Case Presentation

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Case Presentation

• Shiraaz Shaikjee
• 08 April 2008

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• 41 yr old male
• High speed MVA 100 km/hr
• Head on collision with a pedestrian
• Restrained and airbag deployed
• On scene altered LOC, hypotensive and
  tachycardic.
• Injuries facial injuries, rib L,
• L femur

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Emergency management

• Splint , decompress r chest, sedate and intubate
• Significant disruption of the facial bones
• Lots of blood in oropharynx and nose
• Packaged and taken to hospital

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Facial Fractures

• Approach clinical assessment standpoint
• Look out for orbital blowout s
• Search for Leforte s
• Not to forget mandibular s
• NB, start at one point and work systematically or
  in an orderly fashion

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LOOK

• Swelling and deformity
• Raccoon eyes/ Battles sign
• Nasal s
• Csf leaks
• Lacerations
• Always have a high index of suspicion for a
  c-spine injury in pts with significant head and
  facial trauma

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PALPATE

• Skull and forehead
• Orbits
• Nasal bones
• Maxilla and Zygoma
• Mandible
• Instability, depression, crepitus, fracture

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FRONTAL BONE

• Direct force
• Intracranial injury because of damage to the
  posterior table of the sinus
• Dural tears associated wih orbital roof s
  ------ lead to blindness
• Clnically disruption/crepitus of supraorbital
  rim or subcut emphysema

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Eye - Orbit

• Open eye paper clip
• Cheimosis
• Pupil, globe penetration, corneal laceration
• Hyphema, subconjunctival hemorrhage
• Full 360 of the orbit
• BLOW OUT

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Blowout

• 2 mechanisms
• 4 clinical finding
• Enopthalmous
• Infraorbital anaesthesia
• Diplopia
• Step off deformity subcut emphysema
  pathognomonic
• Xray hanging tear drop sign

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Blow out
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NASAL BONES

• Palpate for obvious s
• Biggest problem being that of hemorrhage
• Rich blood supply Littles area
• May need packing BOS

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MID FACE

• Palpate maxilla and zygoma
• Hemorrhage
• Le forte s

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Le Forte s I/II/III
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(No Transcript)
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What are the s???
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Mandibular s
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Mandibular s
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• Thank You