Download Maxillofacial trauma Exam Questions And Answers Latest Update 2025 and more Exams Traumatology in PDF only on Docsity!
Answers Latest Update 2025
Airway management - correct answer ✅Airway compromise is common in patients with severe maxillofacial injuries Since airway compromise can be abrupt, continuous monitoring is necessary Immediate surgery may be necessary to reduce fractured facial bones which are encroaching on the airway A surgical airway may be necessary to facilitate later surgical procedures Airway management: warning signs - correct answer ✅hoarseness, subcutaneous emphysema of the neck, laryngeal pain, visible edema, or the presence of an expanding hematoma Airway management: assessment - correct answer ✅Initial jaw thrust and clearing of debris often will be sufficient
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Rapid sequence intubation (RSI) is the preferred method of securing an airway in a patient without contraindications...however Avoid paralytics if the facial injury will make use of a bag-valve mask impossible Intubation with only sedatives is an option Remember the importance of C-spine immobilization Airway management: neck - correct answer ✅Concurrent neck injury will dictate the approach to airway management Endotracheal intubation is possible in associated pharyngeal, laryngeal and tracheal airway injuries Surgical airway is a distinct possibility (emergency crichothyroidotomy preferred) Airway management: caution - correct answer ✅Avoid nasotracheal intubation
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Facial trauma: zygoma - correct answer ✅Simultaneous palpation of zygomatic arches will reveal asymmetry To distinguish between tenderness of the soft tissue of the malar region from bony tenderness use intraoral palpation Place gloved finger on buccal surface of upper molars and locate the zygomatic arch Facial trauma: assess facial stability - correct answer ✅opening the mouth and grasping the maxillary arch (not the teeth) Rock the maxillary arch and simultaneously feel the central face for movement with the opposite hand Facial trauma: test for sensation - correct answer ✅along nerve distribution
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Numbness may be a result of nerve contusion, but it often indicates fracture Infraorbital nerve damageanesthesia to ipsilateral upper lip, nasal mucosa at vestibule, lower eyelid, and maxillary teeth Mandibular fractureslower lip and dental anesthesia Facial trauma: orbit - correct answer ✅Periorbital and Orbital Exam Perform early in the encounter--> lid edema Check pupils for reactivity Visual acuity-->Snellen chart-->finger counting-->light perception Early recognition of traumatic optic neuropathy may prevent blindness
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Fractures of the zygomatic and infraorbital floor frequently cause diplopia on upward gaze Significant pain with extraocular motions may indicate an occult injury Facial trauma: nose - correct answer ✅Inspect the nose from various angles to detect deformity Palpate for crepitus, subtle deformity, and subcutaneous air Be on alert for septal hematoma and CSF rhinorrhea Facial trauma: ear - correct answer ✅Inspect the ear for subperichondral hematoma Examine the EAC for lacerations and CSF leak, along with hemotympanum
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TM rupture may occur with fracture of the mandibular condyle Battle sign--> basilar skull fracture (behind the mastoid process) Facial trauma: imaging - correct answer ✅Plain films may be useful as screening studies, but CT is used for definitive diagnosis Waters view is probably the most useful view of the midface: it will demonstrate orbital rims, indicate a blow-out fracture, and demonstrate air-fluid levels in the maxillary sinus Facial trauma: Caldwell view - correct answer ✅Caldwell view is useful in confirming Ethmoidal and Frontal sinus fractures Also useful for examining lateral margins of orbits Facial trauma: submental-vertex - correct answer ✅Submental-vertex view (jug-handle) shows skull base and zygomatic arches
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Cortical defect or diastatic suture Bone fragments overlapping causing a "double-density" Asymmetry of face Indirect Signs Soft tissue swelling Periorbital or intracranial air Fluid in a paranasal sinus Facial fx: management - correct answer ✅Frontal Sinus Orbital Floor (Blowout) Nasal Zygomatic (Tripod) Maxillary (LeFort I, II, III, IV) Frontal sinus fx: definition/etiology - correct answer ✅Typically result from a direct blow to the frontal bone with a blunt object (classically a lead pipe or a brick); also frequently associated with MVA
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Frequently associated with intracranial injury, secondary to disruption of the posterior table of the sinus Associated dural tears are frequent complications Frontal sinus fx: complications - correct answer ✅May be associated with injuries to the orbital roof, which can lead to blindness Other complications include cranial empyema, and mucopyoceles (collections of pus and mucus which block the nasal frontal duct, preventing sinus drainage) Frontal sinus fx: exam - correct answer ✅Exam may reveal disruption or crepitance of the supraorbital rims Subcutaneous emphysema may be observed A fracture of the frontal sinus should be considered clinically when a gross depression or laceration is found over the supraorbital
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Orbital contents herniate into the maxillary antrum, often orbital fat and intraocular muscles become entrapped Orbital floor fx: s/s/dx - correct answer ✅Enopthalmos, or sunken globe, is essentially pathognomonic Entrapment of the inferior rectus muscle creates diplopia on upward gaze Dilated internal exam of the eye is important component of work- up CT of orbits is study of choice Orbital floor fx: complications - correct answer ✅Retina detachment, ruptured globe, hyphema Orbital floor fx: tx - correct answer ✅MXF/Ophthalmology consultation
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Blowouts with enophthalmos or persistent diplopia require surgical repair Pts. with uncomplicated fracture may be d/c with analgesics and prompt follow-up Nasal fx - correct answer ✅Most common facial fracture Appearance and the ability to breathe through the nose are the only concerns Anterior force on the nose is the most common mechanism No imaging necessary Reduce displaced fractures Drain hematomas Follow-up with ENT Zygomatic fx: tripod (def)/etio - correct answer ✅Consist of three separate fractures: infraorbital rim, zygomatic-frontal suture, and zygomatic temporal junction Results from a medially directed blunt force on the cheekbone
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LeFort fx - correct answer ✅Result of significant force Look for associated intracranial or c-spine injury LeFort system designed to describe common patterns, and combinations or variations may be seen LeFort I - correct answer ✅(horizontal) may result from a force of injury directed low on the maxillary alveolar rim in a downward direction. Essentially separates the maxillary teeth from the face LeFort I: presentation - correct answer ✅Malocclusion, local tenderness, and edema Can mobilize the hard palate and upper teeth CT
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MXF surgery consult D/C with analgesia and close follow-up LeFort II - correct answer ✅Le Fort II fractures (pyramidal) may result from a blow to the lower or mid maxilla. Has a pyramidal shape and now involves the bony nasal skeleton LeFort II: presentation - correct answer ✅Malocclusion, ecchymosis of the nasal dorsum and lower eyelids Infraorbital nerve canal disrupted--> numbness below eyelid Hard palate, teeth, and nose are mobile
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Management is the same as for LeFort III Ellis system - correct answer ✅System used to describe tooth fractures Class I: fracture of enamel alone Class II:deeper fracture which exposes the dentin Class III:exposure of the pulp Dental trauma: management -- CLASSES I-III - correct answer ✅Class I--> No urgent treatment Class II--> Irrigate with sterile saline, cover area Class III--> Irrigate, cover, +/- nerve block Dental trauma: subluxation - correct answer ✅injury resulting in loosening of tooth in socket Depending on mobility of tooth, treatment ranges from advising soft diet and dental follow-up to immobilization
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Dental trauma: avulsion - correct answer ✅complete disruption of tooth from socket Likelihood of tooth survival decreases the longer tooth is out of socket Dental trauma: management - correct answer ✅Tooth needs to be replanted quickly-->after being irrigated with Hanks solution or sterile saline Splinting of tooth ABX coverage Dental referral Ear problems - correct answer ✅Foreign bodies: Careful visualization Suction Curette ENT referral Mineral oil/lidocaine
