Maxillofacial Trauma for Certified Emergency Nursing (CEN)

Maxillofacial Trauma:

Definition/Etiology:

Maxillofacial trauma is anything that causes trauma to the face. Common sources of maxillofacial trauma include the following:

• Motor vehicle crashes
• Intimate partner violence
• Sporting injuries
• Penetrating trauma
• Falls

In the past MVCs were the top culprit for these injuries. However, with better safety features in cars these days, like airbags and seatbelts and crumple zones, this number has decreased. Unfortunately, it means that now IPV is considered the leading cause of maxillofacial trauma.

Pathophysiology:

The patho behind maxillofacial trauma is anything that can cause insult to the area. Fractures, lacerations, abrasions, dislocations, any of these injuries can be present. And most if not all of them are caused by external factors.

Clinical Presentation:

The clinical presentation depends on the injury we are focusing on.

Facial and Soft Tissue Trauma:

• Bleeding…lots of bleeding. The face is very vascular. depending on location of soft tissue injury (mouth) airway problems become a top priority

Auricular Trauma:

• This is the outer, visible part of the ear. Again, bleeding can be present. Also, as this is a highly pierced area, severe lacerations can occur.

Ruptured Tympanic Membrane:

• Blood or other drainage from the ear canal
• Sudden, sharp ear pain
• Tinnitus
• Vertigo

Facial fractures:

• Nasal fracture
  • Epistaxis
  • Deformity
  • Periorbital ecchymosis

• Zygomatic Fractures (cheekbone)
  • Trismus (lockjaw)
  • Diplopia with upward gaze
  • Periorbital ecchymosis
  • Palpable step defect and point tender
  • Sub Q Emphysema of the face

• Orbital Rim Fractures
  • Visible or palpable deformity around orbit
  • Diplopia
  • Ocular entrapment
  • Periorbital edema and ecchymosis

• Maxillary Fractures
  • Lefort I
  • Lefort II
  • Lefort III
  • OK we are not going to go into each of the lefort fractures as we have limited time here, but i highly… highly recommend you look these up and know the difference. I will say this; a lefort III is a complete craniofacial separation!

• Mandibular Fractures
  • Malocclusion of teeth
  • Trismus
  • Blood and bony fragments in mouth
  • Point tender

Collaborative Management:

There are very similar things we need to do with any of these injuries. First things first, assess and maintain an airway. Be careful with this because as with any maxillofacial trauma you have to keep in mind the possibility of a basilar skull fracture. If you can, get a good history and mechanism of injury.

We need to control bleeding as best we can. We know direct pressure is a first line, but again, have an idea what you’re working with. If you apply direct pressure to the nose of someone with a Lefort III, you will push their nose through their skull. Maybe some light pressure until you get that X-ray ASAP.

Oh yeah and get an x-ray ASAP. You need to know what kind of injuries you are dealing with.

Might need ortho, plastics, some more specific subspecialities within those.

Evaluation | Patient Monitoring | Education:

ABCs:
Determine extent of injuries once stable. If it’s a ruptured tympanic, can they hear? If it’s a lefort fracture, can they breathe? Is bleeding controlled? Are the wounds cleansed?

Education for these patients will be specific to the injury they have suffered.

Linchpins: (Key Points)

• Airway
• Assess and act
• Radiology
• Consults