- 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.
- Apply C-Collar until c-spine injury is ruled out by exam or x-rays.
- Assure that no head trauma occurred and do head CT as needed. Common diagnostic studies are:
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.
- CT - Once fx is diagnosed by x-ray, CT helps in reconstructing the injury, detection of retrorbital hematomas, evaluation of ocular globe.