Maxillofacial trauma

Diagnosis

ALWAYS ASK ABOUT VISION.

facial numbness, misalignment o teeth, and diploplia (monocular vs binocular)

anesthesia of upper lip and/or maxillary teethmay be due to infraorbital nerve injury fromorbital blowout or orbital rimFx.

Exam (finer points): jaw deviation-the chin will point away from a dislocation and towards a fracture.

The best way to palpate the mandibular condyles is to place a finger in the external auditory canal and press down while pt opens and closes mouth.

Radiology-

If high suspicion of midface Fx then o directly to facial CT. Orbital floor Fx can be seen w/ orbital CT.

Water's view- can see orbital rims, floors, zygmatic arch, as well as maxillary sinus and maxilla.

Bucket handle view to examine zygomatic arches.

Panorex or mandibular series for mndibular Fx. Fractures throughthe mandibular body are best seen on the oblique view. Fractures through theangle and symphysis are best seen on th PA view. Fx through themandibular condyles are best seen through the AP axial(Towne's) view

DDx

Frontal sinus fractures: ant wall isthick and the posterior wall is thin. Only 18% of frontal sinus fractures are anterior wall only. If ant wall Fx-need CT t evaluate posterior wall. (75% have both walls Fx). Need neurosurg or ENT for post wall since many need surgery and IVABx.

Naso-ethmoid fractures- diffuse tearing and increased intercanthal distance are suggestive. intranasal palpation w/ hemostat while palpating along bonyrim for crepitus useful.

complications include lacrimal disruption, medial cathal ligament rupture, and dural tears. intracranial injury seen in up to 70%. can develop malignant periorbital emphysema and blinndness. cover w/ABx and have pt see maxillofacial surgeon.

Nasal Fx-clincal diagnosis (no xrays) drain septal hematomas and f/u with ENTin 7-10 days

Zygomatic arch fractures- unlikely isolated

Tripod Fractures-

Fx through 1)inf orbital rim, 2) lateral orbital wall, 3) fx/disocation of zygomatic arch.

-must rule out associated ocular injuries. usually requires admission and surgical repair.

Disposition

bedside consult is necessary for:

decreased vision, tripod fractures, Lefort fractures, openmandibular fractures, frontal sinus fractures with intracranial involvement, NEO injuries.

See Also

Trauma: Mandible Fx

Optho: Orbital Blowout Fx