Facial trauma

Facial trauma

Trauma to the face is often accompanied by other extensive injuries. In case of a severe concomitant injury, first of all, it will be necessary to ensure adequate ventilation of the lungs of the victim and stable hemodynamics, to exclude damage that poses a threat to life. After urgent measures, a thorough examination of the face is carried out.

Injuries

• • Ragged-bruised wounds of the face bleed heavily. Bleeding is stopped by pressing on the bleeding vessel, but never by blind clamping. Final hemostasis is performed in the operating room.
  • Stab wounds may involve deep-seated structures (eg, the facial nerve and duct within the ear gland).

Blunt facial trauma

• • General information
  • Physical examination often reveals facial asymmetry. The following symptoms are possible:
  • Anomalies of bite can be a sign of a fracture of the upper or lower jaw
  • Pathological mobility of the upper jaw – a sign of its fracture or fracture of the bones of the facial skull
  • Pain on palpation, depression or asymmetry of the nose – signs of a fracture of the bones of the nose
  • Diplopia, deformity of the zygomatic arch, anophthalmos and hypesthesia of the cheek skin are manifestations of a comminuted fracture of the orbit.
  • X-ray examination is required. As a rule, the treatment is surgical.
  • The main types of facial injuries
  • Fracture of the zygomatic bone. More often the zygomatic arch breaks in the area of ​​​​the junction of the zygomatic and temporal bones
  • Manifestations. Pain when opening the mouth, eating. Lateral movements of the jaw in the direction of damage are not possible. On examination, retraction of soft tissues at the fracture site is revealed. Often determine the unevenness in the region of the lower edge of the orbit (symptom of a step). On the radiograph in the axial (axial) projection, the displacement of the broken section of the zygomatic bone and the decrease in the transparency of the maxillary sinus (if it is damaged) are visible
  • Surgical treatment.
  • Mandibular fractures traditionally occur at the neck, angle, and body of the bone, as well as along the midline. There are fractures unilateral, bilateral, multiple, comminuted. Fractures passing within the dentition are considered open, they are accompanied by ruptures of the periosteum and mucous membrane of the alveolar process. The root of the tooth is often visible in the fracture gap
  • fr Manifestations: pain when moving the lower jaw, malocclusion. On examination: facial asymmetry, possible hematoma. Mouth opening is usually limited. Palpation determines the pathological mobility of the jaw. To determine the location of the fracture, a load symptom is used – the occurrence of pain at the fracture site when pressing on the bone body in the anteroposterior direction. X-ray examination helps to clarify the localization of damage
  • Treatment. Produce reposition of fragments. Options for immobilization of fragments of damaged bone can be divided into two groups:
  • a structure for fixing fragments is inserted directly into the fracture area or brought into close contact with it (intraosseous metal rods, pins, screws; suturing of fragments, fixing them with a combination of a bone suture with a pin, using self-hardening plastic, fixing with bone plates, etc.)
  • the structure for fixation is placed away from the fracture zone

(special extraoral devices, the use of external ligatures, elastic suspension of the jaw, compression osteosynthesis).

• • Fractures of the upper jaw. The upper jaw is tightly connected with other bones of the facial skeleton and the base of the skull. There are three main types of fracture
  • Upper (Lefort-1). Its line passes through the nasofrontal suture, along the inner and outer walls of the orbit, reaches the upper part of the pterygoid process and the body of the sphenoid bone. At the same time, the zygomatic process of the temporal bone and the nasal septum are fractured in the vertical direction. Thus, with a Lefort-1 fracture, the facial bones are separated from the bones of the skull. Clinical picture: loss of consciousness, retrograde amnesia, vomiting, bradycardia, bradypnea, nystagmus, pupillary constriction, coma, liquorrhea from the nose and / or ear; due to hemorrhage in the retrobulbar tissue, exophthalmos occurs; mouth opening is limited; while maintaining consciousness, the patient complains of diplopia, painful and difficult swallowing. X-ray of the facial bones: signs of damage to the zygomatic arch, the greater wing of the sphenoid bone and the fronto-zygomatic joint, as well as a decrease in the transparency of the maxillary and sphenoid sinuses; on lateral radiographs – signs of a fracture of the body of the sphenoid bone
  • Medium (Lefort-II). Its line passes through the junction of the frontal process of the maxilla with the nasal part of the frontal bone and nasal bones (nasofrontal suture), then goes down the medial and lower walls of the orbit, crosses the bone along the infraorbital margin and reaches the pterygoid process of the sphenoid bone. With a bilateral fracture, involvement of the nasal septum is likely. The ethmoid bone with the cribriform plate is often damaged. Complaints: hypesthesia of the infraorbital region, upper lip and wing of the nose; when the nasolacrimal canal is damaged, lacrimation occurs; probably damage to the cribriform plate. Objective data: typical subcutaneous hematomas in the area of ​​damage, more often in the area of ​​the lower eyelid; possible hemorrhages in the mucous membrane of the oral cavity; palpate bone fragments. Radiography of the facial bones: in the axial projection – numerous injuries of the upper jaw (in the region of the bridge of the nose, the lower edge of the orbit, etc.); on lateral radiographs – a fracture line running from the ethmoid bone to the body of the sphenoid bone; when a bone step is found in the region of the Turkish saddle, they speak of a fracture of the bones of the base of the skull
  • Lower type of fracture (Lefort-III). Its line runs in a horizontal plane. Starting at the edge of the piriform opening from 2 sides, it goes posteriorly above the level of the bottom of the maxillary sinus and passes through the tubercle and the lower 30% of the pterygoid process of the sphenoid bone. Complaints: pain in the upper jaw, hypoesthesia of the gingival mucosa, malocclusion. Objective data: on examination, swelling of the upper lip, smoothness of the nasolabial fold are revealed; palpation determine the protrusions of bone fragments; load symptom put-

body. Radiography: in the axial projection – a violation of the integrity of the bone in the region of the zygomatic-alveolar crest and a decrease in the transparency of the maxillary sinuses. See also Dislocation of the lower jaw, Fracture, Traumatic brain injury

ICD

• SOO Superficial head injury
• S01 Open wound of head
• S02 Fracture of skull and facial bones
• S09 Other and unspecified head injuries