex fracture]] | |||
File:PMC4772575 AMS-5-262-g001.png|thumb|[[Zygomaticomaxillary complex fracture]] | |||
</gallery> | |||
==Management== | ==Management== | ||
Latest revision as of 19:41, 1 March 2023
Background
Prehospital Care
- Assess patients ability to speak and protect the airway before and frequently during transport
- Hematomas can significantly distort pharyngeal and facial anatomy making intubation or cricothyroidotomy difficult
- Increased jaw mobility from a mid face fracture may help with intubation
- Penetrating trauma to the lower third of the face frequently requires intubation or a surgical airway[1]
- Place a protective shield over an eye suspected to have a ruptured globe
- Patients should remain upright or reverse trendelenburg if there is oropharyngeal and nasal bleeding to avoid aspiration especially if placed in cervical protection
- Temporizing hemostasis with oral and nasal packing in an intubated patient may help with persistent bleeding
- Transport all avulsed pieces of the face including ears and nose
Pediatric Considerations
- Cricothyrotomy is contraindicated in patients <8yr old
- Maxillary sinuses do not develop until 6 yr old (reduces midfacial fracture)
- Pediatric orbital floor is more pliable, more likely to lead to entrapment
- Mandible fracture requires prompt referral (1-2d) due to rapid bone remodeling
Clinical Features
Ears
- Auricular Hematoma
- Signs of basilar skull fracture
- CSF leak
- Hemotympanum
- Battle Sign
Nose
- Crepitus over any facial sinus suggests sinus fracture
- Septal Hematoma
- Make sure simple nasal fracture isn't a complex naso-orbito-ethmoid injury
Oral
- Intraoral palpation of zygomatic arch to distinguish bony from soft tissue injury
- Mandible Fracture
- Place finger in auditory canal while patient opens and closes jaw to detect condyle fracture
- Tongue blade test
- 95% Sn for no fracture if can bite down hard enough to break it when twisted by examiner
- Jaw deviation due to mandible dislocation or condyle fracture
- Chin will point away from dislocation, towards a fracture
- Malocclusion occurs in mandible, zygomatic, and Le Fort fractures
- Lacerations and mucosal ecchymosis suggests mandible fracture
Other Face
- Numbness
- Check supraorbital, infraorbital, and mental nerves
- Assess Le Fort by rocking hard palate with one hand while stabilizing forehead with other
Eye
- See Orbital trauma
Visual Diagnosis
Periorbital ecchymosis
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
Workup
- Suspect midface fracture > facial CT
- Suspect orbital floor fracture > orbital CT
- Suspect mandibular fracture > CT face
Diagnosis
- Frequently on CT
Example Images
Le Fort type 1 fracture
Management
- Treat underlying process/diagnosis
Disposition
- Bedside consult is necessary for:
- Decreased vision
- Tripod Fracture
- Le Fort Fracture
- Open Mandibular Fracture
- Frontal Sinus Fractures with intracranial involvement
See Also
References
- ↑ Hollier L. et al. Facial gunshot wounds: A 4-year experience. Journal of Oral and Maxillofacial Surgery. 2011: 59:277-282