Facial Trauma in Adults
ðī 1. Core Principles (āļŠāļģāļัāļāļี่āļŠุāļ)
- Priority
= life before face
- Airway
→ Breathing → Circulation (ATLS)
- Secondary
goals:
- ð§
Function (vision, airway, occlusion)
- ð
Cosmesis
ðī 2. Mechanism &
Epidemiology
- Common
causes:
- āļีāļŽāļē, MVC, assault, fall
- Severe
trauma:
- gunshot
/ explosion → ↑ morbidity & mortality
- ⚠️
āļĄัāļāļĄีāļĢ่āļ§āļĄāļัāļ head & C-spine injury
ðī 3. Primary Survey
(critical)
Airway (high risk!)
- risk:
- bleeding
- edema
- fractured
structures
- Management:
- suction
aggressively (often 2 devices)
- orotracheal
intubation preferred
- ⚠️
anticipate difficult airway →
double setup (ETT + surgical airway)
Bleeding
- First
line → direct
pressure
- Adjunct:
- TXA
topical/systemic
- packing
- Rare
severe case →
embolization / external carotid ligation
ðī 4. Key History
āļāļēāļĄ targeted:
- nasal
breathing → nasal
fracture
- malocclusion
→ mandibular fracture
- diplopia
/ visual change →
orbital fracture
- numbness
→ nerve injury
- hearing
/ vertigo → temporal
bone
- bleeding
(nose / mouth / ear)
- prior
surgery
ðī 5. Physical Exam
(systematic)
1. Inspection
- asymmetry
- swelling
/ laceration / deformity
2. Palpation
- step-off
- crepitus
- abnormal
mobility
3. Nerve exam
- CN V
(sensation)
- CN VII
(motor)
→ facial paralysis = urgent consult
4. Eye exam (critical)
- visual
acuity
- EOM
- signs:
- diplopia
- enophthalmos
- afferent
pupillary defect
→ urgent ophthalmology
5. Nose
- septal
hematoma (bluish swelling) →
drain ASAP
- CSF
rhinorrhea → skull
base fracture
6. Midface
- telecanthus
→ NOE fracture
- infraorbital
numbness → orbital
floor fracture
- maxillary
mobility → LeFort
fracture
7. Mouth / Mandible
- malocclusion
= key sign
- tongue
blade test:
- āļ้āļē bite āļāļāļŦัāļ → fracture
unlikely
8. Ear
- Battle
sign → basilar skull
fracture
- hemotympanum
/ CSF otorrhea
ðī 6. Imaging
Gold standard = CT face
- thin
cut + 3D reconstruction
X-ray
- limited
role (screening only)
Ultrasound
- useful
in ocular trauma (āļāļēāļāļāļĢāļี)
ðī 7. Red Flags (āļ้āļāļāļĢีāļ consult)
- airway
compromise
- vision
change
- septal
hematoma
- CSF
leak
- facial
nerve paralysis
- LeFort
fracture
- orbital
compartment syndrome
ðī 8. General Management
Airway
- suction
+ positioning
- early
intubation if risk
Bleeding
- compression
→ packing → surgical
Wound care
- irrigation
+ minimal debridement
- repair
within 24 hr
Antibiotics (āđāļāļāļēāļ°āļāļēāļāļāļĢāļี)
āđāļŦ้āđāļĄื่āļ:
- bite
wound
- contaminated
wound
- exposed
cartilage
- open
fracture
- through-and-through
oral wound
Tetanus ± Rabies prophylaxis
ðī 9. Fracture Management
Principles
- non-displaced
→ conservative
- displaced
→ reduction (≤7
days ideal)
- urgent
admission:
- LeFort
II/III
- NOE
fracture
- zygomatic
+ trismus
- multiple
trauma
ðī 10. Important Specific
Injuries
ð§ Orbital compartment
syndrome
- sign:
proptosis + vision loss
- → lateral canthotomy
immediately
ð Nasal fracture
- common
- imaging
not always needed
- treat:
- ice
+ head elevation
- reduction:
- immediate
(<6 hr) āļŦāļĢืāļ
- 3–7
āļ§ัāļ (āļŦāļĨัāļ swelling āļĨāļ)
ð§ Midface (LeFort)
- I:
maxilla
- II:
pyramidal
- III:
craniofacial dissociation
- → āļ้āļāļ CT
+ surgical consult
ðĶ· Dental injury
- avulsed
tooth:
- reimplant
ASAP
- āđāļ็āļāđāļ milk/saline
- Class
III fracture → urgent
dental
ð Ear hematoma
- → drain (prevent cauliflower
ear)
ðĶī Mandible fracture
- sign:
- malocclusion
- trismus
- chin
numbness
ðī 11. Clinical Pearls
(high-yield)
- ⚠️
Airway = biggest killer in facial trauma
- ⚠️
Septal hematoma →
necrosis āļ āļēāļĒāđāļāđāļĄ่āļี่āļ§ัāļ
- ⚠️
Vision change →
treat as emergency
- ⚠️
Malocclusion = mandibular fracture āļāļāļāļ§่āļēāļāļ°āļิāļŠูāļāļ์āļ§่āļēāđāļĄ่āđāļ่
- ⚠️
CT = imaging āļŦāļĨัāļ
ðĨ ER Algorithm (āļŠāļĢุāļāļŠั้āļāđāļ้āļāļĢิāļ)
1.
ABC →
airway + suction
2.
Control bleeding
3.
Eye exam (vision!)
4.
Check:
o septal
hematoma
o malocclusion
o neurologic
deficit
5.
CT if moderate–severe trauma
6.
Consult:
o ENT
/ OMFS / Ophthalmology āļāļēāļĄ indication
āđāļĄ่āļĄีāļāļ§āļēāļĄāļิāļāđāļŦ็āļ:
āđāļŠāļāļāļāļ§āļēāļĄāļิāļāđāļŦ็āļ