FACIAL TRAUMA, ORAL TRAUMA, READING FACIAL X-RAYSA POWERPOINT PRESENTATION BY THE CASUALTY CREW, MADADENI HOSPITALINTENDED FOR INTERNS AND JUNIOR MO’S COVERING CASUALTY

POTENTIAL SCENARIOS

MVA’S, PVA’S,

FIGHTS, WITH WEAPONS AND WITHOUT

BURGLARIES, MUGGINGS

FALLS, TRIPS AND SLIPS

DOMESTIC VIOLENCE

NASAL INJURIES

NASAL DEFORMITIES ARE SOMETIMES EASILY OBVIOUS

DONT FORGET TO EXCLUDE INJURIES IN THE SURROUNDING TISSUE

YOU DON’T NEED TO REDUCE IN CASUALTY, CAN BE DONE WHEN SWELLING REDUCES

SEVERE EPISTAXIS MAY REQUIRE THEATRE BUT NASAL PACKING USUALLY IS ENOUGH

A SEPTAL HAEMATOMA IS A RARE COMPLICATION

IF LEFT UNTREATED IT WILL CAUSE A SADDLE NOSE DEFORMITY

IDEALLY IT SHOULD BE INCISED AND PACKED THEREAFTER

COMPLEX INJURIES WITH FRACTURES SHOULD BE PACKED OR TAGGED AND REPAIRED BY MAX-FAC OR SURGICAL TEAMS DONT FORGET ASSOCIATED INJURIES

WE CANT FIX EVERYTHING

NON-DISPLACED NASAL

FRACTURE

NORMAL NASAL XRAY

NORMAL FACIAL OCCIPITO-MENTAL VIEW

NORMAL OM 30 VIEW

ZYGOMA FRACTURE

ZYGOMA CONSISTS OF THE ARCH AND BODY

ARCH CONSISTS OF LATERAL AND INFERIOR ORBIT

BODY IS MALAR EMINENCE

TRIPOD IS # FRONTOZYGOMATIC SUTURE,MAXILLARY PROCESS INFERIOR ORBITAL FLOOR, INFERIOR ORBITAL RIM, LAT WALL OF MAXILLARY SINUS, TEMPEROZYGOMATIC SUTURE

TRIPOD FRACTURE

FIND THE FRACTURE/S

INFERIOR ORBITAL RIM

FONTOZYGO- MATIC

TEMPEROZYGOMATIC

ZYGOMATIC BODY/ MAXILLARY SINUS

LETS TRY ONE MOREWHATS THAT AT THE TOP OF THE RIGHT ORBIT?WHATS THAT IN THE RIGHT MAXILLARY SINUS?

A TEAR DROP MEANS ORBITAL CONTENTS HAVE LEAKED INTO THE MAXILLARY SINUS, THE AIR-FLUID LEVEL MAY OCCUR IN ISOLATION THESE PATIENTS NEED ADMISSION FOR MAX-FAC

ORBITAL EMPHYSEMA MEANS THERE IS A FRACTURE EVEN IF YOU CANT SEE IT

ORBITAL EMPHYSEMA

TEAR DROP SIGN +

AIR-FLUID LEVEL IN MAXILLARY SINUS

INFERIOR RECTUS ENTRAPMENT

INFERIOR RIM # WITH TEAR

DROP CT

ORBITAL EMPHYSEMA

MEDIAL WALL

FRACTURE

LE FORT FRACTURES

TYPE 1- UNDER NASAL FOSSA

TYPE 2- THE PYRAMID

TYPE 3- MIDFACE DISLOCATION

MAINLY DX ON CT

MOVEMENT OF FACIAL BONES SHOULD CREATE SUSPICION

DISH FACE WITH TYPE 3

THE MANDIBLEONE OF THE MOST COMMON FRACTURES WE SEE

FIND THE FRACTUREWHAT DO YOU CHECK NEXT?

IS IT OPEN OR CLOSED

THIS IS AN OPEN #

CHANGES THE MANAGEMENT

CLOSED CAN BE TREATED AS AN OUTPATIENT

OPEN REQUIRES ADMISSION AND ANTIBIOTIC COVER

SUBLINGUAL HAEMORRHAGE IS PATHOGNOMIC OF MANDIBLE# NORMAL MANDIBLE CAN BITE A TONGUE DEPRESSOR UNTIL YOU CAN BREAK IT OFF ROTATION OF TONGUE ALONG THE MOLARS SHOULDN’T CAUSE PAIN

FOLLOW/ TRACE THE OUTLINE OF THE MANDIBLE

WHERE’S THE FRACTURE

MUCH EASIER WHEN YOU REMEMBER TO CHECK THE

WHOLE XRAY

FIND THE FRACTUREHOW MANY FRACTURES ARE THERE?

FIND THE FRACTURE/S

THE LAST SLIDE I PROMISEIF YOU SEE THIS DONT TOUCH IT, DO X-RAYS AND A CT, IDEALLY THE PT SHOULD BE TRANSFERRED TO A CENTRE WITH MULTIPLE SUBSPECIALTY CARE AS THERE IS PROBABLY INJURY TO MULTIPLE SYSTEMS (BONE, NERVE , BLOOD VESSELS, BRAIN, EYE,PHARYNX,ETC)