Facial trauma Facial trauma is any injury of the face and upper jaw bone (maxilla). facial trauma can involve soft tissue injuries such as: burns, lacerations , bruises . Or can lead to bone fracture such as nasal fracture and fracture of the jaw .
Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result • Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe
causes Blunt or penetrating trauma can cause injury to the area of the face that includes the upper jaw (maxilla). Common causes of injury to the face include: • Automobile accidents • Penetrating injuries • Violence
Signs and symptoms • Changes in sensation and feeling over the face • Deformed or uneven face or facial bones • Difficulty breathing through the nose due to swelling and bleeding • Double vision • Missing teeth • Swelling around the eyes that may cause vision problems
Signs and symptoms • Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues • Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising • People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin
Physical exam The doctor will perform a physical exam, which may show: • Bleeding from the nose, eyes, or mouth, or nasal blockage • Breaks in the skin (lacerations) • Bruising around the eyes or widening of the distance between the eyes, which may mean injury to the bones between the eye sockets
Physical exam The following may suggest bone fractures: • Abnormal sensations on the cheek and irregularities that can be felt • An upper jaw that moves when the head is still
Exam and tests • X ray is used to rule out facial fractures. • Angiography can be used to locate the source of bleeding . • CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary.
Prevention • seat belt use and public education to increase awareness about the importance of seat belts. • airbags alone are not very effective at preventing the injuries. • In sports, safety devices including helmets have been found to reduce the risk of severe facial injury. • Avoid violent confrontations with other people.
Treatment The goal of treatment is to: • Control bleeding • Create a clear airway • Fix broken bone segments with titanium plates and screws • Leave the fewest scars possible • Rule out other injuries • Treat the fracture
Treatment • Treatment should be immediate, as long as the person is stable and there are no neck fractures or life-threatening injuries. • Tracheal intubationmay be difficult or impossible due to swelling. • Nasal intubation(endotracheal tube ) may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain.
Treatment • Patients who cannot function normally or who have significant deformity will need surgery. • A dressing can be placed over wounds to keep them clean and to facilitate healing, and antibiotics may be used in cases where infection is likely
Prognosis • Patients generally do very well with proper treatment. • however it is often associated with dangerous injuries, and life-threatening complications such as blockage of the airway may occur. • they have the potential to cause disfigurement and disability.
Complications • Nerves and muscles may be trapped by broken bones (in these cases the bones need to be put back into their proper places quickly). • Bleeding • Uneven face (asymmetry) • Infection • Brain and nervous system (neurologic) complications • Numbness or weakness
Frontal sinus fracture • Frontal sinus: Both the anterior and posterior wall may be damaged. Because the posterior wall is adjacent to the dura mater, damage in this region could result in central nervous system (CNS) complications such as a cerebrospinal fluid (CSF) leak or meningitis • This injury results from a severe blow to the frontal or supraorbital region, which can result in fracture of the anterior and/or posterior wall. • The patient may report numbness in the distribution of the supraorbital nerve.
Nasal fractures • Nasal bone fractures are the most common of all facial fractures. The upper third of the nose is supported by the paired nasal bones and the frontal process of the maxilla, whereas the lower two thirds of the nose are maintained by cartilaginous structures.A more serious injury, a nasoorbitoethmoid fracture, occurs with trauma to the bridge of the nose. This injury involves extension into the frontal and maxillary bones and can result in disruption of the cribriform plate with concomitant CSF rhinorrhea.
Nasal fractures • Evidence of a nasal fracture includes epistaxis, swelling, tenderness, deformity, crepitus, nasal airway obstruction, and periorbital ecchymosis. • Always evaluate for septal deviation or septal hematoma. A bulging, bluish, tender septal mass requires evacuation. Failure to do so can result in necrosis of the nasal septum. Widening of the intercanthal distance suggests the possibility of a nasoorbitoethmoid fracture.
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