Facial Structures and Injuries

Orbit Fracture

A blow to the eye can cause the orbit to blow out and fracture

Eyeball retracts into the socket (Enophtalmos)

Double vision (diplopia) and/or loss of upward vision

Pupils at different horizontal level to each other

Loss of sensation above eyebrow & over cheek

Maxilla Fracture

Most common in RTC, other blunt injuries including assault and sports injuries

Maxilla fractures are associated with injuries to other facial structures

Teeth

Frequently knocked out (avulsed) due to trauma

Can be inhaled in unconscious patients

Avulsed teeth can displave soft tissue including lips

Fractures to crown of tooth extremely painful

Soft Tissue Facial Injuries

Tissue has an abundant blood supply and can result in dramatic looking wounds

Uncommon to lead to Hypovolemia except in children

Large facial lacerations often gape due to muscle pull & those in the middle third of the face can swell rapidly masking underlying fractures

If swelling involved the eyelids this van prevent examination of the globe of the eye hiding damage to the patents vision

Facial Injuries - Complications

Immediate:

Airway compromise

Aspiration

Haemorrhage

Infection

Longer Term:

Scars and permanent facial deformity

Nerva damage leading to loss of facial sensation, movement, smell, taste or vision

Facial Injuries - Management

ABC

Consider postural drainage or suction

OP’s are not always helpful in facial injuries

NP’s are better tolerated but use with caution

Application of BVM can be challenging

Advanced airway and pain management are usually required

Bets managed sitting up and leaning forward if tolerated to allow drainage and removal of debris from the mouth