Sunday, November 11, 2018

Facial Trauma Exam

Thorough MaxilloFacial exams are often necessary during secondary survey in EDs to convey the findings to the Facial surgeons/Ophthalmology. Things you should worrk about is vision, eye muscle entrapment and maxilla/mandible fractures. Ask these three questions to start with and check all the orifices in and around the face. 


Key Questions:
  • Is your vision okay?
  • Do you feel numb on your face?
  • Is your bite okay?
Rule out any ABC compromise first including Cervical Spine injury. 

Head and Neck

External evidence of head trauma
Neck injuries - wounds, swellings

FACE
Look
Watch from front, top and sides
Swelling/Deformity 
Obvious bleeding sites - lacs, avulsed wounds, bruising

Feel
Palpate entire facial bones
Assess TMJ
Surgical Emphysema
Facial Sensations

Move
Mouth opening
Check dental occlusion (Bite)
Bimanual facial exam to assess LeForte Fractures




Check all facial orifices:
Eyes - VA, Pupils, EOM, Visual Fields, Slit Lamp, IOP, Fundus, Intercanthal distance
Ears - TMJ Tenderness, Hemotympanum, Ottorhea, Auricular Hematoma
Nose - Septal Hematoma, Bleeding, Deformity
Mouth - Intraoral lacs, tooth fractures, salivary gland duct site lacs, dentoalveolar fractures



Posted by:

              
     Lakshay Chanana
     
     ST4 Trainee
     Royal Infirmary of Edinburgh
     Department of Emergency Medicine
     Edinburgh
     Scotland

     @EMDidactic

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