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    EM Facial Trauma Slides

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    abdulsajjadpathan
    This document discusses various types of facial trauma, including midface fractures, orbital fractures, nasal trauma, mandibular fractures, dental trauma, and ear trauma. It provides classifications for different types of fractures, signs and symptoms to look for, recommended treatments which may include antibiotics, surgery, and follow-up. Key points covered are LeFort classifications of midface fractures, blowout fractures of the orbital floor, management of nasal fractures, considerations for mandible fractures, classification of dental fractures, and treatments for auricular hematomas, hemotympanum, and perforated tympanic membranes.

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    EM Facial Trauma Slides

    Uploaded by

    abdulsajjadpathan
    4 views10 pages
    This document discusses various types of facial trauma, including midface fractures, orbital fractures, nasal trauma, mandibular fractures, dental trauma, and ear trauma. It provides classifications for different types of fractures, signs and symptoms to look for, recommended treatments which may include antibiotics, surgery, and follow-up. Key points covered are LeFort classifications of midface fractures, blowout fractures of the orbital floor, management of nasal fractures, considerations for mandible fractures, classification of dental fractures, and treatments for auricular hematomas, hemotympanum, and perforated tympanic membranes.

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    Facial Trauma

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    This document discusses various types of facial trauma, including midface fractures, orbital fractures, nasal trauma, mandibular fractures, dental trauma, and ear trauma. It provides classifications for different types of fractures, signs and symptoms to look for, recommended treatments which may include antibiotics, surgery, and follow-up. Key points covered are LeFort classifications of midface fractures, blowout fractures of the orbital floor, management of nasal fractures, considerations for mandible fractures, classification of dental fractures, and treatments for auricular hematomas, hemotympanum, and perforated tympanic membranes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views10 pages

    EM Facial Trauma Slides

    Uploaded by

    abdulsajjadpathan
    This document discusses various types of facial trauma, including midface fractures, orbital fractures, nasal trauma, mandibular fractures, dental trauma, and ear trauma. It provides classifications for different types of fractures, signs and symptoms to look for, recommended treatments which may include antibiotics, surgery, and follow-up. Key points covered are LeFort classifications of midface fractures, blowout fractures of the orbital floor, management of nasal fractures, considerations for mandible fractures, classification of dental fractures, and treatments for auricular hematomas, hemotympanum, and perforated tympanic membranes.

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    Facial Trauma

    Midface Fractures
    Orbital Fracture
    Nasal Trauma
    Mandibular Fracture
    Dental Trauma
    Ear Trauma

    Midface Fractures
    ● Described using the Le Fort classification.
    ● A facial fracture is rarely isolated; find the others!
    ● Look for: septal hematoma, CSF leak
    Le Fort I
    ● Transverse fracture through
    the lower maxilla, above the
    roots of the teeth
    ● Palate is mobile
    ● Malocclusion
    ● Often stable

    Le Fort II
    ● Pyramidal fracture through from central maxilla
    through orbital rim, nasal bridge and hard palate
    ● Nose and maxilla mobile

    Le Fort III & IV


    ● Fracture through
    frontozygomatic sutures,
    orbits, nose, and ethmoids (III)
    plus frontal bone (IV)
    ● Entire face mobile
    ● Unstable
    ● +/- CSF leak (cribiform plate)

    Admit
    IV antibiotics
    Le Fort Fractures
    ● Facial CT

    ● Airway protection
    ● Control bleeding (packing, arterial
    embolization)
    ● Antibiotics to cover sinus pathogens
    ● Urgent oral or facial surgery consult for
    surgical repair

    Pearl

    If intubation is required, consider awake


    procedure and avoid paralytics

    Midface Fractures
    Orbital Fracture
    Nasal Trauma
    Mandibular Fracture
    Dental Trauma
    Ear Trauma
    Orbital Fractures
    Most common = floor
    Blow out fracture = orbital wall (inf/med)
    LOOK FOR ● CT orbit
    ● Globe injury ● Abx (if sinus wall fx)
    ● SQ air (medial wall) ● Canthotomy prn
    ● Diplopia (inferior wall) ● Entrapment?
    ● Enophthalmos ○ f/u 24 hours
    ● Proptosis (retrobulbar clot)
    ● No entrapment?
    ● Facial numbness
    ○ surgical repair 1-2 wks
    (infraorbital nerve)

    Enophthalmos
    Proptosis

    inferior wall
    blow-out fracture

    Midface Fractures
    Orbital Fracture
    Nasal Trauma
    Mandibular Fracture
    Dental Trauma
    Ear Trauma
    Nasal Fractures
    Most common facial fx
    Nasal bone, septum, or both
    LOOK FOR ● Clinical dx
    ● Septal hematoma ● Decongestants
    (incise and pack if ● Control epistaxis
    present) ● Avoid nose blowing
    ● F/U ENT 3-5 days
    (prn need for reduction)

    Midface Fractures
    Orbital Fracture
    Nasal Trauma
    Mandibular Fracture
    Dental Trauma
    Ear Trauma
    Mandible Fractures

    Should be considered bilateral and open


    (until proven otherwise)
    Condyles - most common site
    LOOK FOR ● CT > Panorex
    ● Malocclusion ● Closed: Barton
    ● Trismus bandage,
    ● Lower lip ○ f/u OMFS
    paresthesia ● Open: Admit, IV abx
    ○ OR

    Pearl

    Intraoral exam is critical to exclude open


    fracture and evaluate dentition.

    Midface Fractures
    Orbital Fracture
    Nasal Trauma
    Mandibular Fracture
    Dental Trauma
    Ear Trauma
    Anatomy of the Tooth

    Dental Fracture
    Classification Fracture Pattern Treatment
    Ellis Class I Through enamel ● Routine dental f/u

    Ellis Class II Through enamel + ● Cover dentin with


    dentin calcium hydroxide
    yellow
    ● Dental f/u 1-2 days
    Ellis Class III Through enamel + ● Cover with calcium
    dentin + pulp hydroxide + dental
    cement
    red ● Rx PCN or Clinda
    ● Dental f/u 1-2 days

    Dental Luxation and Avulsion


    ● Luxation
    ○ Intrusive (into socket) → allow tooth to erupt
    ○ Lateral → reposition, splint, f/u 24 h
    ○ Extrusive (removed from socket) → reposition, f/u 24 h
    ● Avulsion
    ○ Primary tooth → don’t reimplant - f/u 1 week
    <5 years–primary teeth
    ○ Secondary → replace, abx, f/u 1-2 days >13 yrs -secondary

    ○ Best viability: Hank’s Salt Solution > milk > saliva > saline

    Implantation→Tetanus Risk
    Midface Fractures
    Orbital Fracture
    Nasal Trauma
    Mandibular Fracture
    Dental Trauma
    Ear Trauma

    Auricular Hematoma
    Blunt trauma to auricle
    Typically sports-related

    LOOK FOR ● Needle aspiration if


    ● Tense, fluctuant small (<2 cm)
    mass ● I&D if larger (>2 cm)
    ● Usually on anterior ● If >7 days old, refer to
    pinna ENT (can’t drain)
    ● Pressure dressing

    Auricular Hematoma
    Hemotympanum
    Causes Treatment
    ● Basilar skull fx ● Decongestants
    ● Direct blow ● CT if suspect basilar
    ● Barotrauma skull fx
    ● Blast injury ● Eval for CSF leak
    ● ENT follow up

    Perforated TM
    Causes Look for
    ● Blunt Trauma ● Vertigo
    ● Blast Injury ● Hearing loss
    ● Barotrauma ● Facial nerve palsy
    ● Lightning ● Tinnitus
    ● Otitis media ● Otorrhea
    Perforated TM
    ● Keep ear dry
    ● Analgesia
    ● Abx drops if contaminated
    ○ (eg. ofloxacin)
    ● Most heal
    ● ENT f/u

    Image Attribution
    LeFort1e by RosarioVanTulpe is licensed under CC BY-SA 3.0

    LeFort2a by Original: RosarioVanTulpe~commonswiki Vector: Ashy Minivet is licensed under CC BY-SA 3.0
    LeFort2b by RosarioVanTulpe is licensed under CC BY-SA 3.0

    LeFort3b by RosarioVanTulpe is licensed under CC BY-SA 3.0

    Pblowoutfracture by James Heilman, MD is licensed under CC BY-SA 3.0

    BrokenNose by en:User:Rls is licensed under CC BY-SA 3.0


    Nasal septal hematoma by S Bhimji MD is licensed under CC BY 4.0
    Tooth Anatomy Part 1 by BruceBlaus is licensed under CC BY 4.0
    Cauliflower ear by martialartsnomad.com is licensed under CC BY 2.0
    Erckscauliflowerear by Djerickson94 is licensed under CC BY 4.0
    Archivo:Traumatic Perforation of the Tympanic Membrane by Michael Hawke MD is licensed under CC BY 4.0

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