Handover teaching

Facial injuries

Objectives

• History • Examination • Requesting x-rays •  Interpreting x-rays

History

• Mechanism of injury – Fall, Assault, Collapse

• Visual Disturbance • Otorrhoea • Epistaxis • Teeth missing • Eating ok? / Malocclusion

Examination

• Associated injuries – head, neck • Thirds!

– Forehead, Eyes and Orbital Margins – Nose, Maxilla and Ears – Mouth and Mandible

• Look, Feel, Move

Eyes

• Visual Acuity must be assessed and documented

• Fundoscopy • FROEM

Nose

• Allignment • Patency • Septal Haematoma

– Rare, Document

Jaw

• Normal bite / malocclusion • Teeth present • Mouth opening • Sublingual haematoma

X-rays of facial bones

• What to request • ABCs • Systems • Tips and symmetry • Low threshold for senior advice

Requests

• Orbit and Zygoma injuries ask for ‘facial views’

•  Jaw injuries ask for ‘OPG’ and PA mandible

• Do not x-ray nasal bones

2 Elephants, 4 Rings, Symmetry

1 2

3 4 5 6

McGrigor’s lines…

Mandible fractures

• Picture mandible as a bony ring (include base of skull for complete ring)

• One disruption in a bony ring rare - usually a second fracture or dislocation is present

• Second one may be hard to spot

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Summary

• Why did they fall? • Associated injuries? • Specific points in examination • X-rays – use system • Ask for advice