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CATA 462 > Facial trauma > Flashcards

Facial trauma Flashcards

1
Q

what is the 2nd most common facial fx

A

mandible fracture

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1
Q

1st most common facial fx

A

nose

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2
Q

mandible is attached to skull by and is prone to injury in which type of sport

A

muscle ant TMJ, collision sport

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3
Q

mandibular fracture S/S

A

Initial obs: change in bite, jaw mobility swelling,
S/S:
bruising, or bleeding

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4
Q

if an athlete have increase salivation, pain on mastication, bleeding at gum, lower lip anesthesia, ecchymosis floor of month what can he have

A

mandibular fracture

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5
Q

mandibular fracture eval

A

If trauma occurred from one side, examine body of mandible on same side and opposite condyle
If blow straight on , both condyles at risk.

Observe points of impact / jaw movement
Rinse mouth with water if ↓ bleeding
Palpate intra/extra orally (deformity?)
Palpate border of mandible/TMJ for movement or deformity Crepitus?

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6
Q

mandibular fracture treatment

A

MANDIBULAR FRACTURE: TX
Bleeding control,
Prevent swallowing of avulsed teeth
Tx for shock , position of comfort
Allow for drainage of blood , salivation Transport side-lying: blood/ saliva drainage Stabilize/ immobilize:
MOUTHGUARD + “BARTON BANDAGE”
(looks like baby bonnet) tensor wrap around jaw - head without cutting off airway
Ice locally
Hospital: reduction/plates/screws

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7
Q

how do you transport an athlete with mandibular fracture

A

Transport side-lying: blood/ saliva drainage Stabilize/ immobilize:
MOUTHGUARD + “BARTON BANDAGE”
(looks like baby bonnet) tensor wrap around jaw - head without cutting off airway

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8
Q

mandibular disclocation MOI

A

MOI: usually lateral blow to open mouth
Mandibular condyle is anterior

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9
Q

what can make you prone to a mandibular dislocation

A

MANDIBULAR DISLOCATION (LUXATION) Involves TMJ; a bilateral synovial joint
allowing jaw movement in three planes
Inequity between condyle of mandible and mandibular fossa of temporal bone
Inequity - prone to dislocations

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10
Q

mandibular disclocation S/S

A
  • Inability to close mouth
  • Pain / deformity anterior to ear * Condyles may be palpable
  • Malocclusion
  • Chin deviated to one side (opposite)
  • Spasm of surrounding musculature
  • Subluxations: audible crepitis from discs
  • Some clicks/pops opening/closing is normal
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11
Q

mandibular disclocation TX

A

Initial Immobilization, ice
Reduction procedure: MD/ DDS/ DO * Gloves/gauze to protect practitioner
* Intra-oral reduction required
Thumbs push inferior/posterior on molars
Complications: recurrent, malocclusion TMJ dysfunction

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12
Q

maxilla fracture s/s

A

Malocclusion
Elongated face
Epitaxis
Peri-orbital deformity
Facial ecchymosis (next day) Rhinorrhea ( clear CSF)
Infra-orbital paresthesia
Palpate: increased mobility/crepitus

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13
Q

if an athlete have elongate face, facial ecchymosis the next day, rhinorrhea, epitaxial, malocclusion what can he have

A

maxilla fracture

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14
Q

maxilla fracture tx

A

Airway maintenance Bleeding control
Ice application
Refer Hospital

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15
Q

zygomatic arch fracture s/s

A

Lateral cheek flatness
Unilateral epitaxis: maxillary sinus bleed Anaesthesia of cheek
Deformity of nose / upper lip Diplopia (double vision) Trismus (spasm of masseters)

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16
Q

if athlete have deformity of nose, double vision, trismus, lateral cheek flatness what can he have

A

zygomatic arch fracture

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17
Q

zygomatic arch fracture tx

A

Ice pack locally/gently
Patch both eyes, transport supine Hospital for x-ray/reduction prn Edema may delay correction

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18
Q

nasal fracture s/s

A
  • Epitaxis, crepitus, Pain on palpation * Deformity,deviation,depression
  • Swelling, laceration possible
  • ↓ smell
  • Ecchymosis- next day (black eyes)
  • Septal hematoma
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19
Q

if an athlete have epitaxis, decrease smell, septal hematoma, ecchymosis the next day, swelling what can he have

A

nasal fracture

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20
Q

nasal fracture tx

A

Control bleeding:- rest, gauze, pinch pressure,ice,internal lubricated packing Pt Position: never supine (swallow)
lean forward , poke head Airway concerns
Do not blow nose
Cosmetic importance- reduce by 5 days Usually some aesthetic affect

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21
Q

pt position with nasal fracture and can he blow his nose

A

never supine, lean forward and no

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22
Q

nasal fracture need to be reduce by when

A

5 days

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23
Q

if auricular hematoma is left untreated what happen and what is the permanent deformity

A

fibrosis and cauliflower ear

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24
Q

auricular hematoma tx

A

Ice locally
* Sterile needle aspiration (MD)
followed by compression x 3-5 days
* Tight pressure dressing and contouring mold made with flexible collodian and gauze.
* Drain re-accumulations
* Ear protectors for 4-6 weeks

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25
Q

Moi of tympanic membrane rupture

A

Pentrating object
Rapid displacement of air
Head Slap, ball, fall

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26
Q

S/S of tympanic membrane rupture

A

Severe pain
Muffled hearing Bleeding Tinnitus
Vertigo

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27
Q

if an athlete have muffled hearing, vertigo, tinnitus what can he have

A

tympanic membrane rupture

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28
Q

when should an athlete must use protective eyewear when playing sport

A

athlete with reduced vision in one eyes

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29
Q

what do you palpate during eye exam

A

orbital rim

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30
Q

what do you inspect during eye exam

A

conjunctiva, sclera, pupil, iris,

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31
Q
A
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32
Q

which type of eyes laceration need expert care

A

lid margin
naso-lacrimal apparatus

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33
Q

what is subconjunctival haemorrhage + s/s + treatment

A

bleeding under conjunctiva
no pain or change in vision
clear spontaneously

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34
Q

which eyes condition don’t need treatment

A

subconjunctival haemorrage

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35
Q

what is hyphema + moi

A

bleeding in anterior chamber, blunt trauma to eye

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36
Q

what is the commonest significant eye injury in sport

A

hyphema

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37
Q

hyphema s/s

A

Blurred vision
Loss of field of vision
May see loss of iris detail
Rarely see a blood fluid level – happens later Clears spontaneously, may re-bleed day 4-6

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38
Q

if an athlete have blurred vision, loss of field of vision but blood clear spontaneously in eye what can he have

A

hyphema

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39
Q

long terme complication of hyphema

A

glaucoma

40
Q

if an athlete have light sensitivity, double vision and irregular pupil following a blunt trauma what could he have

A

iris injury

41
Q

iris injury tx

A

Immediate referral to ophthalmologist

42
Q

if an athlete have blurred vision, double vision and darkening vision after a blunt trauma what could he have

A

lens trauma

43
Q

can a lens dislocate

A

yes

44
Q

can a lens opacify

A

yes, cataract occurs slowly

45
Q

what is conjunctival foreign body

A

Dirt or other extraneous material on conjunctival membrane

46
Q

conjunctival foreign body tx

A

Rinse eye with sterile water (or clean)
* Evert lid and use wet Q-tip if necessary
* May RTP if otherwise cleared

47
Q

if an athlete have reduced visual acuity, foreign body sensation and photophobic what could he have

A

corneal foreign body,Material embedded in clear window of eye

48
Q

what is corneal abrasion

A

Scratch, scrape, erosion of clear window

49
Q

s/s of corneal abrasion

A

↓ visual acuity (depends on location)
foreign body sensation
photophobia

50
Q

if an athlete have decrease visual acuity, foreign body sensation in eye and photophobia what could he have

A

corneal abrasion

51
Q

corneal abrasion heal within

A

24-48h with patch and/or drug

52
Q

first response for corneal abrasion

A
  • Irrigate with sterile saline solution
  • Patch eye
  • Refer for opthalmic exam by physician
53
Q

what can increase the risk of corneal laceration

A

previous laser eye surgery

54
Q

if an athlete have decrease vision, increase light sensitivity and irregular pupil following an blunt or sharp trauma what could he have

A

corneal laceration

55
Q

corneal laceration s/s

A

decrease vision
increase light sensitivity
irregular pupil

56
Q

what is vitreous hemmorhage

A

Bleeding into the vitreous jelly in the posterior chamber of the eye.

57
Q

if an athlete have decrease vision and floater what could he have

A

vitreous hemorrage

58
Q

which injury is more common with athlete with myopia

A

detached retina

59
Q

if an athlete have flashing lights, floater, blurred vision, visual field defect what could he have

A

detached retina

60
Q

s/s of detached retina

A

flashing lights, floaters
blurred vision, visual field defect
As detachment progress: ”curtain is falling”

61
Q

if an athlete have blurred central vision after a blunt trauma what could he have

A

macular injury

62
Q

macular injury is often permanent why

A

scarring

63
Q

what is orbital blowout fracture and which nerve is affected

A
  • Fracture of the thin bones of the orbit
    infra-orbital n
64
Q

if an athlete have double vision, orbital bruising, air bubble, numbness below eye after a blunt trauma what could he have

A

orbital blowout fracture

65
Q

how do you treat an extrude eye

A

Control bleeding, calm patient
* Wet saline notched dressing below/above
* Cover with notched cup – (optic nerve) with loose padding inside
* Secure cup with transpore tape * Cover both eyes , TLC
* Transport supine

66
Q

An athlete may NOT return to play if they have any of the following:

A

VISUAL BLURRING
* DOUBLE VISION
* FLASHERS OR FLOATERS
* LIGHT SENSITIVITY
* ABNORMAL PENLIGHT EXAM
* PROBLEMS WITH:
lid margins, pupil changes, loss of iris detail abnormal extra-ocular movements

67
Q

EYE Sideline Kit

A
  • Visual acuity chart
  • Penlight
  • Cotton-tip applicator for lid eversion * Eye patches / transpore tape
  • Sterile saline
  • Gloves / bandaging
  • Contact lens case
68
Q

EYE Urgent Referral
* 911

A
  • ruptured globe / embedded sharp object * associated injuries
69
Q

Urgent Referral to Ophthalmologist (ASAP)

A

visual field loss with flashers / floaters
* visual acuity loss
* photophobia
* diploplia

70
Q

teeth most affect in dental injury and between what ge

A

Most victims between ages of 8 -15 yrs old Teeth most affected: upper incisors

71
Q

how many teeth per quadrant of mouth

A

8

72
Q

teeth in mid-line in

A

2 incisors, 1 canine, 2 premolar 3 molars

73
Q

what can we see when we smille

A

crowns

74
Q

root are attached to and hidden by

A

Roots are hidden supporting structures
which attach to skull via peridontal ligs

75
Q

what are the 3 layer of the teeth

A

All teeth have 3 layers:
* *
Enamel – hard outer layer caps the tooth
Cementum – coats root surface, attaches
tooth to peridontal lig of socket
Dentin – forms bulk of tooth/walls for pulp

76
Q

what is located in the pulp chamber

A

space in middle contains
nerve, blood for tooth viability

77
Q

crown fracture may involve what

A

enamel only
* enamel and dentin
* enamel, dentin, and pulp
* The more severe the fracture, the greater discomfort, more immediate the need for treatment by a dentist.

78
Q

what is a root fracture

A

Breakage of the root of a tooth
* Surrounding teeth are also likely involved * Trauma usually greater than in crown fx.

79
Q

what is tooth luxation- concussion

A

Breakage of the root of a tooth
* Surrounding teeth are also likely involved * Trauma usually greater than in crown fx.

80
Q

what is a tooth subluxation

A

a mobile but undisplaced tooth, sensitivity
may be some bleeding at gum margins

81
Q

what is tooth luxation

A

displacement of tooth, intrusive, extrusive, labial lingual, or lateral depending on force direction blood supply is fully compromised.

82
Q

what is tooth avulsion

A

tooth is “out of socket”

83
Q

what is a alveolar fracture

A

Fracture of the supporting bony ridge of the teeth, called the alveolus

84
Q

if an athlete have mobility for a group of teeth what could he have

A

The affected area will show mobility for a group of teeth

85
Q

dental injuries examination

A

Work top-to-bottom , inside out
* Look for fluid, note its colour
* Look for lacerations,contusions,abrasions * Wound under chin…jaw fracture?
* Some injuries apparent, others hidden
* Do not assume absence of other injuries

86
Q

dental injury verification

A
  • Mobility of teeth in affected area by gently
    trying to move them with gloved hand instrument best-to pick up subtle movement
    En bloc movement is sign of alveolar fx
87
Q

what is the finger pressure test

A

mild pressure inward then outward on teeth

88
Q

difference between concussion dental injury and subluxation

A

concussion -> no looseness
subluxation -> loose but not displaced

89
Q

A tooth chipped to dentin layer will show

A

colour change from whitish enamel to the more yellow dentin. Sensitive to hot/cold

90
Q

crown fracture management

A

If pulp (nerve) involved, see small bleeding from tooth itself. Need to cover fx part ASAP
* Need urgent dental tx to prevent infection and prevent need for root canal
* Locate missing pieces of teeth. Out of mouth, in soft tissue,swallowed, inhaled (pneumonitis!)

91
Q

tooth displacement management

A

Whether root fx, crown root fx, tooth
luxation,or alveolar fx:
PUT AFFECTED TEETH BACK INTO AS
NORMAL A POSITION AS POSSIBLE
Hold them in place: custom or stock mouthguard, or cotton rolls.
Immediate dental consult for wire splint

92
Q

with tooth avulsion, tooth need to be place in socket within

A

3 min

93
Q

tooth avulsion management

A

Rinse debris off tooth, DON’T scrub tooth * Handle tooth by the crown, NOT the root * Clean a blood clot out of socket with
LIGHT GENTLE irrigation

94
Q

if tooth can’t be re-implanted immediately what need to be done

A

STORE tooth in appropriate medium
HBBS, Egg White,Coconut Water,Milk, * Don’t let tooth dry out
* Don’t re-implant a baby tooth

95
Q

do you re-implant a baby tooth

A

no

96
Q

storage medium time

A

dry <30min
tap water 30-60min
vestibule of mouth 90-120 min
physiologic saline 90-120min
cold milk 3h
coconut water better than milk
egg with +++
viaspan >24h

97
Q
A

CATA 462 (22 decks)

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