1. Shiraaz Shaikjee 08 April 2008
Case Presentation
Shiraaz Shaikjee
08 April 2008

2. 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 #

3. 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

4. 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

5. 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

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

7. 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

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

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

10. Blow out #

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

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

13. Le Forte #’s I/II/III

15. What are the #’s???

16. Mandibular #’s

17. Mandibular #’s

18. Thank You