most frequently fx’ed facial bone
nasal
what is the best dx test for nasal fx?
trickster!! This is a clinical dx.
What soft tissue issue are you looking for in a nasal fx? How will you treat it and why?
septal hematoma, drain it to reduce risk of septal necrosis
Crepitus over maxillary sinus and CSF rhinorrhea following a head on MVA is most likely what type of fx?
frontal sinus
Are frontal sinus fractures known to occur in an isolated area, or in conjunction with another fracture?
Look for another fx
This fracture often has no obvious visible signs, but patient might c/o hearing loss, facial numbness, vertigo, or CSF otorrhea
temporal fx
This fracture commonly presents with the Battle sign, which is bruising to the _______ or the Raccoon sign, which is bruising to the _______
Basilar skull fx
Battle = behind ear
Raccoon = black eyes
This fracture presents with a flattened cheek, low eyelid swelling, pain opening mouth, cheek numbness, and possible vision changes
zygomatic complex fx
Are zygomatic fractures typically isolated?
No, often a “tripod fx”
Which bones are part of a tripod fx?
1) zygomatic arch
2) zygomaticofrontal suture
3) infraorbital foramen
If you have a tripod fracture, which muscle is typically entrapped? Which direction CAN’T you look?
lateral rectus, can’t look medial
What part of the orbit is most likely to fx?
floor
When do you need to provide abx for orbital fx’s?
Always, risk of cellulitis = blindness
orbital floor fractures cause pain and limited ROM when looking in what direction
up
which sinus is mostly affected by orbital floor fractures?
Mostly maxillary….sometimes ethmoid
If your patient has epistaxis and limitation of the lateral gaze, they most likely have what fracture? What sinus does this affect?
medial orbital, ethmoid
this orbital fracture is life threatening and requires immediate neurosx consult
orbital roof
This low impact orbital floor fracture causes muscle entrapment, but has few other symptoms
trapdoor fx, most common in kiddos
During TBI, what confounding factor increases mortality by 50%? How can this be prevented?
hypoxia, provide O2 via NC, check blood gasses. Maintain adequate perfusion (MAP at 90mmHG)
At what level on the GCS do you consider intubation
8-9 (depressed gag, not handling secretions)
This brain bleed is most common in the elderly or alcoholics (brain atrophy). It is caused by a rupture of a vein or artery? Does it cross suture lines?
subdural, vein, yes (crescent)
This brain bleed is fast. Patients will have brief periods of lucidity, but you shouldn’t assume they are getting better. It is caused by a rupture of a/an ________. Does it cross suture lines?
epidural, artery, no (lens)
this type of brain bleed can lead to the blockage of CSF from the 3rd and 4th ventricles.
subarachnoid
This type of brain bleed is deep within the brain and causes edema
contusion: coup/contracoup
occurs when an athlete sustains a second concussion before being completely asymptomatic from the first and then experiences a rapid, usually fatal, neurologic decline
second impact syndrome
This occurs as a result of shearing and edema that affects the nerves in the brain. It is often the cause of traumatic coma.
diffuse axonal injury
How will you dx diffuse axonal injury (what imaging? and what does it look like on imaging?)
CT typically neg. Get MRI, look for
1) punctate hemorrhages
2) blurred gray/white matter border
what type of skull fracture is most concerning for airway compromise?
Le Fort III (face smashed back and down)
Where is the fracture line in a Le Fort III?
horizontally at mid eye level
Where is the fracture line in Le Fort II?
triangle of nose, medial/inferior orbital, maxillary, pterygoid plates (nose smashed into dental space)
which le fort fx is highest risk for blindness?
III
This is the most common type of Le Fort fracture (use fancy name). The fracture line falls where?
Guerin’s fx (le fort I), horizontally across the maxilla/pterygoid plates
what is the classification system for dental injuries?
Ellis:
1) chipped tooth, enamel only
2) enamel + dentin
3) enamel + dentin + pulp
Which of the ellis classifications are true emergencies?
Ellis III
If a tooth is avulsed, what do you do?
rinse only with saline, put it back. (unless baby tooth)….if you can’t, put in Hanks, which keeps it viable x 4-6 hours
What ligament are you preserving by not rubbing the tooth?
periodontal ligament
You’re told a patient has a maxillary fracture….what is the first thing you should assess.
airway. (maxillary has common a/w airway compromise)
General observation….
CSF rhinorrhea seems to be bad.
What type of history is a common MOI for a mandibular fx?
1) MVA
2) assault
what are the s/s of mandibular fx?
1) malocclusion,
2) dental injury,
3) bruising on floor of mouth,
4) numbness of lower lip
In general, open fractures require what medications?
1) tetanus
2) abx
The _____nerve supplies the motor function of the face, and the _____nerve supplies the sensation.
Facial = motor
Trigeminal = sensation
(I know, they both do both….but this is a general rule of thumb….I think the exceptions are in the tongue)
what is the best imaging for a mandibular fx?
Panorex (also dental fx’s)…all the rest is CT head
when I say “craniofacial dysjunction” you say:
dish face….(Le Fort III)