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Maxillofacial Injuries


General Principles

Epidemiology

  • Three to twenty-nine percent of facial injuries are a result of sporting activities.

  • Sixty to ninety percent of facial injuries in sports occur in males aged 10–29 years.

  • Approximately 75% of facial fractures involve the zygoma, mandible, or nose.

  • Most commonly injured teeth are maxillary central incisors, followed by lateral incisors and mandibular incisors.

Initiation of Care of the Head-Injured Athlete

Airway Injury or Compromise

  • Perform primary survey, following the ABCDEs (airway, breathing, circulation, disability/neurologic assessment, exposure) of basic life support.

  • May need to secure airway before making any other assessment.

  • If neck is injured, use jaw thrust maneuver and maintain cervical spine precautions.

  • May be difficult to maintain airway with unstable mandibular fracture and some soft tissue injuries.

  • Can use oral airway or endotracheal tube as indicated in unconscious patients. A nasal trumpet works well in an awake patient without a midface fracture.

  • Cricothyrotomy may be the only option in emergency.

Cervical Spine Injury and Concussion (See Chapter 45 : “Head Injuries” and Chapter 46 : “Neck Injuries”)

  • The spine must be stabilized if there is any doubt regarding injury or if the athlete shows altered mental status.

  • With facial injuries, providers must check for associated cervical spine injuries or concussion. Approximately 1 in 20 mandibular fractures will have an associated cervical spine injury.

History

  • Check for history of abnormalities such as crooked nose, missing teeth, malocclusion, or anisocoria to look for preexisting condition.

Physical Examination

Inspection

  • Observe for facial asymmetry, facial nerve function, midface widening (intercanthal distance), ocular asymmetry, and malocclusion from multiple angles.

  • Early examination before swelling causes any asymmetry is optimal.

  • Bleeding or bruising may be indicative of other possible injuries.

Palpation

  • Systematically palpate bony structures, including maxilla and mandible, bimanually with gloved fingers in the oral cavity.

  • Conduct sensory examination for possible nerve injuries, including all three branches of the trigeminal nerve ( Fig. 48.1 ).

    Figure 48.1, Cutaneous nerves of head and neck.

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