Lecture 9C: Facial Trauma

Question 1

What should be your priorities when dealing with facial traumas?

Answer 1

airway maintenance
in-line immobilization spinal control
oro-pharynx bleeding control
LOC management
Shock prevention/treatment

Question 2

What is the general management of facial trauma?

Answer 2

airway adjunct where possible
suction available
patient position preference (forward lean/ side-lying permits secretions and blood to drain allows mandible/ tongue to fall forward

Question 3

What are some characteristics of mandible fractures?

Answer 3

Most common fx area of jaw are condyles and body of mandible
10% of sports related facial trauma
2nd most common facial fx (after nasal)
Attached to skull by muscles and TMJ
Prone to injury in collision sports
few muscles/ protection/ sharp contours

Question 4

What are the s/s of mandibular fractures?

Answer 4

change in bite
jaw mobility swelling, bruising or bleeding
step deformity
increased salivation
malocclusion, awkward movement
pain on mastication
bleeding at gums
ecchymosis floor of mouth
lower lip anesthesia

Question 5

What are the treatment steps for mandibular fractures?

Answer 5

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: mouth guard+ barton bandage
ice locally
hospital

Question 6

Characteristics of mandibular dislocations.

Answer 6

involves TMJ, bilateral synovial joint (movement in 3 planes)
inequity between condyle of mandible and mandibular fossa of temporal bone
inequity - prone to dislocations
MOI: usually lateral blow to open mouth mandibular condyle is anterior

Question 7

List the s/s of mandibular dislocations.

Answer 7

inability to close mouth
pain/deformity anterior to ear
condyles may be palpable
malocclusion
chin deviated to one side
spasm of surrounding musculature
subluxation: audible crepitus from discs
some clicks/pops opening/closing is normal

Question 8

What is the treatment of mandibular dislocations?

Answer 8

initial immobilization, ice
reduction procedure: MD/DDs/DO
complications: recurrent, malocclusion, TMJ dysfunction

Question 9

List the S/S of maxillary fractures.

Answer 9

Malocclusion
elongated face
epistaxis
peri-orbital deformity
facial ecchymosis
rhinorrhea (clear CSF)
infra-orbital paresthesia
palpate: increased mobility/crepitus

Question 10

What is the treatment of maxillary fractures?

Answer 10

airway maintenance
bleeding control
ice application
refer to hospital

Question 11

List the zygomatic arch fracture s/s.

Answer 11

lateral cheek flatness
unilateral epistaxis: maxillary sinus bleed
anesthesia of cheek
deformity of nose/ upper lip
diplopia (double vision)
trismus (spasm of masseters)

Question 12

What are the eval and tx steps of zygomatic arch fx?

Answer 12

eval: head injury ax, palpate for deformity, sensation

tx: ice pack locally/gently
patch both eyes, transport supine
hospital for xray/ reduction
edema may delay correction

Question 13

List the characteristics of nasal injuries.

Answer 13

most common facial bone fracture
prominent/weak structure
function: respiration/olfactory/filtering
physical exam more value than x-ray, should x-ray to R/O max/facial bones
bleed profusely

Question 14

List the s/s of nasal fractures.

Answer 14

epistaxis, crepitus, pain on palpation
deformity, deviation, depression
swelling, laceration possible, decreased smell
ecchymosis (next day)
septal hematoma

Question 15

what is the treatment for nasal fx?

Answer 15

control bleeding
patient never supine
airway concerns
do not blow nose
cosmetic important reduce within 5 days
usually some aesthetic effect

Question 16

What is a permanent deformity of the ear?

Answer 16

cauliflower ear

Question 17

what is the treatment for auricular hematomas?

Answer 17

ice locally
sterile needle aspiration followed by compression 3-5 days
tight pressure dressing and contouring mold made with flexible collodian and gauze
drain re-accumulations
ear protectors for 4-6 weeks

Question 18

What are the s/s of tympanic membrane rupture?

Answer 18

severe pain, muffled hearing, bleeding, tinnitus, vertigo

Question 19

What are the steps to an eye examination?

Answer 19

open the eye, look for foreign body
observe: intra-ocular swelling
inspect: conjunctiva, sclera, pupil, iris
palpate: orbital rim
check: PERRLA
movement
visual acuity

Question 20

What are the different types of eye injuries?

Answer 20

lids
cornea and conjunctiva
anterior chamber
lens
vitreous
retina
orbit

Question 21

What kinds of lacerations require expert care?

Answer 21

lacerations involving lid margins and/or naso-lacrimal apparatus

Question 22

What is subconjunctival hemorrhage?

Answer 22

bleeding under the conjunctiva
often spontaneous
asymptomatic: no pain or change in vision
no treatment required, clears spontaneously
may return to play if cleared

Question 23

What is hyphema?

Answer 23

bleeding in anterior chamber (most common injury in sport)
MOI: blunt trauma to eye

Question 24

What are the s/s of hyphema and what is its treatment?

Answer 24

s/s: blurred vision
loss of field of vision
may see loss of iris detail
rarely see a blood fluid level
clears spontaneously may rebleed day 4-6

tx: immediate non-urgent referral for tx and meds

Question 25

List the MOI, S/S and Tx of iris injuries.

Answer 25

MOI: usually blunt trauma S/S: light sensitivity, double vision, irregular pupil Tx: immediate referral to ophthalmologist

Question 26

List the MOI, S/S and Tx of lens trauma.

Answer 26

MOI: usually blunt trauma Lens can dislocate lens can opacify (cataract) S/s: blurred vision, double vision, darkening of vision Tx: immediate referral to ophthalmologist

Question 27

List the MOI, S/S and Tx of conjunctival foreign body .

Answer 27

description: dirt or other extraneous material on conjunctival membrane s/s: foreign body sensation first response: rinse eye with sterile water, evert lid and use wet Q-tip if necessary May RTP if fully cleared

Question 28

List the MOI, S/S and Tx of corneal foreign body.

Answer 28

Corneal foreign body material embedded in clear window of eye s/s: reduced visual acuity, foreign body sensation, photophobic first response: immediate referral to ophthalmologist for surgical removal

Question 29

List the MOI, S/S and Tx of corneal abrasion.

Answer 29

scratch, scrape, erosion of clear window s/s: decreased visual acuity, foreign body sensation, photophobia heals in 24-48h with patch and/or drugs tx: irrigate with sterile saline solution patch eye refer for ophthalmic exam

Question 30

List the MOI, S/S and Tx of corneal laceration.

Answer 30

MOI: blunt or sharp or trauma, previous laser eye surgery increases risks S/S: decrease vision, increased light sensitivity, irregular pupil tx: urgent referral to opth

Question 31

List the MOI, S/S and Tx of vitreous hemorrhage.

Answer 31

Bleeding into the vitreous jelly in the posterior chamber of the eye MOI: blunt or sharp trauma S/S: decreased vision, floaters Tx: immediate referral to ophthalmologist resolves spontaneously (may take weeks)

Question 32

List the MOI, S/S and Tx of detached retina.

Answer 32

separation of very thin retina from underlying structures, usually painless More common with athletes with myopia S/S: flashing lights, floaters, blurred vision, visual field defect, as detachment progress ==> curtain is falling Tx: True ocular emergency, immediate referral

Question 33

List the MOI, S/S and Tx of macular injury.

Answer 33

macula is central part of retina, required for central vision acuity MOI: blunt trauma S/S: blurred central vision Tx: immediate referral to ophthalmologist damage to vision often permanent due to scarring

Question 34

List the MOI, S/S and Tx of orbital blowout fracture.

Answer 34

fracture of thin bones of orbit MOI: blunt trauma s/s: double vision, orbital bruising/air bubbles, numbness below eye Tx: immediate referral, may require surgery

Question 35

What is the treatment for an extruded eye?

Answer 35

tx associated injuries first control bleeding, calm patient wet saline notched dressing below/above cover with notched cup with loose padding inside secure cup with transpore tape cover both eyes, TLC transport supine

Question 36

What symptoms prevent an athlete from RTP?

Answer 36

visual blurring double vision flashers or floaters Light sensitivity abnormal penlight exam Problems with: lid margin, pupil changes, loss of iris detail, abnormal extra-ocular movements

Question 37

When is it a 911 versus an urgent referral to the ophthalmologist?

Answer 37

911: ruptured globe/ embedded sharp object, associated injuries urgent referral: visual field loss with flashers/floaters, visual acuity loss, photophobia, diploplia

Question 38

How many teeth do we have?

Answer 38

32, 8 per quadrants ==> 2 incisors, 1 canine, 2 premolars, 3 molars

Question 39

What are the three layers of teeth?

Answer 39

enamel: hard outer layer cementum: coats root surface, attaches tooth to periodontal lig of socket dentin: forms bulk of tooth/walls for pulp pulp chamber: space in middle contains nerve, blood for tooth viability

Question 40

What are the 4 types of tooth luxations?

Answer 40

concussion: no breakage, loosening or displacement subluxation: mobile but undisplaced luxation: displacement of tooth, blood supply fully compromised avulsion: tooth is out of socket

Question 41

How can you tell if its an alveolar fracture versus a tooth luxation?

Answer 41

alveolar fractures will show mobility for a group of teeth no tooth independently mobile

Question 42

What is one of the best ways to protect teeth?

Answer 42

wearing a mouth guard

Question 43

What is the management of a crown fracture?

Answer 43

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

Question 44

What is the management of a tooth avulsion?

Answer 44

replace tooth in socket ASAP (within 3 min) rinse debris off tooth, don't scrub tooth handle tooth by crown, not root clean a blood clot out of socket with light gentle irrigation if can't be re-implanted immediately, store tooth in appropriate medium, (egg white, coconut water, milk) don't let tooth dry out don't re-implant a baby tooth