Maxillofacial Trauma
August 19, 2010
Jay 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, intoxicated
Fell striking cheek on the bar
Laceration to anterior cheek
Through-and-through
Case 2
18y hockey player
“Too good” to wear a face mask
High stick to the face
Upper lip laceration
Crosses vermillion border
Involves muscular layer
Infraorbital nerve block
Case 3
25y female MVC, ejected
Intubated by STARS on scene
Swelling facial and periorbital
Extensive abrasions to forehead with
gravel/glass in wound
Ophthalmic (V1) nerve block
Case 4
It’s June 28, 1997
35y male boxer
Lac to right ear during fight
Through cartilage
Claims he was bitten
Opponent says it was a punch
Ear field block
Case 5
12y female
Skateboarding for the first time
Fell
Caught tongue between teeth
Tongue laceration
Indications for tongue laceration repair
(controversial)
Midline
Need hemostasis
Large flap (>1cm or gaping)
Avulsion/amputation
Nonlinear 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 trauma
Bite wound
Devascularized tissue
Through-and-through buccal mucosa
Cartilage involvement (nose/ear)
Extensive contamination
Open #
# 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 microstomia
Trivial looking initial wound may progress over days
5-21 days post-burn get eschar separation and can
have lift-threatening labial artery bleeding
NEED TO D/W plastics in the ED!
Can d/c home with close watching and F/U ENT/plastics if
not extensive initially
Options: early surgery, oral splinting, delayed surgery
Additional questions
Q) Management of subperichondral hematoma?
Risk factor for cauliflower ear
Needs needle aspiration
Compressive dressing
R/A in 24hrs to ensure hematoma has not reaccumulated
Additional questions
Q) Describe appropriate ED management of
eyelid lacerations.
Superficial lacs can be repaired with 6-0
Ethilon
Lid margin, canalicular, lacrimal involvement
need ophtho/plastics
Quick break
Case 6
It’s 0100
Dude and his girlfriend come in
She was “yawning” and mouth got stuck open
Case 7
16y male
Tough guy
Punched in the nose
Swelling to nasal bridge
Crooked nose? Hard to tell…
Case 8
22y female
Squash player
Hit in eye by ball
Diplopia on up-gaze
CT shows orbital floor blowout # without
entrapment of EOM
Case 9
Same polytrauma as Case 3
Still intubated
Bleeding into oropharynx & nasopharynx from ?
You think her face is mobile
Case 10
35y female, fell down stairs
Teeth don’t fit right
Neck pain, no c-spine #
No other injuries
Bone/Joint Injuries
Questions?