Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-swprf Total loading time: 0 Render date: 2025-05-07T02:39:13.308Z Has data issue: false hasContentIssue false

Chapter 8 - Facial Trauma

Published online by Cambridge University Press:  23 August 2019

By
Norah Kairys  and
Zachary Repanshek
Edited by
Alex Koyfman  and
Brit Long
Alex Koyfman
Affiliation:
University of Texas Southwestern Medical Center
Brit Long
Affiliation:
San Antonio Military Medical Center
Get access

Summary

Facial trauma is a common presentation in the Emergency Department. As the face is vital to both physical appearance and the ability to eat, speak, and perform other important functions, proper management of patients presenting with facial trauma is critical. Initial treatment must focus on life-threatening injuries, but careful attention to long-term function and cosmesis must also be considered. Any patient presenting with facial trauma must also be evaluated for other traumatic injuries, as more than 50% of these patients will have injuries in multiple systems.1 As with any trauma patient, ATLS guidelines should be followed, and the initial evaluation of injuries should begin with management of the airway, breathing, and circulation.

Type
Chapter
Information
The Emergency Medicine Trauma Handbook , pp. 105 - 121
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Tintinalli, JE, Kelen, GD, Stapczynski, JS, et al. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004.Google Scholar
Erdmann, D, Follmar, KE, Debruijn, M, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008;60(4):398–403.CrossRefGoogle ScholarPubMed
Shetty, V, Dent, DM, Glynn, S, Brown, KE. Psychosocial sequelae and correlates of orofacial injury. Dent Clin North Am. 2003;47(1):141–57, xi.Google Scholar
Jose, A, Nagori, SA, Agarwal, B, Bhutia, O, Roychoudhury, A. Management of maxillofacial trauma in emergency: an update of challenges and controversies. J Emerg Trauma Shock. 2016;9(2):73–80.Google Scholar
Crewdson, K, Jerry, PN. Management of the trauma airway. Trauma. 2011;13(3):221–32.Google Scholar
Rosen, CL, Wolfe, RE, Chew, SE, Branney, SW, Roe, EJ. Blind nasotracheal intubation in the presence of facial trauma. J Emerg Med. 1997;15(2):141–45.CrossRefGoogle ScholarPubMed
Roppolo, LP, Vilke, GM, Chan, TC, et al. Nasotracheal intubation in the emergency department, revisited. J Emerg Med. 1999;17(5):791–99.Google Scholar
Ardekian, L, Samet, N, Shoshani, Y, Taicher, S. Life-threatening bleeding following maxillofacial trauma. J Craniomaxillofac Surg. 1993;21(8):336–38.Google Scholar
Thaller, SR, Beal, SL. Maxillofacial trauma: a potentially fatal injury. Ann Plast Surg. 1991;27(3):281–83.CrossRefGoogle ScholarPubMed
Buchanan, RT, Holtmann, B. Severe epistaxis in facial fractures. Plast Reconstr Surg. 1983;71(6):768–71.CrossRefGoogle ScholarPubMed
Gwyn, PP, Carraway, JH, Horton, CE, Adamson, JE, Mladick, RA. Facial fractures – associated injuries and complications. Plast Reconstr Surg. 1971;47(3):225–30.CrossRefGoogle ScholarPubMed
Dakir, A, Ramalingam, B, Ebenezer, V, Dhanavelu, P. Efficacy of tranexamic acid in reducing blood loss during maxillofacial trauma surgery – a pilot study. J Clin Diagn Res. 2014;8(5):ZC06–8.Google Scholar
Bynoe, RP, Kerwin, AJ, Parker, HH 3rd, et al. Maxillofacial injuries and life-threatening hemorrhage: treatment with transcatheter arterial embolization. J Trauma. 2003;55(1):74–79.CrossRefGoogle ScholarPubMed
Shimoyama, T, Kaneko, T, Horie, N. Initial management of massive oral bleeding after midfacial fracture. J Trauma. 2003;54(2):332–36; discussion 336.Google Scholar
Sargent, LA, Rogers, GF. Nasoethmoid orbital fractures: diagnosis and management. J Craniomaxillofac Trauma. 1999;5(1):19–27.Google Scholar
Crean, SJ. Cranial nerves: functional anatomy. Ann R Coll Surg Engl. 2007;89(2):194.CrossRefGoogle Scholar
Dahiya, R, Keller, JD, Litofsky, NS, et al. Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations. J Trauma. 1999;47(6):1079–83.Google Scholar
Yilmazlar, S, Arslan, E, Kocaeli, H, et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 2006;29(1):64–71.Google Scholar
Nosan, DK, Benecke, JE Jr, Murr, AH. Current perspective on temporal bone trauma. Otolaryngol Head Neck Surg. 1997;117(1):67–71.CrossRefGoogle ScholarPubMed
Freihofer, HP. Inner intercanthal and interorbital distances. J Maxillofac Surg. 1980;8(4):324–26.CrossRefGoogle ScholarPubMed
Chang, CY, Cass, SP. Management of facial nerve injury due to temporal bone trauma. Am J Otol. 1999;20(1):96–114.Google Scholar
Sun, JK, LeMay, DR. Imaging of facial trauma. Neuroimaging Clin N Am. 2002;12(2):295–309.Google Scholar
Mondin, V, Rinaldo, A, Ferlito, A. Management of nasal bone fractures. Am J Otolaryngol. 2005;26(3):181–85.CrossRefGoogle ScholarPubMed
Singer, AJ, Mach, C, Thode, HC Jr, et al. Patient priorities with traumatic lacerations. Am J Emerg Med. 2000;18(6):683–86.CrossRefGoogle ScholarPubMed
Moran, GJ, Talan, DA, Abrahamian, FM. Antimicrobial prophylaxis for wounds and procedures in the emergency department. Infect Dis Clin North Am. 2008;22(1):117–43, vii.Google Scholar
McClenaghan, FC, Ezra, DG, Holmes, SB. Mechanisms and management of vision loss following orbital and facial trauma. Curr Opin Ophthalmol. 2011;22(5):426–31.CrossRefGoogle ScholarPubMed
Stuteville, OH, Janda, C, Pandya, NJ. Treating the injured ear to prevent a “cauliflower ear.” Plast Reconstr Surg. 1969;44(3):310–12.CrossRefGoogle ScholarPubMed
Greywoode, JD, Pribitkin, EA, Krein, H. Management of auricular hematoma and the cauliflower ear. Facial Plast Surg. 2010;26(6):451–55.Google Scholar
Gao, T, Li, X, Hu, J, et al. Management of traumatic tympanic membrane perforation: a comparative study. Ther Clin Risk Manag. 2017;13:927–31.CrossRefGoogle ScholarPubMed
Hough, JVD. Fractures of the temporal bone and associated middle and inner ear trauma. Proc R Soc Med. 1970;63;245–56.Google Scholar
Dula, DJ, Fales, W. The ‘ring sign’: Is it a reliable indicator for cerebral spinal fluid? Ann Emerg Med. 1993;22(4):718–20.CrossRefGoogle ScholarPubMed
Friedman, JA, Ebersold, MJ, Quast, LM. Post-traumatic cerebrospinal fluid leakage. World J Surg. 2001;25(8):1062–66.CrossRefGoogle ScholarPubMed
McCudden, CR, Senior, BA, Hainsworth, S, et al. Evaluation of high resolution gel beta(2)-transferrin for detection of cerebrospinal fluid leak. Clin Chem Lab Med. 2013;51(2):311–15.Google Scholar
Olsen, KD, Carpenter RJ 3rd, Kern EB. Nasal septal injury in children. Diagnosis and management. Arch Otolaryngol. 1980;106(6):317–20.Google Scholar
Rohrich, RJ, Adams, WP Jr. Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg. 2000;106(2):266–73.Google Scholar
Bell, RB, Dierks, EJ, Homer, L, Potter, BE. Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg. 2004;62(6):676–84.CrossRefGoogle ScholarPubMed
Kuhnel, TS, Reichert, TE. Trauma of the midface. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:10.Google ScholarPubMed
Jacoby, CG, Dolan, KD. Fragment analysis in maxillofacial injuries: the tripod fracture. J Trauma. 1980;20(4):292–96.Google Scholar
Motamedi, MH, Dadgar, E, Ebrahimi, A, et al. Pattern of maxillofacial fractures: a 5-year analysis of 8,818 patients. J Trauma Acute Care Surg. 2014;77(4):630–34.Google Scholar
Fraioli, RE, Branstetter, BF 4th, Deleyiannis, FW. Facial fractures: beyond Le Fort. Otolaryngol Clin North Am. 2008;41(1):51–76, vi.Google Scholar
Yanagisawa, E. Symposium on maxillo-facial trauma. 3. Pitfalls in the management of zygomatic fractures. Laryngoscope. 1973;83(4):527–46.Google Scholar
Gorchynski, J, Karabidian, E, Sanchez, M. The “syringe” technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department. J Emerg Med. 2014;47(6):676–81.Google Scholar
Shorey, CW, Campbell, JH. Dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(6):662–68.Google Scholar
Schwab, RA, Genners, K, Robinson, WA. Clinical predictors of mandibular fractures. Am J Emerg Med. 1998;16(3):304–5.CrossRefGoogle ScholarPubMed
Caputo, ND, Raja, A, Shields, C, Menke, N. Re-evaluating the diagnostic accuracy of the tongue blade test: still useful as a screening tool for mandibular fractures? J Emerg Med. 2013;45(1):8–12.Google Scholar
Alonso, LL, Purcell, TB. Accuracy of the tongue blade test in patients with suspected mandibular fracture. J Emerg Med. 1995;13(3):297–304.CrossRefGoogle ScholarPubMed
Lazaridou, M, Iliopoulos, C, Antoniades, K, et al. Salivary gland trauma: a review of diagnosis and treatment. Craniomaxillofac Trauma Reconstr. 2012;5(4):189–96.CrossRefGoogle ScholarPubMed
Belmonte, FM, Macedo, CR, Day, PF, Saconato, H, Fernandes Moca Trevisani, V. Interventions for treating traumatised permanent front teeth: luxated (dislodged) teeth. Cochrane Database Syst Rev. 2013;(4):CD006203.Google Scholar
Day, P, Duggal, M. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. Cochrane Database Syst Rev. 2010;(1):CD006542.Google Scholar
Petrovic, B, Markovic, D, Peric, T, Blagojevic, D. Factors related to treatment and outcomes of avulsed teeth. Dent Traumatol. 2010;26(1):52–59.Google Scholar
Schatz, JP, Hausherr, C, Joho, JP. A retrospective clinical and radiologic study of teeth re-implanted following traumatic avulsion. Endod Dent Traumatol. 1995;11(5):235–39.CrossRefGoogle ScholarPubMed
Perry, M. Advanced trauma life support (ATLS) and facial trauma: can one size fit all? Part 1: dilemmas in the management of the multiply injured patient with coexisting facial injuries. Int J Oral Maxillofac Surg. 2008;37(3):209–14.Google Scholar
Merritt, RM, Williams, MF. Cervical spine injury complicating facial trauma: incidence and management. Am J Otolaryngol. 1997;18(4):235–38.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×