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Facial Fractures, Emergency Medicine

David W. Munter Reviewed 06/2017
 


Basics

Description

  • Typically blunt trauma from motor vehicle accidents, direct blows including assaults, or falls.

  • Consider physical assault and domestic violence, especially in women and children.

  • Open ...

Diagnosis

Signs and Symptoms

  • Most post-traumatic deformities of the face represent underlying fractures.

  • Pain, swelling, ecchymosis, and deformity.

  • CSF rhinorrhea, facial hemorrhage, epistaxis, raccoon e...

Treatment

Pre-Hospital

  • Airway control takes precedence:

    • Attempt chin lift, jaw thrust, and suctioning first.

    • Underlying injuries may make these attempts as well as use of bag/valve/mask (BVM) device unsu...

Follow-Up

Disposition

Admission Criteria

  • Significant associated trauma.

  • Airway compromise.

  • Le Fort II and III fractures.

  • CSF leak.

  • Posterior table frontal sinus fractures.

  • Most open fractures, excluding simp...

Pearls and Pitfalls

  • Facial fractures and injuries can be very dramatic in appearance.

    • Airway management always takes precedence. Avoid nasotracheal intubation.

    • After the airway is secured as necessary, ...

Additional Reading

  • Chapman  VM, Fenton  LZ, Gao  D, et al. Facial fractures in children: Unique patterns of injury observed by computed tomography. J Comput Assist Tomogr.  2009;33(1):70–72.

  • Cole ...

Codes

ICD9

  • 802.4 Closed fracture of malar and maxillary bones

  • 802.6 Closed fracture of orbital floor (blow-out)

  • 802.8 Closed fracture of other facial bones

  • 802.9 Open fracture of other facial bones

  • 802.5 O...

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