CM- ENT-3- ENT Emergencies
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| Where do majority of facial fractures occur | 60-70% involve the orbit
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| what is the most common cause of facial injury |
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| What is the best view on plain film x-ray for facial injury fractures also name the other 2 common plain film views | best is waters view- tilting the head back; other two are Caldwell view and submentovertex view
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| what is the most common fracture type of the facial fractures | zygomaticomaxillary complex (tripod fracture) 40%
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| What is the second most common type of facial fracture | LeFort types I-15%, II-10%, III-10%;
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| What is the third most common facial fracture | zygomatic arch fracture 10%
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| What is a tripod fracture | separation of all three major attachments of the zygoma with the face; inferior orbital rim, lateral orbital rim, zygomatic arch
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| what are the sx of tripod fracture | pain, step deformity, numbness over affected area, edema/swelling, epistaxis, tinnitus
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| what are the fractures involving the maxilla termed | LeFort fractures divided into 3 types I,II,III
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| Which of the LeFort Fractures does not cause visual problems | types II and III
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| What are the sx of LeFort fractures | can't bring teeth together in proper alignment, visual problems (types II and III), clear nasal discharge, bruising around eyes, may be able to move part of face
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| your pt has been in a traumatic accident presents with clear nasal discharge and can move their lower maxillae and hard palate independently of their face what type of trauma are they likely suffering from | LeFort type I fracture palate face disjunction
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| If you can move the maxillary and nasal regions relative to the midface and skull what type of fracture do you have | LeFort type II- pyramidal disjunction
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| if you can move your pts entire upper face relative to their skull and their pterygoid plates are usually fractured free from the base of the skull what type of fracture is this | LeFort Type III- Craniofacial disjunction
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| what is the tx for a LeFort type fracture | stabilization and rigid plating get bones realigned to help swelling reduce faster and give them antibiotics and steroids
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| Your patient has flattened cheeks after a significant trauma they complain of visual changes, pain with jaw movements, altered sensation underneath their right eye with a hemorrhage what has likely happened | they have fractured their right zygomatic arch
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| What test could you do to test for zygomatic arch fracture | do a two ruler test deviation should occur on the side of the fracture
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| What are the sx of orbital fracture | sunken eye (enophthalmos) altered sensation beneath the affected eye, double vision especially with upward gaze
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| What are the sx of nasal fracture | pain, swelling, tenderness, deformity, epistaxis (minor)
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| What would indicate you want to get a CT scan done for a broken nose | PE reveals, rhinorrhea, extraocular movement abnormalities or malocclusion
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| After stabilizing the pt with a nasal fracture what do you want to check for next | septal hematoma because septum can die from it and it is easy to take care of
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| why don't you want to miss a septal hematoma and how would you tx it | can lead to death of septal cartilage and saddle nose deformity, tx by I&D and packing then checking to make sure it doesn't reform
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| What is the tx for nasal fractures | ice nose, analgesics reassess 5-10 days later for consideration of closed reduction under local anesthesia (wait for it to be numb)
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| What should you do to tx a nasal fracture in a child | consider rhinoplasty at an older age unless it is problematic or complicated then send for consult.
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| Where are you most likely going to see a fx of the mandible | Body, Angle Condyle, and symphysis menti
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| You are performing a PE of a patient in the ER who just came in from a MVA you are looking in the mouth and notice bruising under the tongue what should you be concerned about | The pt most likely has a mandible fx as bruising under the tongue is indicative of this type of fx
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| You have just finished fixing a jaw fracture what are you going to prescribe the pt and more importantly why are you prescribing what you do (not pain killers) | Antibiotics are important with jaw fractures because the mandible communicates with the oral cavity and is considered an open fracture. Prescribe PCN, Ancef, Keflex or Cleocin to avoid complications of infection that can involve the heart
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