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Maxillofacial injury (Overview (Diagnosis (Investigations (Bedside Obs:…

- - - - Bedside
        Obs: sats, RR, HR, BP, temp
        ECG
      - Bloods
        Crossmatch/G&S, FBC, CRP, U+E, LFTs
      - Imaging
        X-rays (C-spine, head [occipomental, lateral, orthopantomogram)
        CT head
- - - - History
        Mechanism of injury
      - Examination
        Facial exam: surgical emphysema
        CN exam: diplopia (inferior rectus), reduced acuity
        Fundoscopy: hyphaema, retinal detachement, glaucoma, blindness
      - Investigations
        Bedside: obs, ECG
        Bloods: crossmatch, G&S, FBC, U+Es
        Imaging: X-ray head (may see visible fracture, 'tear drop' sign in maxilla due to soft tissue swelling, surgical emphysema)
  - - - Examination
        Facial: supraorbital swelling, tenderness, crepitus
        CN exam: supraorbital nerve anasthesia
      - Investigations
        Bedside: obs, ECG
        Bloods: crossmatch, G&S, FBC,, U+Es
        Imaging: X-ray head, CT head
      - History
        Mechanism of injury
  - - - Examination
        Facial: palpable infraorbital margin step and/or zygomatic arch step
        CN exam: diplopia (infraoribtal nerve)
        Fundoscopy: subconjunctival haemorrhage
      - History
        Mechanism of injury
- - - - Types
        Le Fort 1: lower maxilla (tooth bearing area)
        Le Fort 2: upper maxilla, nasal bones, medial orbit
        Le Fort 3: maxilla, zygoma, nasal, ethmoid, small base of skull bones;
        Entire midface fractured
      - Clinical
        presentation
        
        Le Fort 2
        Dish face, infraorbital step, infraorbital nerve damage, malocclusion of teeth, surgical emphysema (sinuses), floating maxilla, epistaxis, CSF rhinorrhoea, diplopia, subconjunctival haematoma, facial swelling (severe), bilateral periorbital brusing
        
        Le Fort 3
        Features of Le Fort 2 plus: flat zygoma, fronto-zygomatic step, deformed zygomatic arch, different pupilary levels, severe facial brusing, pharyngeal bleeding (shock)
        
        Le Fort 1
        Lengthened face (dropped maxilla), moved/split hard palate, soft palate haematoma, malocclusion of upper teeth
      - Pathophysiology
        Between frontal bone, skull base and mandible
        Upper jaw, teeth, nose, maxillary and ethmoid sinuses
        May be asymmetrical
    - - Clinical presentation
        Flattened nasal bridge and splayed nasal complex
        Saddle deformity
        Telecanthus (inc distance betw medial canthi of eye)
        Periorbital bruising
        Subconjunctival haematoma
        Epistaxis
        CSF rhinorrhoea
        Supraorbital/supratrochlear nerve parasthesia
    - - Clinical presentation
        Deranged occlusion
        Misaligned teeth
        Bruised gums
        Palpable buccal fracture
      - Pathophysiology
        Fractures of teeth and bony support
  - - - Conservative
        Refer to maxfax
        Clean and dress wounds
        Nasal packing
        Tell patient NOT to blow nose (drive bacteria into fractures)
      - Medical
        Prophylactic abx
        Tetanus prophylaxis
      - Surgical
        ORIF, repositioning
        Debridement
        Immobilisation (splints, wiring)
- - - - History
        Mechanism of injury
      - Examination
        Unable to close mouth, drooling
        Anterior jaw protrusion
      - Investigations
        Bedside: obs, ECG
        Bloods: crossmatch, G&S, FBC, U+Es
        Imaging: Xray head if trauma
    - - Iniital cABCDE
      - Definitive
        
        Conservative
        Refer maxfax
        Soft diet
        
        Surgical
        Reduction without anaesthesia
  - - - History
        Mechanism of injury
      - Examination
        Facial: sweilling, tenderness, stepping,
        malocclusion, loose/missing teeth, intra-oral bruises
        CN exam: lower lip numbness (inferior dental nerve)
      - Investigations
        Bedside: obs, ECG
        Bloods: crossmatch, G&S, FBC, U+Es
        Imaging: X-ray head (orthopantomogram)
    - - Initial ABCDE
      - Definitive
        
        Medical
        Prophylactic abx
        Tetanus prophylaxis
        
        Surgical
        Indication: displaced/multiple fractures
        
        Conservative
        Refer to maxfax
        Soft diet