Facial Trauma

There are 6 major areas/injuries to the face.



Basic Approach to Facial Injury



* Step 1: Airway* Indications for intubation after trauma* Burns to the airway* Rapidly expanding hematoma* GCS <8* Step 2: CT Maxillofacial Without Contrast* Step 3: Supportive Care* Stop bleeding* Apply pressure* Control epistaxis* Caution advised with packing if patient has basilar skull fracture* Ice* Analgesics* Step 4: Antibiotics* Common indications* Fractures of a sinus* Open fractures* Step 5: Consider Consulting the Appropriate Specialist* Eye trauma -> Ophthalmology* ENT trauma -> ENT* Oral/Dental trauma -> Oral/maxillofacial surgery or dentistry



Six Key Facial Injuries



* Frontal bone* Fractures of the INTERNAL frontal sinus wall = BAD* Eyes and orbits* “Blowout” fractures with entrapment of the extra-occular muscles = BAD* Nose* Septal hematoma = BAD* Zygoma (Cheekbone)* Zygomaticomaxillary complex fracture (aka Tripod fracture) = BAD* Maxilla (Upper jaw)* Le Fort fractures = BAD* Mandible (Lower jaw)* Open fractures (intraoral laceration) = BAD



Additional Reading



* Trauma Basics (EM Clerkship)* CORE EM: Facial Fractures (emDOCs)