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Trauma
Andi Siswandi, MD
Surgeon
Malahayati University, Medicine Faculty
in community EDs
Midface and zygomatic injuries most common
in Trauma centers
25% of women with facial trauma result of
domestic violence
Incidence of concomitant cervical spine
injuries with facial fractures
Maxillofacial Trauma
Intubation
Avoid nasotracheal intubation
May not want RSI
Benzodiazepines
Ketamine
Etomidate
Be Prepared and Be Creative
Palpation
Tenderness
Step offs
Facial stability
Crepitus
Subcutaneous air
Cutaneous anesthesia
Orbital Exam
Perform early
Professional Lid
Retractor
Maxillofacial TraumaImaging
Head, chest and abdominal trauma takes
precedence
PE detects up to 90% of fractures
Plain Films
CT
Orbital fractures
3D images available
Maxillofacial Trauma-Specific
Fractures
Frontal Sinus/Bone Fractures
Direct blow
Frequent intracranial injuries
Mucopyoceles
Consult with NS for treatment, disposition and
antibiotics
Nasoethmoidal-Orbital Injuries
Lacrimal apparatus disruption
Bimanual palpation if medial canthus pain
CT face
Maxillofacial Trauma-Specific
Fractures
Orbital Fractures
Usually through
floor or medial wall
Enophthalmos
Anesthesia
Diplopia
Infraorbital stepoff
deformity
Subcutaneous
emphysema
Maxillofacial Trauma-Specific
Fractures
Orbital Fissure Syndrome
Fracture of the orbital canal
Extraocular motor palsies and blindness
If significant retrobulbar hemorrhage, may
need cantholysis to save vision
Zygomatic Fractures
Tripod fracture
Most serious
Arch fracture
Lateral subconjunctival hemorrhage
Most common
Need ORIF
Outpatient repair
Tripod Fracture
Maxillofacial Trauma-Specific
Fractures
Maxillary Fractures
High-energy injury
100x gravity
Malocclusion
Facial lengthening
CSF rhinorrhea
Periorbital ecchymosis
LeFort Fractures
fracture
Often multiple
Plain films
Malocclusion
Panorex
Intraoral lacerations CT
Sublingual ecchymosis
Nerve injury
Open Fractures
Pen
G or Cleocin
Body
30-40 %
Angle
25-30 %
Condyle
15-17 %
Symphysis
7-15 %
Ramus
3-9 %
Alveolar
2-4 %
Coronoid
Process
1-2 %
Lecture Questions
1. What portion of the mandible is most
commonly fractured?
Ramus
b. Coronoid process
c. Body
d. Angle
e. Symphysis
a.
except:
Blindness
b. Motor palsies
c. Facial anesthesia
d. Enophthalmos
e. Hyphema
a.
maxillary fractures?
Only minimal force necessary
b. Rarely cause CSF rhinorrhea
c. May cause facial lengthening
d. Usually the only sustained injury
e. All of the above are true
a.
or facial fractures is
Plain films
b. MRI
c. CT
d. Ultrasound
e. Osteopathic palpation
a.
THANK YOU