Facial injury
| Treat this as a head/c-spine injury, THEN think about the face | |
|---|---|
| Mechanism | |
| Examination | Significant signs: - Visual disturbance – indicating possible orbital or globe injury - Eye position and visual acuity; enopthalmos and proptosis are BAD - Entrapment of orbital muscles more likely in children - Subconjunctival haemorrhage - no posterior border = orbital wall # - Retrobulbar haemorrhage - Alteration in bite or difficulty moving the jaw – suggests mandible, maxilla or zygomatic arch injury - Sensory disturbance to the cheek and upper gum – a sign of infraorbital nerve injury - Dental trauma? |
| Diagnostic investigations | ➥ Facial XR - OM15/OM30 (with reference to specific views) ➥➥ teardrop sign - inferior orbital wall fracture ➥ CT facial bones - gold standard for orbital floor injuries, or if XRs cannot be performed e.g. C spine concerns ➥ Beta-2 transferrin - detect CSF in nasal discharge |
| Immediate management | Resuscitation: Bleeding from facial injuries unlikely to cause such significant hypovolaemia to produce shock. In the stable patient: - Orbital injury → maxfax - Restricted mouth opening → maxfax Discharge advice: - Avoidance of nose blowing as this may produce surgical emphysema - Not to occlude the nose when sneezing |