Maxillofacial Trauma

August 19, 2010Jay Green

Colin Del Castilho

• Intro• Soft tissue injuries– Case work– Case discussion– Regional anesthesia

• Bone/joint injuries– Case work– Case discussion

Intro stuff

Soft tissue injury cases

Case 1

48y male, intoxicatedFell striking cheek on the barLaceration to anterior cheekThrough-and-through

Case 2

18y hockey player“Too good” to wear a face maskHigh stick to the faceUpper lip lacerationCrosses vermillion borderInvolves muscular layer

Infraorbital nerve block

Case 3

25y female MVC, ejectedIntubated by STARS on sceneSwelling facial and periorbitalExtensive abrasions to forehead with

gravel/glass in wound

Ophthalmic (V1) nerve block

Case 4

It’s June 28, 199735y male boxerLac to right ear during fightThrough cartilageClaims he was bittenOpponent says it was a punch

Ear field block

Case 5

12y femaleSkateboarding for the first timeFellCaught tongue between teethTongue laceration

Indications for tongue laceration repair (controversial)

MidlineNeed hemostasisLarge flap (>1cm or gaping)Avulsion/amputationNonlinear laceration or U-shaped

emedicine, EM Clinics of North America, Roberts & Hedges, Rosen

Inferior alveolar/lingual nerve block

Soft Tissue Injuries

Questions?

Additional questions

Q) What are indications for abx in facial traumaBite woundDevascularized tissueThrough-and-through buccal mucosaCartilage involvement (nose/ear)Extensive contaminationOpen ## into sinus# with CSF leak

Additional questions

Q) What is appropriate mgmt of pediatric peri-oral electrical burns? What is the concern here?Can result in severe cosmetic issues and microstomiaTrivial looking initial wound may progress over days5-21 days post-burn get eschar separation and can have lift-threatening labial artery bleedingNEED TO D/W plastics in the ED!

Can d/c home with close watching and F/U ENT/plastics if not extensive initiallyOptions: early surgery, oral splinting, delayed surgery

Additional questions

Q) Management of subperichondral hematoma?Risk factor for cauliflower earNeeds needle aspirationCompressive dressingR/A in 24hrs to ensure hematoma has not re-accumulated

Additional questions

Q) Describe appropriate ED management of eyelid lacerations.Superficial lacs can be repaired with 6-0 EthilonLid margin, canalicular, lacrimal involvement need ophtho/plastics

Quick break

Case 6

It’s 0100Dude and his girlfriend come inShe was “yawning” and mouth got stuck open

Case 7

16y maleTough guyPunched in the noseSwelling to nasal bridgeCrooked nose? Hard to tell…

Case 8

22y femaleSquash playerHit in eye by ballDiplopia on up-gazeCT shows orbital floor blowout # without

entrapment of EOM

Case 9

Same polytrauma as Case 3Still intubated Bleeding into oropharynx & nasopharynx from ?You think her face is mobile

Case 10

35y female, fell down stairsTeeth don’t fit rightNeck pain, no c-spine #No other injuries

Bone/Joint Injuries

Questions?