TRAUMA YELLOW
  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map

Facial Trauma Assessment

10/12/2016

0 Comments

 
Adapted from Dr. Calabrese's October 12th Grand Rounds presentation.
Picture
Evaluation of every facial trauma patient should include a complete facial assessment
  • Do you have numbness in your face? 
    • Lower lip/chin (mental n)
    • Cheek, upper lip, nose
    • Lower lid, cheek
  • What part of your face hurts?
  • Do your teeth fit normally? 
    • Alveolar ridge fractures vs. mandibular fractures
  • Does it hurt to open your mouth?
    • Zygomatic or high mandibular fractures
  • Does your neck hurt?
  • Complete evaluation of pupils and extra-ocular movements. 

Evaluation of the patient with Facial Trauma

Patients presenting with facial trauma have several immediate concerns
  • Evaluation of the airway
  • Bleeding into the airway
  • Unstable Facial fractures
  • Brain and cervical injuries

Agitation can be due to pain, intoxication, or air hunger/airway compromise. It is important to not only recognize agitation but attempt to identify the cause. 

Your secondary survey must evaluate for skull and facial fractures, neurological injuries, and insidious airway injuries. 
  • Battle Sign or Raccoon Eyes
  • Unstable midface (Lefort Fractures)
  • Extraoccular muscles and orbital trauma
  • Mandibular fractures/dental alignment
  • Crepitus
  • Injuries hidden by a cervical collar

Orbital Injury & Entrapment

Evaluation of orbital fractures is important to identify entrapment of the extra-ocular muscles. Patients who have extra-ocular muscles require emergent ophthalmology consults if they have afferent pupilary defects or increased pressure, concerning for retrobulbar hematomas or nerve impact. A very subtle orbital floor fracture may present as a slight difference in the level of the pupils. 

Lateral Canthotomy Indications

Suspected acute orbital compartment syndrome (OCS), plus one or more of the following:
  • Decreased visual acuity
  • IOP >40 or marked difference in globe compressibility by palpation
  • Proptosis
​Secondary indications (subjective and nonspecific) - if only secondary indications are present, get emergent ophthalmology consult prior to performing canthotomy.
  • Afferent pupillary defect
  • Cherry red macula
  • Ophthalmoplegia
  • Nerve head pallor
  • Significant eye pain

Nasal Injury

Evaluate all your facial trauma patients for septal hematomas, nasal fractures and dislocations, and telecanthis (flattening of the nasal bridge). Telecanthis can indicate a higher potential for CSF leakage, and these patients will require further monitoring. 

​Septal Hematomas can lead to; 
  • Infection
  • Erosion or necrosis of the septum causing Saddle Nose deformity
  • Septal perforation

Mandibular Injury

Evaluate not only the external mandible, but also the oral floor to evaluate for hematoma or expanding mass. Mandibular fractures can lead to airway compromise by deformation of the airway or tongue displacement. 

Lefort Fractures

Picture
Patients with an initial evaluation concerning for a 'flattened' appearance to the face or significant trauma should have a higher suspicion of maxillary fractures leading to one of three Lefort fractures. 
0 Comments



Leave a Reply.

    Categories

     

    All
    Abx
    Article
    Cardiac
    EKG
    EKG Challenge
    GI Bleed
    Grand Rounds
    Headache
    ICU
    Orthopedic
    Pain
    Peds
    Reading
    Stroke
    Subarachnoid Hemorrhage
    Syncope
    Teaching Pearl
    Trauma
    Travel
    Zika

    Archive

     

    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    January 2016
    December 2015
    November 2015

    Picture
    Please read our Terms of Use.
Donate
This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

​Please refer to our Terms of Use. 
  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map