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:
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
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
No comments:
Post a Comment