1 head and face injuries anatomy and select facial injuries
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Head and Face InjuriesHead and Face Injuries
Anatomy and Select Facial Injuries
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Many times the blood masks what the Many times the blood masks what the “problem” is…..have gloves handy!“problem” is…..have gloves handy!
Diving Example
http://www.youtube.com/watch?v=i5RqhiGdP0c
Ice Hockey Example
http://www.youtube.com/watch?v=cIVAUo1CL2g&feature=PlayList&p=29D8DEB14BDCC1D6&playnext=1&playnext_from=PL&index=25
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Protection of the CNSProtection of the CNS1. Cerebrospinal fluid2. Blood brain barrier3. Meninges
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Location of the CSFLocation of the CSF
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Vascular SupplyVascular Supply
Carotid arteriesVertebral arteries
Jugular veins
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Soft Tissue Injuries - LacerationsSoft Tissue Injuries - Lacerations
Causes?
Rule out head injury
Use of steri-strips
Sutures
Why wouldn’t you shave the eyebrow?
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Skull FracturesSkull Fractures
Forceful blow to head
Rule out C-spine injury
SignsHA
NauseaDeformity
Raccoon eyesBattle’s sign
Blood or CSF drainage from ears (ottorhea) or
nose (rhinorhea)
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Blood from ear (Ottorhea)Blood from ear (Ottorhea)
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Skull Fractures con’tSkull Fractures con’t
Immediate referral!!
Skull fracture itself is not the most
serious problem….
ComplicationsIntracranial injury
Subdural or epidural hemorrhage
Infections (meningitis)
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Mandible FractureMandible Fracture
2nd most common fracture (nose is 1st)
Direct blow to mandible
SignsDeformity (step defect)
MalocclusionPain biting down
Bleeding around teethLower lip anesthesia
Ecchymosis on floor of mouth
Treatment
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Mandibular Dislocation
MOI:Side blow to the jaw◦subluate or complete dislocation
S&S: Locked open jaw◦movement of jaw?◦how to reduce dislocation?
Recovery time?Complications
◦Recurrent dislocations◦TMJ dysfunction
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Temporomandubular joint (TMJ) Temporomandubular joint (TMJ) dislocationdislocation
Direct blow to side of jaw
SignsLock jaw
Malocculsion
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Maxillary FractureMaxillary Fracture
Direct blow
SignsMalocclusion
PainEpistaxis (nose bleed)Diplopia (dbl. vision)
Numbness in lip and cheek
LeFort Fracture types I - III(red indicates fracture
location; III worse!)
Admission 3 days post surgery
Le Fort Type II
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Zygoma Fracture Zygoma Fracture
Direct blow
SignsDeformity (flatness of cheek,
step defect)Numbness in cheek, nose,
and upper ipLimited TMJ movement
Restricted eye movementDiplopiaEpistaxis
Edema/ecchymosis
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Blow Out Fracture – Orbital FloorBlow Out Fracture – Orbital Floor
Direct blow
SignsEdema
EcchymosisSubconjunctival
hemorrhage
Don’t allow pt. to sneeze or blow
nose
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““Quiz”Quiz”
1. Mandible fracture2. Blow-out fracture3. Maxillary fracture4. Skull fracture5. Laceration6. Ottorhea7. Rhinorrhea8. Epistaxis9. Diplopia
A. Double visionB. Steri-stripsC. Orbital floorD. Battle’s sign,
racoon eyesE. Fluid from noseF. MalocclusionG. Le Fort typesH. Fluid from earsI. Nosebleed
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““Quiz” AnswersQuiz” Answers
1. Mandible fracture2. Blow-out fracture3. Maxillary fracture4. Skull fracture5. Laceration6. Ottorhea7. Rhinorrhea8. Epistaxis9. Diplopia
A. Double visionB. Steri-stripsC. Orbital floorD. Battle’s sign,
racoon eyesE. Fluid from noseF. MalocclusionG. Le Fort typesH. Fluid from earsI. nosebleed
FCGDBHEIA
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Dental, Nasal, Ear and Eye Dental, Nasal, Ear and Eye Injuries on Wednesday!Injuries on Wednesday!