Shiraaz Shaikjee 08 April 2008 Case Presentation Shiraaz Shaikjee 08 April 2008

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 #

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

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

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

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

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

Eye - Orbit Open eye – paper clip Cheimosis Pupil, globe penetration, corneal laceration Hyphema, subconjunctival hemorrhage Full 360˚ of the orbit BLOW OUT #

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

Blow out #

NASAL BONES Palpate for obvious #’s Biggest problem being that of hemorrhage Rich blood supply – Littles area May need packing – BOS

MID FACE Palpate maxilla and zygoma Hemorrhage Le forte #’s

Le Forte #’s I/II/III

What are the #’s???

Mandibular #’s

Mandibular #’s

Thank You