Copy of Facial Truma 11

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Facial trauma

DR : RAMI ELIAS SAAB

CONSULTANT OF ORAL &

MAXILLOFACIAL SURGERY



The term facial trauma means any injury to the face orupper jaw bone. Facial traumas include injuries to the

skin covering, underlying skeleton, neck,ear, nasal

(sinuses), orbital socket, or oral lining, as well as the

teeth and dental structures. Sometimes these types of

injuries are called maxillofacial injury. Facial trauma is

often recognized by lacerations (breaks in the skin);

bruising around the eyes, widening of the distance

between the eyes (which may indicate injury to the

bones between the eye sockets); movement of theupper jaw when the head is stabilized (which may

indicate a fracture in this area); and abnormal

sensations on the cheek.

What is facial trauma?



Photo at time of

admission in

emergency

department, showing

extent of injuries

After reconstructive...

skin covering

3D

Ct /scan



Classification of Injury

Contusion

Abrasion

Accidental Tattoo

Retained Foreign Bodies

Puncture Wounds

Simple Laceration

Avulsion (flap)

Avulsion (complete)



Contusions Abrasion

Accidental Tattoo

Avulsion

puncture wound looss of tissue



case report

a b

a b

c





Special regional considerations

All injuries need to be copiously irrigated and have allforeign bodies removed. Simple linear lacerations withgood hemostasis can be closed with staples. Close moreextensive lacerations, lacerations with profuse bleeding,or large avulsions of the nonabsorbable suturesencompassing all layers of the scalp. This methodusually achieves good hemostasis.

Lacerations



Blunt or penetrating trauma can cause injury to the

midface region, which includes the upper jaw

(maxilla). Common causes of facial injury include:

Automobile accidents ,Penetrating injuries , Violence

Causes

Occupation

accident.Animal

bite.

Home

violence

Sport

accident



Gunshot wound sustained injury to

t he Face, Closure / Tracheostomy

Facial X-Ray

Gunshot wound sustained injury to t he Face



pat hological truma.

a b

c



Exams and Tests

The doctor will perform a physical exam, which may show:

.Bleeding from the nose, ear, eyes, or mout h, or nasal obstruction

.Bruising around the eyes or widening of the distance between the

eyes, which may mean injury to the bones between the eye sockets

.Lacerations (breaks in t he skin)

The following may suggest bone fractures:

.Abnormal sensations on the cheek and irregularities that can be felt

.An upper jaw that moves when the head is still

.A CT scan of the head may be done .



Diffirent types of x-rays



Clinical signs & symptoms

Traumatic telecanthus

Normal intercanthal distance = 33-34 mm>35 mm may indicate NOE disruption

.Damage to lacrimal apparatus => (epiphora)

.CSF leak



Battle SignRacoon sign

train sign



.Depression or angulation

.Periorbital ecchymosis

.Epistaxis

.Tenderness

.Crepitus.Septal deviation

.Septal hematoma

.Rule out septal hematoma.Remove clots with suction

.incise and drain if present to prevent septal

necrosis

.Closed reduction for simple fractures

.Open reduction for severelydisplaced fractures

Nasal Fractures

Treatment

clinical observation



This pictures shows a septal

hematoma on both sides of thenose. The black arrows point to

the lining of the septum that is

ballooned up by underlying blood

Control epistaxis.

Drain septal hematomas.Refer patients to ENT as outpatient

This clinical photograph

shows septal hematoma.



Clinical photograph shows delayed

drainage of septal hematoma resulting in

infection. This patient did not present tothe emergency room until 1 week

following sustaining nasal trauma

Traumatic telecanthus secondary

to nasoorbitoethmoid fracture.Intercanthal distance is( 39 mm).

Postoperative view of patient, demonstrating

normal intercanthal distance (33 mm) after resuspension of the medial canthal ligament

and fixation of the nasoorbitoethmoid

component.



Nasal-Orbital-Et hmoid Fractures

.Epistaxis.

.Severe periorbital edema &

Ecchymosis.

.Subconjunctival hemorrhage.

.Comminuted With posterior displacement.

.Widened nasal bridge.

.Splaying of nasal complex.

Nasalh

emorrh

age.Epistat

.Foley cathe

.Nasal packing

.Merocel sponge

.Nasopharyngeal ballon



Why is facial trauma different in children t han adults?

Facial trauma can range between minor injury to

disfigurement that lasts a lifetime. The face is critical in

communicating with others, so it is important to get the

best treatment possible. Pediatric facial trauma differs

from adult injury because the face is not fully formed and

future growth will be a factor in how the child heals and

recovers. (Certain types of trauma may cause a delay in

t he growt h or furt her complicate recover) . Difficult

cases require physicians with great skill to make a repair that will grow with your child.



trauma

Pediatric facial

Certain

types of

trauma may

cause a

delay in t hegrowt h or

furt her

complicate

recovery

a b c

d e f



Treatments

Surgery is needed if the person cannot function normally

or if there is significant deformity.

.Control bleeding

.Create a clear airway

.Fix broken bone segments with titanium plates

and screws

.Leave the fewest scars possible

.Rule out other injuries

.Treat the fracture

.Treatment should be immediate, as long as the

person is stable and there a no neck fractures

or life-t hreatening injuries

The goal of treatment is to:



NECK FRACTURES



Neck collar

a b

c



Patients generally do very well with proper treatment. Thepatient should gently be told that they will probably look

different than they did before their injury, and that additional

surgeries may be needed 6-12 months later.

Prognosis

General complications include, but are not limited to:

.Bleeding

.Facial asymmetry

.Infection

.Neurologic complications

Possible Complications

When to contact a medical professional

Go to the emergency room or call the local emergency

number if you have a severe injury to your face.



MAXILLARY FRACTURES

(Low Maxillary) (Pyramidal) (Craniofacial Dysjunction)

Rene Le Fort : French surgeon (1869-1951)



Prevalence of mid-face fracturesFracture TypeFracture Type PrevalencePrevalence

ZygomaticomaxillaryZygomaticomaxillary complex (tripodcomplex (tripod

fracture) fracture)40 %40 %

LeFort LeFort

II 15 %15 %

IIII 10 %10 %

IIIIII 10 %10 %

ZygomaticZygomatic arch

arch 1

0 %1

0 %Alveolar process of maxillaAlveolar process of maxilla 5 %5 %

Smash fracturesSmash fractures 5 %5 %

Ot herOt her 5 %5 %



ZYGOMATICOMAXILLARY & ORBITAL FRACTURES



MUSCLE ENTRAPMENT

This child presented with diplopia following blunt

trauma to the right eye. On exam, he was unable to

move his right eyeball up on upward gaze.



The facial skeleton is one of the most complex arrangements of

curving bony surfaces in the body. Today, facial imaging is most

successfully performed with CT.

a b

C d e



CT: Blowout Fracture of Orbit

A: Orbital blowout fracture with displacement of thefloor (arrow), distortion of the inferior rectus, andherniation of orbital fat through defect. Arrowheadindicates medial fracture.

B: Note opacified left anterior ethmoid air cells anddisplaced medial orbital fracture (arrowheads).

A B



Isolated injuries to teeth are quite common and mayrequire the expertise of various dental specialists.

Because of the specific needs of the dental

structures, certain actions and precautions should

be taken if a child has received an injury to his or

her teeth or surrounding dental structures.

If a tooth is ³ knocked out ´, it should be placed

in salt water or milk. The sooner the tooth is re-

inserted into the dental socket, the better chance it

will survive. Therefore, the patient should see a

dentist or oral surgeon as soon as possible.

Never attempt to ³ wipe t he toot h off ´ since

remnants of the ligament which hold the tooth in the

jaw are attached and are vital to the success of

replanting the tooth

Injuries to t he teet h and surrounding dental structures style



Panfacial fracture showing

characteristic anterior open

bite deformity which iscommonly associated with

Le Fort fractures. Multiple

dentoalveolar injuries are

present.

Clinical photographs show palatal

displacement of an alveolar

fracture comprising right central

and lateral maxillary incisors.



case report

Dentoalveolar #

a b

c



Clinical photographs showing extrusion of the coronal fragment

Intraoral films will show the root fracture usually diagonal and

located in the apical, middle, or cervical third of the root, or

combinations of these (middle cervical).



The tooth is out of its socket, and

radiographic examination has

excluded intrusive luxation. The

patient frequently presents the

tooth exhibiting with varying

degree of contamination,

periodontal ligament injury, and/or

dryness, unless kept moist.

Inhaled toothSwallowed tooth



Frontal and palatal view of

left central maxillary incisor with lateral luxation. The

tooth is only attached to the

palatal mucosa, and it is

displaced in palatal direction.

Intraoral films will show the tooth

axially dislocated out of its socket

with partial or total loss of bony

attachment. In this case, there is atotal loss of periodontal attachment

to the bone, and the tooth is

retained solely by the palatal

mucosal attachment.



The left central maxillary incisor is intruded in half its crown

length in apical direction.

. X-ray shows the same patient case report



case report

a b c

d f e

3/mont h

later



case report

a b

c



case report

a b

c d



case report

a b

c d



6/mont h post operative



case report

a b

dc



direct post operative

a b

c



One week

post operative

a b

c d



3 / week post operative

a b

c d



case report

a b c

d



a b c

d e f

Intraoperative vision



case report

a b

c




a b c

d e f f



Postoperative frontal view

of patient, demonstrating

good facial symmetry

Initial clinical presentationof a patient with panfacial

fracture

Large stellate upper liplaceration demonstrating

comminution of anterior

a b c

case report



Coronal access to nasal and

medial orbital components.

Fixation of zygoma and

zygomatic arch.

Fixation of nasoorbitoethmoid

component.

Comminuted zygomatic arch.

a b

c d




case report

Pre operativerPost operative



6 / mont h postoperative

a

b

c



Three-dimensional post operative



case report



Facial trauma can range between minor injury

to disfigurement that lasts a lifetime. The face

is critical in communicating with others, so itis important to get the best treatment possible.

The End

Facial lacerations, oral trauma and dental

trauma are the most common injuries. The

majority of patients are dealt with ,without

admission or referral to another speciality.

Conclusions



THANK YOU

A I

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Copy of Facial Truma 11