Facial Trauma Learning Points:
- Look to get a CT scan of the maxillofacial bones based on mechanism, external signs of trauma, diplopia, or signs of ocular entrapment
-Excessive nasal discharge in the setting of facial trauma is a concerning finding.
- Traumatic subconjunctival hemorrhage is concerning and you should have a higher alert for a possible orbital floor fracture.
- Indications for emergency facial consultation include persistent epistaxis, nasal septal hematoma, significant or concerning lacerations, exposed cartilage, orbital entrapment
- Binocular double vision has you concerned for entrapment while monocular diplopia is worrisome for an injury to the eye itself.
- Antibiotics should be given to patients with fractures with sinus involvement, open fractures, bite wounds, and penetrating trauma.
-Sinus precautions are done to prevent subcutaneous emphysema. These include avoiding nose blowing, sneezing, straining/heavy lifting, and avoiding pressure changes (e.g. swimming, flying, scuba diving, blowing up balloons). Patients should also keep their head elevated.
-Delayed surgery or secondary reconstruction on facial trauma patients can be very challenging. Early consult is beneficial for most complex facial fractures.
