耳鼻喉科Otolaryngology topic thirteen: Maxillofacial injury

Maxillofacial injury

1. Types and presentations

-- sport injury: from frontal bone to mandible  ↓

-- traffic injury:  from the lower part of a head to the upper  ↑

2. Top priority: airway

Beware of

-- fallen teeth

-- tongue

-- blood clot

3. Circulation

-- rarely cause shock

4. Secondary survey

-- medical record, drug history, allergy, CBC, CXR, urine routine...

5. Intervention

-- surgery: 5~8 days afterwards

-- suture: DO NOT create dead space

-- DO NOT offer morphine as they depress cough reflex and constrict pupils

-- Avoid treatment if no significant displacement of zygoma is present.

-- intervention when orbital floor damage>50%

-- can use iliac crest for reconstruction

6. Trauma

-- 70% lower extremity 

-- 50% ↑upper extremity, chest

7. PE/CT check key spots

-- eminence(-) --> check zygoma 

-- vertical buttress

-- mandible 

-- orbit 

-- soft tissue if complex injury ( eyes, facial n., dental occlusion...)

***Forced duction test: check orbit floor fracture

***Medial canthal ligament

8. Le Fort classification of maxilla fracture

From: RosarioVanTulpe
Red: type 1
Blue: type 2
Green: type 3, craniofacial

-- type 1: floating palate

-- type 2: infraorbital nerve, 35~55% (highest!)

-- type 3: worst-->raccoon eyes, panda face, CNS leakage, olfactory n. damage; least common

9. Zygoma fracture

-- lateral canthal ligament: causing diplopia 

10. Sinus fracture & CSF rhinorrhea

-- caution: anterior cranial fossa, cribriform plate, ethmoid sinus (maxillary sinus-->less likely)

-- 25% CSF leakage

-- CSF rhinorrhea after 1 wk, unilateral, wet handkerchief test, beta-2 transformin

-- treatment: absolute bed rest 7~10 days, avoid weight-lifting, acetazolamide, surgery

*** Antibiotics are NOT needed.

-- localization of CSF rhinorrhea: lumber puncture + contrast media/radioactive agents

11. Children

-- anatomy: cranium to face ratio↑

-- earlier treatment