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Facial trauma
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Facial trauma
Facial trauma is any injury of the face and upper
jaw bone (maxilla).
facial trauma can involve soft tissue injuries
such as: burns, lacerations , bruises .
Or can lead to bone fracture such as nasalfracture and fracture of the jaw .
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Facial injuries have the potential to cause
disfigurement and loss of function; for example,
blindness or difficulty moving the jaw can result
Although it is seldom life-threatening, facial
trauma can also be deadly, because it can cause
severe bleeding or interference with the airway;
thus a primary concern in treatment is ensuringthat the airway is open and not threatened so
that the patient can breathe
http://en.wikipedia.org/wiki/Airwayhttp://en.wikipedia.org/wiki/Airway -
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causes
Blunt or penetrating trauma can cause injury to
the area of the face that includes the upper
jaw (maxilla). Common causes of injury to the
face include:
Automobile accidents
Penetrating injuries
Violence
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Signs and symptoms
Changes in sensation and feeling over the face
Deformed or uneven face or facial bones
Difficulty breathing through the nose due toswelling and bleeding
Double vision
Missing teeth Swelling around the eyes that may cause
vision problems
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Signs and symptoms
Fractures of facial bones, like other fractures,may be associated with pain, bruising, andswelling of the surrounding tissues
Nasal fractures may be associated withdeformity of the nose, as well as swelling andbruising
People with mandibular fractures often havepain and difficulty opening their mouths andmay have numbness in the lip and chin
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Physical exam
The doctor will perform a physical exam, which
may show:
Bleeding from the nose, eyes, or mouth, or
nasal blockage
Breaks in the skin (lacerations)
Bruising around the eyes or widening of thedistance between the eyes, which may mean
injury to the bones between the eye sockets
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Physical exam
The following may suggest bone fractures:
Abnormal sensations on the cheek and
irregularities that can be felt
An upper jaw that moves when the head is
still
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Exam and tests
X ray is used to rule out facial fractures.
Angiography can be used to locate the source
of bleeding .
CT scanning is better for detecting fractures
and examining soft tissues, and is often
needed to determine whether surgery is
necessary.
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Prevention
seat belt use and public education to increaseawareness about the importance of seat belts.
airbags alone are not very effective at
preventing the injuries. In sports, safety devices including helmets
have been found to reduce the risk of severe
facial injury. Avoid violent confrontations with other
people.
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Treatment
The goal of treatment is to:
Control bleeding
Create a clear airway
Fix broken bone segments with titaniumplates and screws
Leave the fewest scars possible
Rule out other injuries
Treat the fracture
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Treatment
Treatment should be immediate, as long as theperson is stable and there are no neck fracturesor life-threatening injuries.
Tracheal intubationmay be difficult or impossibledue to swelling.
Nasal intubation(endotracheal tube ) may becontraindicated in the presence of facial trauma
because if there is an undiscovered fracture atthe base of the skull, the tube could be forcedthrough it and into the brain.
http://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheal_intubation -
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Treatment
Patients who cannot function normally or who
have significant deformity will need surgery.
A dressing can be placed over wounds to keep
them clean and to facilitate healing, and
antibioticsmay be used in cases where
infection is likely
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Prognosis
Patients generally do very well with proper
treatment.
however it is often associated with dangerous
injuries, and life-threatening complications
such as blockage of the airway may occur.
they have the potential to cause disfigurement
and disability.
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Complications
Nerves and muscles may be trapped by brokenbones (in these cases the bones need to be putback into their proper places quickly).
Bleeding
Uneven face (asymmetry)
Infection
Brain and nervous system (neurologic)complications
Numbness or weakness
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Frontal sinus fracture
Frontal sinus: Both the anterior and posterior wallmay be damaged. Because the posterior wall isadjacent to the dura mater, damage in this region
could result in central nervous system (CNS)complications such as a cerebrospinal fluid (CSF)leak or meningitis
This injury results from a severe blow to the frontal or
supraorbital region, which can result in fracture of theanterior and/or posterior wall.
The patient may report numbness in the distributionof the supraorbital nerve.
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Nasal fractures
Nasal bone fractures are the most common of allfacial fractures. The upper third of the nose issupported by the paired nasal bones and thefrontal process of the maxilla, whereas the lower
two thirds of the nose are maintained bycartilaginous structures.A more serious injury, anasoorbitoethmoid fracture, occurs with traumato the bridge of the nose. This injury involves
extension into the frontal and maxillary bonesand can result in disruption of the cribriformplate with concomitant CSF rhinorrhea.
http://www.medscape.com/resource/traumahttp://www.medscape.com/resource/traumahttp://www.medscape.com/resource/trauma -
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Nasal fractures
Evidence of a nasal fracture includes epistaxis,
swelling, tenderness, deformity, crepitus, nasal
airway obstruction, and periorbital ecchymosis.
Always evaluate for septal deviation or septalhematoma. A bulging, bluish, tender septal mass
requires evacuation. Failure to do so can result in
necrosis of the nasal septum. Widening of the
intercanthal distance suggests the possibility of anasoorbitoethmoid fracture.
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Done by:Qais samara