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Maxillofacial Trauma

Maxillofacial Trauma. August 19, 2010 Jay 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, intoxicated

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Maxillofacial Trauma

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  1. Maxillofacial Trauma August 19, 2010 Jay Green Colin Del Castilho

  2. Intro • Soft tissue injuries • Case work • Case discussion • Regional anesthesia • Bone/joint injuries • Case work • Case discussion

  3. Intro stuff

  4. Soft tissue injury cases

  5. Case 1 48y male, intoxicated Fell striking cheek on the bar Laceration to anterior cheek Through-and-through

  6. Case 2 18y hockey player “Too good” to wear a face mask High stick to the face Upper lip laceration Crosses vermillion border Involves muscular layer

  7. Infraorbital nerve block

  8. Case 3 25y female MVC, ejected Intubated by STARS on scene Swelling facial and periorbital Extensive abrasions to forehead with gravel/glass in wound

  9. Ophthalmic (V1) nerve block

  10. Case 4 It’s June 28, 1997 35y male boxer Lac to right ear during fight Through cartilage Claims he was bitten Opponent says it was a punch

  11. Ear field block

  12. Case 5 12y female Skateboarding for the first time Fell Caught tongue between teeth Tongue laceration

  13. Indications for tongue laceration repair (controversial) Midline Need hemostasis Large flap (>1cm or gaping) Avulsion/amputation Nonlinear laceration or U-shaped emedicine, EM Clinics of North America, Roberts & Hedges, Rosen

  14. Inferior alveolar/lingual nerve block

  15. Soft Tissue Injuries Questions?

  16. Additional questions Q) What are indications for abx in facial trauma Bite wound Devascularizedtissue Through-and-through buccal mucosa Cartilage involvement (nose/ear) Extensive contamination Open # # into sinus # with CSF leak

  17. 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 microstomia Trivial looking initial wound may progress over days 5-21 days post-burn get eschar separation and can have lift-threatening labial artery bleeding NEED TO D/W plastics in the ED! Can d/c home with close watching and F/U ENT/plastics if not extensive initially Options: early surgery, oral splinting, delayed surgery

  18. Additional questions Q) Management of subperichondral hematoma? Risk factor for cauliflower ear Needs needle aspiration Compressive dressing R/A in 24hrs to ensure hematoma has not re-accumulated

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

  20. Quick break

  21. Case 6 It’s 0100 Dude and his girlfriend come in She was “yawning” and mouth got stuck open

  22. Case 7 16y male Tough guy Punched in the nose Swelling to nasal bridge Crooked nose? Hard to tell…

  23. Case 8 22y female Squash player Hit in eye by ball Diplopia on up-gaze CT shows orbital floor blowout # without entrapment of EOM

  24. Case 9 Same polytrauma as Case 3 Still intubated Bleeding into oropharynx & nasopharynx from ? You think her face is mobile

  25. Case 10 35y female, fell down stairs Teeth don’t fit right Neck pain, no c-spine # No other injuries

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