MaxillofacialTrauma-颌面部创伤

LeFort Fractures
Maxillofacial Trauma-Specific Facial Fractures
► Mandibular
Fractures

Second most common facial fracture Plain films Often multiple Panorex Malocclusion CT Intraoral lacerations Sublingual ecchymosis Open Fractures Nerve injury
► Intubation
Avoid nasotracheal intubation May not want RSI
► Benzodiazepines
► Ketamine ► Etomidate
Be Prepared and Be Creative
Emergency Management and Resuscitation
►
Zygomatic Fractures
Tripod fracture
Arch fracture
►Most
common ► Most serious ►Outpatient repair ► Lateral subconjunctival hemorrhage ► Need ORIF
Tripod Fracture
► Ears
Subperichondral hematoma Hemotympanum Battle sign
Maxillofacial Trauma-Physical Exam
► Oral
and Mandibular Exam

Mandible deviation Teeth malocclusion Paresthesia Tongue Blade Test
Maxillofacial Trauma
Anthony G. Hillier, D.O. St. John West Shore Emergency Medicine Resident
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
Maxillofacial Trauma-Specific Fractures
► Maxillary
Fractures

High-energy injury 100x gravity Malocclusion Facial lengthening CSF rhinorrhea Periorbital ecchymosis
► Orbital
Fractures
Usually through floor or medial wall Enophthalmos Anesthesia Diplopia Infraorbital stepoff deformity Subcutaneous emphysema
►95%
Sensitive ►65% Specific
Maxillofacial Trauma-Imaging
► Head,
chest and abdominal trauma takes precedence ► PE detects up to 90% of fractures ► Plain Films ► CT
Maxillofacial Trauma-Specific Fractures
►
Orbital Fissure Syndrome
Fracture of the orbital canal
► ►
Extraocular motor palsies and blindness If significant retrobulbar hemorrhage, may need cantholysis to save vision
► Airway
Management Options

Awake intubation Laryngeal Mask Airway Fiberoptic intubation Lateral or semi-prone position Percutaneous transtracheal jet ventilation Retrograde intubation Cricothyroidotomy
►Pen
G or Cleocin
Body Angle Condyle Symphysis Ramus
30-40 % 25-30 % 15-17 % 7-15 % 3-9 %
Alveolar
Coronoid Process
2-4 %
1-2 %
Questions?
Thank You!
Lecture Questions
Emergency Management and Resuscitation
► Hemorrhage
Control

Rarely develop shock from facial bleeding alone Direct Pressure LeFort Fractures Nasal hemorrhage may require A&P packing
4.
The best modality for diagnosing an orbital or facial fractures is
a. b. c. d. e. Plain films MRI CT Ultrasound Osteopathic palpation
5.
Which statement below is correct?
► Nasoethmoidal-Orbital
Injuries
Lacrimal apparatus disruption Bimanual palpation if medial canthus pain CT face
Maxillofacial Trauma-Specific Fractures
Etiology and Incidence
► Older ► Facial
age, MVC and TBI-higher incidence
fractures-a distracting injury? artery injury may occur with facial fractures
► Carotid
a. Midface fractures usually have minimal morbidity b. The tongue blade test is quite sensitive in assessing need for mandibular xrays c. The bimanual nasal exam is crucial in possible medial orbital wall fracture d. Midface fracture is an indication for nasotracheal intubation and RSI is often needed in these patients
► Bimanual
Palpation Test
Maxillofacial Trauma-Physical Exam
► Penetrating
Injuries
Occult globe penetration Eyelid lacerations
► Nose
Septal hematoma CSF Rhinorrhea
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
1.
What portion of the mandible is most commonly fractured?
a. b. c. d. e. Ramus Coronoid process Body Angle Symphysis
2.
Orbital fractures can cause all of the following except:
► History
Vision Teeth alignment Abuse
Maxillofacial Trauma-Physical Exam
► Inspection
Facial elongation
►High
grade LeFort Fracture and cranial nerve injury
► Blindness
Maxillofacial Trauma
Emergency Management and Resuscitation
► Airway
Most urgent complication-Airway compromise Simple interventions first No mandible?
a. b. c. d. e. Blindness Motor palsies Facial anesthesia Enophthalmos Hyphema
3.
Which of the following is/are true regarding maxillary fractures?
a. b. c. d. e. Only minimal force necessary Rarely cause CSF rhinorrhea May cause facial lengthening Usually the only sustained injury All of the above are true
Asymmetry
►Deformities
► Palpation
Tenderness Step offs Facial stability
Crepitus Subcutaneous air Cutaneous anesthesia
Maxillofacial Trauma-Physical Exam
c, e, c, c, b
► Periorbital
Exam
and
Perform early
Professional Lid Retractor
Maxillofacial Trauma-Physical Exam
► Periorbital
and Orbital Exam

Look for exophthalmos or enophthalmos Pupil shape Hyphema Visual acuity Entrapment signs Raccoon sign