Maxillofacial trauma: Difference between revisions

No edit summary
 
(3 intermediate revisions by the same user not shown)
Line 17: Line 17:


==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]]
Line 50: Line 51:
===Visual Diagnosis===
===Visual Diagnosis===
<gallery mode="packed">
<gallery mode="packed">
File:Black eye 2.jpg|[[Periorbital ecchymosis]]
File:Black eye 2.jpg|Periorbital ecchymosis
File:Cauliflower ear by dr vikram yadav.jpg|[[Auricular hematoma]]
File:Cauliflower ear by dr vikram yadav.jpg|[[Auricular hematoma]]
File:PMC5042625 OAMJMS-4-413-g001.png|[[Septal hematoma]]
File:PMC5042625 OAMJMS-4-413-g001.png|[[Septal hematoma]]
Line 60: Line 61:


==Evaluation==
==Evaluation==
<gallery mode="packed">
File:LeFort109M.jpg|thumb|A 3-D CT reconstruction showing a Le Fort type 1 fracture (marked by arrow).
File:NoDisManFracMark.png|thumb|Non-displaced fracture of the mandible on CT.
File:3D CT mandible fracture.jpg|thumb|3D CT reconstruction of mandible fracture, white arrow marks fracture, red arrow marks moderate displacement and open bite.
File:PMC4311579 eplasty15ic05 fig1.png|thumb|CT face showing an isolated left zygomatic arch fracture impinging the coronoid of the left mandible.
File:PMC3389904 poljradiol-76-1-41-g009.png|thumb|3D reconstruction of CT examination showing acute fracture of the left zygomatic arch.
File:PMC4145677 eplasty14ic27 fig1.png|thumb|CT scan demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection (top left), displacement at the sphenozygomatic suture (top right), zygomaticomaxillary buttress (bottom right), with minimal orbital floor displacement (bottom left).
File:PMC4772575 AMS-5-262-g001.png|thumb|Left zygomaticomaxillary complex fracture with associated orbital fracture.
</gallery>
===Workup===
===Workup===
*Suspect midface fracture > facial CT
*Suspect midface fracture > facial CT
*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

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

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

Visual Diagnosis

Differential Diagnosis

Maxillofacial Trauma

Evaluation

Workup

  • Suspect midface fracture > facial CT
  • Suspect orbital floor fracture > orbital CT
  • Suspect mandibular fracture > CT face

Diagnosis

  • Frequently on CT

Example Images

Management

  • Treat underlying process/diagnosis

Disposition

See Also

References

  1. ↑ Hollier L. et al. Facial gunshot wounds: A 4-year experience. Journal of Oral and Maxillofacial Surgery. 2011: 59:277-282
Retrieved from "https://www.wikem.org/w/index.php?title=Maxillofacial_trauma&oldid=368953"