Maxillofacial trauma: Difference between revisions
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==Clinical Features==
==Clinical Features==
[[File:Black eye 2.jpg|thumb|A woman with periorbital ecchymosis after maxillofacial trauma.]]
[[File:Black eye 2.jpg|thumb|A woman with periorbital ecchymosis after maxillofacial trauma.]]
===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]]''
===Nose===
*Crepitus over any facial sinus suggests sinus fracture
*[[Septal Hematoma]]
*Make sure simple [[nasal fracture]] isn't a complex naso-orbito-ethmoid injury
===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]]''


==Differential Diagnosis==
==Differential Diagnosis==

Revision as of 17:52, 4 February 2021

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

A woman with periorbital ecchymosis after maxillofacial trauma.

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

See Orbital trauma

Differential Diagnosis

Maxillofacial Trauma

Evaluation

Workup

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

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
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