Skip to content

Facial Injuries Module

SHARE VIA:

TopicFacial Trauma
AuthorOrla Kelly
Duration1.5 hours

Basics (20 mins)

Main session: (4 x 15 minute) case discussions covering the key points and evidence

Take home learning points: (5 mins)

Basic Anatomy, Function and Initial Assessment

Fig 1: https://commons.wikimedia.org/wiki/File:Figure_38_01_06.jpg

Above is a depiction of the adult facial bones. Paediatric anatomy differs slightly in the following ways, which affects the likelihood of fracture and injury pattern:

  1. Relative protrusion of the frontal bone from birth protects the smaller midface.
  2. Pneumatisation of the sinuses occurs in a stepwise fashion, leaving the facial bones more dense.
  3. The structure of bone means it is more elastic and resistant to fracture, but more prone to Greenstick fracture.
  4. The presence of unerupted permanent teeth adds strength to maxilla and mandible.
  5. Increased fat pads and soft tissue structures act as buffers to injury. 

Facial fractures occur less commonly in children than in adults, and often follow a particular ‘top down’ pattern of injury in accordance with age. Due to the relative protrusion of the frontal bone from birth, younger children are more likely to have frontal bone and orbital floor fractures, with the incidence of nasal, zygomatic-maxillary complex and mandibular fractures becoming more common in later years, associated with play activities and sports. Nasal bone fractures are the most common fracture of childhood, followed by madibular, orbital, frontal skull and midface.

History

As with any trauma the history of the event is crucial. Facial fractures are often associated with significant intracranial or other injuries and a full history, primary and secondary survey are essential. History of the event will give an indication of the velocity of trauma and likelihood of other injuries. For instance – a direct blow to the orbit will increase suspicion of a blowout fracture rather than a fall from a bike.   

In particular, do not forget:

  1. Red flag questions regarding head injury – loss of consciousness/vomiting/amnesia
  2. Occular symptoms – diplopia/change in visual acuity/pain on eye movements
  3. Jaw closing – does the patient feel their mouth closing is different?

A 12-year-old boy is brought into the department by his father. He was playing a rugby match and during a tackle, he received a blow to the face. When questioned, he thinks he was elbowed in the nose. He had epistaxis on the pitch which has since stopped.

What other questions would you like to ask regarding the history?

How would you examine this patient?

What investigations and management would be appropriate?

What other questions would you like to ask regarding the history?

How would you examine this patient?

What investigations and management would be appropriate?

A 6-year-old girl is brought in by ambulance after falling off her bike. She has been crying uncontrollably since. The fall was witnessed, she did not lose consciousness and has not vomited. She is holding the left side of her face. Mum reports there was no blood at the scene.

What is your first action in the management of this patient?

What clinical signs might give you a clue that a mandible fracture was present?

How would you investigate this injury?

What nerve can be damaged in this injury?

What follow-up is required?

What is your first action in the management of this patient?

What clinical signs might give you a clue that a mandible fracture was present?

How would you investigate this injury?

What nerve can be damaged in this injury?

What follow up is required?

An 8-year-old boy is brought into the ED following a blow to the right eye when playing tennis. He is complaining of pain and has been vomiting.

Describe the anatomy of the orbit

What investigations are appropriate in this case? 

Why is this patient vomiting, and what other signs or symptoms might you expect?

If the patient started complaining of severe pain in the affected eye, what might you consider?

Describe the anatomy of the orbit

What investigations are appropriate in this case? 

Why is this patient vomiting, and what other signs or symptoms might you expect?

If the patient started complaining of severe pain in the affected eye, what might you consider? 

A 12-year-old boy is brought in by ambulance following a road traffic accident. He was a pedestrian hit by a car moving at approximately 40km/hr. His GCS is 14 and he has obvious severe bleeding facial injuries.

Outline the initial management and stabilisation of this patient

What does Le Fort mean?

What are the next steps required for this patient?

Outline the management and stabilisation of this patient.

What does Le Fort mean?

What are the next steps required for this patient?

A 14-year-old girl is brought in by ambulance following a sporting accident. She was playing camogie* without a helmet and was struck with a hurl (similar to a hockey stick) during a mid-air challenge. She received good pre-hospital analgesia by paramedics and is now comfortable. She has significant bruising and a laceration on the left side of her face. You suspect a zygomatic maxillary complex fracture.

*an Irish sport, sort of the female version of hurling (both Gaelic sports)

What specific injury pattern would you expect in a zygomatic maxillary complex (ZMC) fracture?

What neurological defects might be present?

What investigations are necessary?

What treatment should be instigated in the ED?

What specific injury pattern would you expect in a zygomatic maxillary complex (ZMC) fracture?

What neurological defects might be present?

What investigations are necessary?

What treatment should be instigated in the ED?

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7


Please download our Facilitator and Learner guides

Author

  • Orla Kelly is an emergency medicine trainee with an economics degree – frequently found frowning at the frivolous use of IV paracetamol and other expenses in the department. Passionate about recycling and the environmental impact of healthcare waste. When not at work can be found at a rugby match or drafting a screenplay loosely based on past experiences – ‘Bridget Jones’ Infirmary’.

KEEP READING

Diagnosing ASPGN HEADER

Diagnosing acute post-streptococcal glomerulonephritis

,
Not a fever HEADER

When is a fever not ‘just a fever’?

Copy of Trial (1)

Bubble Wrap PLUS – May 2024

Copy of Trial (1)

The 80th Bubble wrap x DFTB MSc in PEM

SVT HEADER

SVT in infants

DACRYOCYSTITIS

Dacryocystitis 

PARDS HEADER

Paediatric acute respiratory distress syndrome (PARDS)

, ,
OXY-PICU HEADER

The Oxy-PICU trial

, , ,
Copy of Trial (1)

Bubble Wrap PLUS – April ’24

PaedsPlacement HEADER

A Medical Students Guide to Paediatrics

Social admsissions

The Silent Crisis: The impact of paediatric hospital social admissions

HUS HEADER (1)

Haemolytic Uraemic Syndrome

,
Copy of Trial (1)

Bubble Wrap PLUS – March ’24

Plagiocephaly HEADER

An approach to the infant with plagiocephaly

Copy of Trial (1)

The 79th Bubble Wrap x Bristol Royal Hospital For Children

Leave a Reply

Your email address will not be published. Required fields are marked *

DFTB WORLD

EXPLORE BY TOPIC