Dentistry OMF

Maxillofacial Trauma PDF

Maxillofacial Trauma

Etiology and Incidence

  • Multisystem injury 20-50%
  • Nasal and mandibular fractures most common in community ED’s
  • Midface and zygomatic injuries most common in Trauma centers
  • 25% of women with facial trauma result of domestic violence
  • Incidence of concomitant cervical spine injuries with facial fractures
  • Older age, MVC and TBI-higher incidence
  • Facial fractures-a distracting injury?
  • Carotid artery injury
  • Blindness may occur with facial fractures
Maxillofacial Trauma
Maxillofacial Trauma

Emergency Management and Resuscitation

Airway
  • Most urgent complication-Airway compromise
  • Simple interventions first
  • No mandible?
Intubation
  • Avoid nasotracheal intubation
  • May not want RSI
  • Benzodiazepines
  • Ketamine
  • Etomidate
  • Be Prepared and Be Creative

Emergency Management and Resuscitation

Airway Management Options
  • Awake intubation
  • Laryngeal Mask Airway
  • Fiberoptic intubation
  • Lateral or semi-prone position
  • Percutaneous transtracheal jet ventilation
  • Retrograde intubation
  • Cricothyroidotomy
Hemorrhage Control
  • Rarely develop shock from facial bleeding alone
  • Direct Pressure
  • LeFort Fractures
  • Nasal hemorrhage may require A&P packing
History
  • Vision
  • Teeth alignment
  • Abuse

Maxillofacial Trauma-Physical Exam

Inspection
  • Facial elongation
  • High grade LeFort Fracture
  • Asymmetry
  • Deformities and cranial nerve injury
Palpation
  • Tenderness
  • Step offs
  • Facial stability
  • Crepitus
  • Subcutaneous air
  • Cutaneous anesthesia
Periorbital and Orbital Exam
  • Perform early
Periorbital and Orbital Exam
  • Look for exophthalmos or enophthalmos
  • Pupil shape
  • Hyphema
  • Visual acuity
  • Entrapment signs
  • Raccoon sign
  • Bimanual Palpation Test
Penetrating Injuries
  • Occult globe penetration
  • Eyelid lacerations
Nose
  • Septal hematoma
  • CSF Rhinorrhea
Ears
  • Subperichondral hematoma
  • Hemotympanum
  • Battle sign
Oral and Mandibular Exam
  • Mandible deviation
  • Teeth malocclusion
  • Paresthesia
  • Tongue Blade Test
    –  95% Sensitive
    –  65% Specific

Maxillofacial Trauma-Imaging

  • Head, chest and abdominal trauma takes precedence
  • PE detects up to 90% of fractures
  • Plain Films
  • CT
    – Orbital fractures
    – 3D images available

Maxillofacial Trauma-Specific Fractures

Frontal Sinus/Bone Fractures
  • Direct blow
  • Frequent intracranial injuries
  • Mucopyoceles
  • Consult with NS for treatment, disposition and antibiotics
Nasoethmoidal-Orbital Injuries
  • Lacrimal apparatus disruption
  • Bimanual palpation if medial canthus pain
  • CT face
Orbital Fractures
  • Usually through floor or medial wall
  • Enophthalmos
  • Anesthesia
  • Diplopia
  • Infraorbital stepoff deformity
  • Subcutaneous emphysema

Orbital Fissure Syndrome

  • Fracture of the orbital canal
  • Extraocular motor palsies and blindness
  • If significant retrobulbar hemorrhage, may need cantholysis to save vision

Zygomatic Fractures

Tripod fracture
  • Most serious
  • Lateral subconjunctival hemorrhage
  • Need ORIF
Arch fracture
  • Most common
  • Outpatient repair

Maxillary Fractures

  • High-energy injury
  • 100x gravity
  • Malocclusion
  • Facial lengthening
  • CSF rhinorrhea
  • Periorbital ecchymosis

Mandibular Fractures

  • Second most common facial fracture
  • Often multiple
  • Malocclusion
  • Intraoral lacerations
  • Sublingual ecchymosis
  • Nerve injury

Plain films
Panorex
CT
Open Fractures
Pen G or Cleocin

Maxillofacial trauma PowerPoint Presentation