19 - facial trauma

8/13/2019 19 - Facial Trauma

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Facial trauma


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Facial trauma

Facial trauma is any injury of the face and upper

jaw bone (maxilla).

facial trauma can involve soft tissue injuries

such as: burns, lacerations , bruises .

Or can lead to bone fracture such as nasalfracture and fracture of the jaw .


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Facial injuries have the potential to cause

disfigurement and loss of function; for example,

blindness or difficulty moving the jaw can result

Although it is seldom life-threatening, facial

trauma can also be deadly, because it can cause

severe bleeding or interference with the airway;

thus a primary concern in treatment is ensuringthat the airway is open and not threatened so

that the patient can breathe
http://en.wikipedia.org/wiki/Airwayhttp://en.wikipedia.org/wiki/Airway


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causes

Blunt or penetrating trauma can cause injury to

the area of the face that includes the upper

jaw (maxilla). Common causes of injury to the

face include:

Automobile accidents

Penetrating injuries

Violence


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Signs and symptoms

Changes in sensation and feeling over the face

Deformed or uneven face or facial bones

Difficulty breathing through the nose due toswelling and bleeding

Double vision

Missing teeth Swelling around the eyes that may cause

vision problems


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Signs and symptoms

Fractures of facial bones, like other fractures,may be associated with pain, bruising, andswelling of the surrounding tissues

Nasal fractures may be associated withdeformity of the nose, as well as swelling andbruising

People with mandibular fractures often havepain and difficulty opening their mouths andmay have numbness in the lip and chin


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Physical exam

The doctor will perform a physical exam, which

may show:

Bleeding from the nose, eyes, or mouth, or

nasal blockage

Breaks in the skin (lacerations)

Bruising around the eyes or widening of thedistance between the eyes, which may mean

injury to the bones between the eye sockets


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Physical exam

The following may suggest bone fractures:

Abnormal sensations on the cheek and

irregularities that can be felt

An upper jaw that moves when the head is

still


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Exam and tests

X ray is used to rule out facial fractures.

Angiography can be used to locate the source

of bleeding .

CT scanning is better for detecting fractures

and examining soft tissues, and is often

needed to determine whether surgery is

necessary.


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Prevention

seat belt use and public education to increaseawareness about the importance of seat belts.

airbags alone are not very effective at

preventing the injuries. In sports, safety devices including helmets

have been found to reduce the risk of severe

facial injury. Avoid violent confrontations with other

people.


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Treatment

The goal of treatment is to:

Control bleeding

Create a clear airway

Fix broken bone segments with titaniumplates and screws

Leave the fewest scars possible

Rule out other injuries

Treat the fracture


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Treatment

Treatment should be immediate, as long as theperson is stable and there are no neck fracturesor life-threatening injuries.

Tracheal intubationmay be difficult or impossibledue to swelling.

Nasal intubation(endotracheal tube ) may becontraindicated in the presence of facial trauma

because if there is an undiscovered fracture atthe base of the skull, the tube could be forcedthrough it and into the brain.
http://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheal_intubation


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Treatment

Patients who cannot function normally or who

have significant deformity will need surgery.

A dressing can be placed over wounds to keep

them clean and to facilitate healing, and

antibioticsmay be used in cases where

infection is likely
http://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Antibiotic


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Prognosis

Patients generally do very well with proper

treatment.

however it is often associated with dangerous

injuries, and life-threatening complications

such as blockage of the airway may occur.

they have the potential to cause disfigurement

and disability.


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Complications

Nerves and muscles may be trapped by brokenbones (in these cases the bones need to be putback into their proper places quickly).

Bleeding

Uneven face (asymmetry)

Infection

Brain and nervous system (neurologic)complications

Numbness or weakness


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Frontal sinus fracture

Frontal sinus: Both the anterior and posterior wallmay be damaged. Because the posterior wall isadjacent to the dura mater, damage in this region

could result in central nervous system (CNS)complications such as a cerebrospinal fluid (CSF)leak or meningitis

This injury results from a severe blow to the frontal or

supraorbital region, which can result in fracture of theanterior and/or posterior wall.

The patient may report numbness in the distributionof the supraorbital nerve.


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Nasal fractures

Nasal bone fractures are the most common of allfacial fractures. The upper third of the nose issupported by the paired nasal bones and thefrontal process of the maxilla, whereas the lower

two thirds of the nose are maintained bycartilaginous structures.A more serious injury, anasoorbitoethmoid fracture, occurs with traumato the bridge of the nose. This injury involves

extension into the frontal and maxillary bonesand can result in disruption of the cribriformplate with concomitant CSF rhinorrhea.
http://www.medscape.com/resource/traumahttp://www.medscape.com/resource/traumahttp://www.medscape.com/resource/trauma


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Nasal fractures

Evidence of a nasal fracture includes epistaxis,

swelling, tenderness, deformity, crepitus, nasal

airway obstruction, and periorbital ecchymosis.

Always evaluate for septal deviation or septalhematoma. A bulging, bluish, tender septal mass

requires evacuation. Failure to do so can result in

necrosis of the nasal septum. Widening of the

intercanthal distance suggests the possibility of anasoorbitoethmoid fracture.


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Thank you

Done by:Qais samara

19 - facial trauma

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