Case Presentation

1. Case Presentation Shiraaz Shaikjee 08 April 2008

2. 41 yr old male • High speed MVA – 100 km/hr • Head on collision with a pedestrian • Restrained and airbag deployed • On scene – altered LOC, hypotensive and tachycardic. • Injuries – facial injuries, rib # L, L femur #

3. Emergency management • Splint #, decompress r chest, sedate and intubate • Significant disruption of the facial bones • Lots of blood in oropharynx and nose • Packaged and taken to hospital

4. Facial Fractures • Approach – clinical assessment standpoint • Look out for orbital blowout #’s • Search for Leforte #’s • Not to forget mandibular #’s • NB, start at one point and work systematically or in an orderly fashion

5. LOOK • Swelling and deformity • Raccoon eyes/ Battles sign • Nasal #’s • Csf leaks • Lacerations • Always have a high index of suspicion for a c-spine injury in pts with significant head and facial trauma

6. PALPATE • Skull and forehead • Orbits • Nasal bones • Maxilla and Zygoma • Mandible • Instability, depression, crepitus, fracture

7. FRONTAL BONE # • Direct force • Intracranial injury because of damage to the posterior table of the sinus • Dural tears associated wih orbital roof #’s ------ lead to blindness • Clnically: disruption/crepitus of supraorbital rim or subcut emphysema

8. Eye - Orbit • Open eye – paper clip • Cheimosis • Pupil, globe penetration, corneal laceration • Hyphema, subconjunctival hemorrhage • Full 360˚ of the orbit • BLOW OUT #

9. Blowout # • 2 mechanisms • 4 clinical finding • Enopthalmous • Infraorbital anaesthesia • Diplopia • Step off deformity + subcut emphysema – pathognomonic Xray hanging tear drop sign

10. Blow out #

11. NASAL BONES • Palpate for obvious #’s • Biggest problem being that of hemorrhage • Rich blood supply – Littles area • May need packing – BOS

12. MID FACE • Palpate maxilla and zygoma • Hemorrhage • Le forte #’s

13. Le Forte #’s I/II/III

15. What are the #’s???

16. Mandibular #’s

17. Mandibular #’s

18. Thank You