Maxillofacial trauma Flashcards

1
Q

What do you need to do when pre assessing a trauma case?

A
  • ATLS principles - Advanced trauma life support
    A (airway Plus C-spine control)
    B (Breathing)
    C (Circulation plus haemorrhage control)
    D (Disability GCS are they head injured)
  • Then assess if any fractures
  • Full history
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2
Q

What might be an indication the mandible has fractured?

A
  • Sublingual haematoma
  • 2 point mobility vertically
  • Abnormal sensation contralateral to side of injury
  • Pain contralateral to side of injury
  • Numbness that can’t be explained by direct injury to the nerve
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3
Q

What is the immediate management of Mandible fracture?

A
  • Fast pt
  • Analgesia
  • AB for open fractures (through dentate mandible or mucosal breach)
  • Liquid diet
  • Immediate discussion with OMFS team
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4
Q

What is indicative of midface fracture (including zygoma)?

A
  • Epistaxis (nosebleed) without a blow to the nose (nosebleed)
  • CN V2 (maxillary branch of trigeminal nerve) numbness without direct blow to the nerve
  • Subconjunctival bleed
  • Midface mobility
  • Malocclsuion
  • Surgical emphysema around eye
  • Swelling after nose blowing
  • Diplopia (double vision)
  • Change of appearance
  • CSF from nose
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5
Q

reason for epistaxis after midface trauma

with no direct trauma to nose

A
  • bleeding from maxillary sinus can travel to nasal cavity through semilunar hiatus
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6
Q

What is the immediate management of midface fracture including zygoma?

A
  • No indication for routine AB
  • Call OMFS (vast majority followed up in 7-10days)
  • No nose blowing
  • Soft diet for their comfort (masseter pull)
  • Give warning re retrobulbar haemorrhage (pain, bruising, bulging around eye - seek medical attention immediately)
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7
Q

What is the immediate tx protocal for Orbital fractures?

A
  • Ensure visual acuity and diplopia (double vision) documented
  • Discuss with OMFS
  • No need routine ABS
  • No nose blowing
  • Give warning re retrobulbar haemorrhage
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8
Q

What is the txt protocol for maxilla (lefort type) fractures?

A
  • Fast
  • ABS
  • Discussion with OMFS immediately
  • Liquid diet
  • No nose blowing
  • Most be will be assessed on the day
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9
Q

What do you need to know on how to refer to OMFS for fractures or injuries of the face?

A
  • Contact QEUH OMFS on call via switchboard at QEUH - page them, don’t get put through to the ward
  • Have pt details ready including CHI, phone numbers etc
  • Keep pt fasted until discussed
  • Don’t tell pt date of review
  • Don’t send to QE without discussion
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10
Q

What would you do if you were unhappy with a discussion with OMFS or failure to reach DCT? (direct consultant)

A
  • Speak to Mr Laraways secretary who knows the consultant covering trauma that week’
  • Discuss with consultant directly if not happy with management or pt is too injured to wait / needs 999
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11
Q

general points in management

A
  • take 2 x-rays
  • keep them fasted until being seen
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