Maxillofacial Trauma: Managing Potentially Dangerous And Disfiguring Complex Injuries -
Publication Date: April 2017 (Volume 19, Number 4)
Devjani Das, MD, RDMS, FACEP
Assistant Professor, Associate Director and Co-Fellowship Director, Division of Emergency Ultrasound, Department of Emergency Medicine, Hofstra Northwell School of Medicine, Northwell Health-Staten Island University Hospital, Staten Island, NY
Lea Salazar, MD
Clinical Assistant Professor, Department of Emergency Medicine, Division of Emergency Ultrasound, Hofstra Northwell School of Medicine, Northwell Health-Staten Island University Hospital, Staten Island, NY
Syed Sameer Ali, MD, MS, FACEP
Assistant Professor, Department of Emergency Medicine, Baylor College of Medicine; Attending Physician, Department of Emergency Medicine, Ben Taub General Hospital; Trauma Medical Director, Clinical Attending Physician, Memorial Hermann Memorial City Medical Center, Houston, TX
Tiffany Murano, MD, FACEP
Clinical Associate Professor, Department of Emergency Medicine, Program Director, Emergency Medicine Residency, St. John’s Riverside Hospital, Yonkers, NY
Patients with maxillofacial trauma require 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.
Excerpt From This Issue
It is Saturday night and your third straight overnight shift. As you step into the trauma bay, your charge nurse approaches. “Doctor, we have a 27-year-old male coming in 5 minutes. He was involved in a high-speed motorcycle accident and EMS says he has quite a bit of facial trauma…” He trails off as you see EMS speeding down the hallway. Your resident looks at you and asks, “How are we going to intubate this patient?”
Your second patient arrives soon after. This patient is clearly inebriated and accompanied by both EMS and security. As the patient is brought closer, you note that he is combative and appears to have extensive facial injuries, with bleeding that you cannot identify as originating from any one location. The patient suddenly becomes minimally responsive, and the EMT repeats the vital signs, revealing a blood pressure of 60/40 mm Hg, heart rate in the 120s, and pulse ox, 88% on room air. You turn to your resident and ask, “What are our initial priorities in management of this patient?”
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