FACIAL FRACTURESIMMEDIATE ASSESSMENT

VITALS SIGNSRESPIRATORY RATEPULSEBLOOD PRESSURENEUROLOGICAL STATUSAIRWAY (BILATERAL/COMMINUTED Man. FRAC)EXCESSIVE BLEEDING

HISTORYHOW DID THE ACCIDENT OCCUR?WHEN DID IT OCCUR?SPECIFICS OF INJURY (TYPE OF OBJECT CONTACTED, DIRECTION?)LOSS OF CONSCIOUSNESS?SYMPTOMS BEING EXPERIENCED (PAIN, ALTERED SENSATION, VISUAL CHANGES, MALOCCLUSION)POLICE INVOLVEMENTMEDICAL HISTORY (TETANUS IMMUNIZATION?)DRUG HISTORYALLERGIESMEDICATIONSSOCIAL HISTORY

PHYSICAL EXAMINATIONLACERATIONSABRASIONSCONTUSIONSBRUISINGSWELLINGEDEMAHAEMATOMAECCHYMOSIS

1) Periorbital ecchyosis +/- subconjuctival hemorhage = Orbital Rim or Zygomatic complex fractures

2) Bruises behind ears (Battle’s sign) = Basilar skull fracture

3) Ecchymosis in the floor of the mouth = Ant. Mand. Fr

NEUROLOGICAL EXAMINATION

-Vision (Hess Chart)-Extra Ocular movements-PERLA

-Visual acuity or papillary changes may suggest CN2, CN3 dysfunction or direct orbital trauma.-Uneven pupils in a lethargic pt indicate intracranial bleed.-Assymetic pupil= globe perforated-Abnormal ocular movements = CN3,CN4,CN6 or mechanical obst.

Motor Function of Facial Muscles/ Sensation (CN 7)Motor Function of Muscles of Mast (CN 5)

-Palpation-bimanual palpation of suspected areaOcclusionStep deformaties (occlusal plane)Gingival tearingTooth mobilityAnterior open bite (Bilateral Fr)

Pain on opening against resistance (If not= no Fr)TrismusMAXILLATrismus and restricted lateral excursionBruising in Buccal sulcusEpistaxisEye Movement, PEARL, Visual Acuity, Diplopia, Enophthalmous, HypoglobusPalpation- One hand on forehead/Nose, with the other hand’s thumb and forefinger grasp maxilla and check for mobility. Tenderness in the buccal sulcus superolaterally?Step deformities- forehead, orbital rim, zygoma and nasal areas.

RADIOGRAPHSMANDIBLEPA MANDIBLEOPTREVERSE TOWNE/ Mod Towne (Condylar frac)LOWER OCCLUSAL (Parasymphyseal frac)Lateral Oblique (Body/ Ramus frac)MAXILLAOM 0, 30CT

CLASSIFICATIONMANDIBLECoronoid, Condyle, Ramus, Angle, Body, Symphysis, AlveolarGreenstick, Simple, Comminuted, Compound (Open)Favourable, UnfavourableMAXILLALe fort 1,2,3, ZAF, ZMC, NOE

MANDIBLE MAXILLACondyle/Undisplaced Liquid Diet, Advice, Ab +/-,

Review Nxt DayBook Patient in the next trauma clinic or organize a review next day

Advise on no Nose blowing/ Retrobulbar

Prescribe Analgesia and Antibiotics if open

Signs of Retrobulbar haemorrhage

1. Pain2. Proptosis3. Perception4. Paralysis5. Pupils

6. CLERKING SHEET7. CONSENT (ORIF)8. MED CHART

IV Abs*AnalgesiaCorsodyl (10ml tds)

PostOpCyclizine 50mg PO/IM PRNOromorph 10mg/5ml PO PRN

10. TTH FORM11. BLOODS FBC

U&ECoAg

PurpleYellowBlue

12. RADIOGRAPHS13. ECG

CALL BED MANAGER (B-505)PUT ON E-LIST (Call Theatre)Let anaesthetist know (B-124)KEEP NBM +/- Fluid regimeCALL 2nd On call

*Coamoxiclav 1.2g IV TDS OR Clarithromycin 250 mg IV BD (IP/TTH for Open Mand. Fractures)

*Coamoxiclav 1.2g IV OR Clarithromycin 250mg IV on TABLE (IP for Zygoma Fractures)