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Maxillofacial Trauma: Managing Potentially Dangerous And Disfiguring Complex Injuries (Trauma CME)

April 2017

Abstract

Patients with maxillofacial trauma require a careful evaluation due to the anatomical proximity of the maxillofacial region to the head and neck. Facial injuries can range from soft-tissue lacerations and nondisplaced nasal fractures to severe, complex fractures, eye injuries, and possible brain injury. Though the Advanced Trauma Life Support (ATLS) guidelines provide a framework for the management of trauma patients, they do not provide a detailed reference for many subtle or complex facial injuries. This issue adds a more comprehensive and systematic approach to the secondary survey of the maxillofacial area and emergency department management of injuries to the face. In addition to an overall review of maxillofacial trauma pathophysiology, associated injuries, and physical examination, this review will also discuss relevant imaging, treatment, and disposition plans.

Keywords: maxillofacial, trauma, facial, craniofacial, fracture, maxilla, mandible, zygoma, ethmoid, nasal, nose, orbital, naso-orbito-ethmoid, blowout fracture, Le Fort, Waters view, Caldwell view, Towne view

Points

  • The main cause of death in severe facial injury is airway obstruction. As with any trauma, perform ABCDE's first.
  • Signs of cerebrospinal fluid (CSF) leak include clear rhinorrhea, subcutaneous emphysema, mental status changes, new malocclusion, or limited extraocular movements. Studies have shown that a persistent CSF leak increase the risk for future meningitis.

Pearl

  • Always perform a full neurological examination to assess for nerve and muscle entrapment in the head and neck.
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Last Modified: 04/26/2017
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