1. FACIAL INJURIES
Dr Pierre Viviers

2. INTRODUCTION Complain of pain above shoulder > injury
Associated injuries
Airway/ C-spine
Needs medical attention
Anatomy

3. Orbit – Zygoma Complex Blow-out #: Blunt trauma (elbow)
Compression (globe & orbital contents)
Fracture – orbital floor
Peri-orbital bleeding
Sunken eye
Double vision on upward gaze (entrapment of inferior rectus muscle)
Numbness of cheek
Refer doctor Immediate anti-biotic
Specialized management

4. Eye All eye injuries-thorough medical examination
Serious injuries-immediate referral (ophthalmologist)
Difficult dilemma-distinguish
Immediate referral:
Severe eye pain
Persistent photophobia
Penetrating injury: pear shaped pupil
Hyphema
Embedded FB
Markedly impaired visual acuity
Loss visual field

5. Eye Corneal Abrasion: Common, red & painful Rinse & refer Antibiotic
Sub-conjunctiva Bleeding:
No treatment
Hyphema:
Bleeding (cornea/ iris)
Severe pain/ blurred vision
Refer (rest & pressure)
Retinal Detachment:
Light flashes
“Curtain” – field of vision
Urgent referral
Eyelid Lacerations:
Exclude coexisting injuries
Lachrymal duct (medial)

6. Nose Epistaxis: Little`s Area Digital compression (sitting upright)
Cold compression on the bridge
> 20min - Refer
Nasal Fractures
Septal Hematoma

7. Ear Auricular Hematoma : Cauliflower Ear External contusion
Bleeding between layers
Swelling, pain & tender
Refer: medical management
Tympanic Membrane Rupt:
Blow to side of head
Pain, bleeding & hearing impairment
Refer: medical examination

8. Mandible (Jaw) Fractures: Common – blow to jaw Associated injuries
More than one site (both sides of the midline)
Swelling, tender & painful
Misalignment of teeth & bleeding
Airway (conscious/ unconscious):
Positioning (ABC)
Forward sitting &supporting jaw with both hands
Cervical collar, immediate referral

9. Mandible (Jaw) Dislocation (TMJ): Blows to mandible Common Pain
Malocclusion
Inability to close
Management:
Reduce (down & back
Refer

10. Teeth Fractures, luxated, avulsed: Common-blows against the head
Thorough examination of oral cavity
Missing tooth – swallow > complication
Management:
Protect fragment (milk, saline, under tongue
Handled by crown
Reposition/ place back
Replace within 60 min
Unconscious (replaced < 2hrs)

11. TONGUE Laceration: Accidental bite Bleeding General Principles:
Rinse/ pressure
Extensive Injuries needs careful suturing

12. Questions
Thank You