Maxillofacial Trauma Group Captain A J Gibbons RAF

Maxillofacial Trauma Group Captain A J Gibbons RAF MA (Cantab) FDS FRCS (OMFS) Consultant Oral and Maxillofacial Surgeon Peterborough NHS Foundation Hospital

Anatomical considerations • Airway • Protect sensory organs • Facial muscles • Mastication and speech • Plates

Incidence of Fractures Condyle 35% Angle 25% Parasymphysis 22% Frequently 2 fractures N Jones Craniofacial Trauma Oxford University Press 1997

Airway Management • Maxilla displaced • Tongue • Airway obstruction • Haemorrhage • Soft tissue swelling

Oedema

Blast Injuries • Primary injury • Secondary injury • Tertiary injury • Flash burn

Airway Management • Posture • Chin lift or jaw thrust • Oral airway • Nasopharangeal • Intubate • Surgical

Tracheostomy

Breathing

Tooth in lung

Circulation

Neurological Disability Expose

Orbital Compartment Syndrome • Leads to ophthalmic artery occlusion • Lateral canthotomy & cantholysis 1. Clamp x 30 seconds 3. Decompress 4. Protect cornea 2. Cut cathus, cut canthal tendon Emergency War Surgery Manual, 3 rd Edition

Secondary Survey • History • Head to toe • Clean up • Good records • Re-evaluate

“P” System of Examination David

Clinical Signs and Symptoms of Fractures • Pain • Swelling and bruising • Deformity • Loss of function • Abnormal mobility • Neurovascular disturbance • Deranged occlusion

Occlusion

Assessment • Soft Tissue Injury • Bone Injury • Soft Tissue Loss • Bone Loss • Teeth

Views at 90 Degrees

Radiographs

CT

CT Head and C Spine • Inform OMFS early • If facial injuries request face as well as head and cspine

Initial Management • Antibiotics • Analgesia • Tetanus • Clean and dress wounds • Maintain airway • Monitor

Early management of soft tissue injury • Debride • Preserve tissue • Primary closure • Delayed primary closure

Tatoos

Explore the wound tract

Outcome Variables • • • Infection Occlusion Scars Mouth opening Nerve damage Removal of plate

Nasal Fractures

Dental Pain

Treatment • Pulpitis – Local aesthetic • Periapical infection – Antibiotics, analgesics, drain infection

Gibbons’ Rules • • Systematic examination Midface trauma check eyes and nose CT head and neck think face Clean soft tissues thoroughly