Maxillofacial Trauma - Recognition, initial management and referral pathways

Question 1

How do we pre assess a maxfax trauma case?

Answer 1

ATLS principles:

A (airway + C-spine control)

B (Breathing)

C (circulation + haemorrhage control)

D (Disability (GCS - are they injured?)

Question 2

what clinical signs would make you suspect a mandible fracture?

Answer 2

• 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 nerve

Question 3

how many/what x - rays are needed to assess mandible fracture?

Answer 3

2 X-rays, 1 OPG and 1 back of head

Question 4

Principles of treatment for mandible fracture?

Answer 4

• fast
• analgesia
• antibiotics for open fractures (through dentate mandible or mucosal breach) - amoxicillin/metronidazole
• liquid diet
• immediate discussion with OMFS team

Question 5

what clinical signs would make you suspect a mid-face fracture?

Answer 5

• Epistaxis without a blow to the nose (epistaxis = stupid fucking word for nosebleed)
• V2 numbness without a direct blow to the nerve
• subconjunctival bleed
• midface mobility
• malocclusion,
• surgical emphysema around eye
• swelling after nose blowing
• diplopia

change of appearance

(2 x-rays needed)

Question 6

what are the most common patterns of mid face fracture known as?

Answer 6

Le Fort fractures - types I, II and III

Question 7

treatment/instructions for zygoma fracture

Answer 7

• no indication for routine antibiotics
• call OMFS (follow up usually 7-10days)
• no nose blowing
• soft diet for comfort (master pull)
• warn about retrobulbar bleed

Question 8

emergency treatment/instructions for orbital fracture?

Answer 8

• Ensure VA and diplopia documented
• discuss with OMFS
• don’t bother citing - omfs can arrange if needed
• most suitable for outpatient (not all)
• no need for routine ABS
• no nose blowing
• give warnings RE retrobulbar bleed

Question 9

ATLS = advanced trauma life support

Question 10

how to differentiate le fort fractures (clinically)

Answer 10

type 1 - grab skull (top jaw, palate) and just teeth move

type 2 - same but teeth and nose

type 3 - same but teeth nose and eyes all move