Facial injury scenario
scenario 1:
They were kneed in the face during a rugby match. Currently has pain around eye only.
O/E: Binocular diplopia, acuity normal
scenario 2:
She crashed her e-scooter and hit her chin on the pavement. Jaw is very painful, unable to close mouth properly and drooling. No other injury.
O/E: Maximal tenderness over L mandibular margin, loss of sensation L lip
examiner brief
- Wash hands, introduce self
- Confirm patient identity
- Check need for analgesia
- Clarifying questions about mechanism
- Patient exposed from neck up
- Clarify no c-spine or head injury concerns
- Inspection:
- deformity, wounds, scars
- asymmetry of cheek
- nasal deviation
- CSF rhinorrhea, otorrhea
- subconjunctival haemorrhage
- Palpation
- Superior orbital margins
- Feels for steps in bone, pain, crepitus
- Tests for sensation in territory of V1/V2/V3
- Side of nose and upper lip (infra orbital nerve)
- Numbness of upper teeth
- Numbness of lower teeth and lip (inferior alveolar nerve suggests mandibular #!)
- Mouth
- Bleeding, malocclusion, loose teeth
- Eyes
- visual acuity, ROM, fundi
- Ears
- Battle's sign, otoscopy
- Summarises findings
- Appropriate management plan
- Thanks patient