Maxilofacial Trauma
G. Jones/R.Yakobi

Choose a sub-category:

Mandible
Nasal Bone
Blow-out fx
Tripod fx
Zigomatic fx
Le Fort
Frontal Sinus fx
Tooth fx

General Overview:

  1. Do "primary" and "secondary survey" of ATLS. Airway compromise is common. Nasotracheal intubation is not advisable. Due to severe facial disruption, cricothyrotomy is more practical.
     
  2. Apply C-Collar until c-spine injury is ruled out by exam or x-rays.
     
  3. Assure that no head trauma occurred and do head CT as needed.  Common diagnostic studies are:
    1. X-ray
      • Water's view -  a occipitomental projection that visualizes maxillary sinuses, infraorbital area, frontozygomatic area. These are three out of  four zygomaticomaxillary complex areas commonly injured in maxillofacial trauma.
         
      •  Submental-Vertex view visualizes the fourth area of  zygomaticomaxillary complex - the zygomatic arches.
         
      •  Caldwell view - is an AP view of face. Visualizes ethmoid sinuses and superior orbits.
         
      •  Lateral view - visualizes sphenoid sinuses, posterior frontal sinuses, nasal bone.
         
      •  Panoramic view - is the best view  to study the mandible but requires pt to be motionless x 30 sec.
         
      •  Towne's  view - obtained in frontomastoid projection, studies the mandibular condyles and rami.
         
      •  Lateral oblique is a good study for mandibular body.
         
    2. CT - Once fx is diagnosed by x-ray, CT helps in reconstructing the injury, detection of retrorbital hematomas, evaluation of ocular globe.

 

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