Maxillofacial Trauma August 19, 2010 Jay Green Colin Del Castilho.
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Transcript of Maxillofacial Trauma August 19, 2010 Jay Green Colin Del Castilho.
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?