MANUAL MINORS
From the perspective of an emergency physician in an emergency department, facial injuries require careful evaluation and treatment due to the anatomical complexity of the face and the potential impact on function and aesthetics. Below are the most common facial injuries and their initial management:
Category | Description |
|---|---|
Fractures | |
Zygomatic Bone (Malar) Fracture | Fracture of the cheekbone caused by direct trauma. Symptoms include pain, swelling, facial deformity, and potential orbital involvement. |
Nasal Fracture | Fracture of the nasal bone, often from direct blows. Symptoms include pain, swelling, nasal deformity, and nasal bleeding. Breathing obstruction may occur. |
Maxillary (Upper Jaw) Fracture | Fracture of the upper jaw, usually from severe trauma. Symptoms include intense pain, swelling, difficulty chewing or speaking, and possible tooth displacement. |
Mandible (Jaw) Fracture | Fracture of the jaw caused by direct trauma or accidents. Symptoms include jaw pain, difficulty opening or closing the mouth, and tooth misalignment. It may affect chewing function. |
Dislocations | |
Jaw Dislocation | Displacement of the jaw from its normal position, usually due to direct trauma or forced movements. Symptoms include severe pain, difficulty closing the mouth, and visible jaw deformity. |
Soft Tissue Injuries | |
Contusions and Haematomas | Facial bruising from direct blows, resulting in pain, swelling, and bruising. Internal haematomas may cause pressure on deep tissues, affecting important structures. |
Lacerations | Cuts in the facial skin, ranging from superficial to deep. Often require suturing. Significant bleeding and damage to underlying structures may occur. |
Ocular Injuries | |
Ocular Contusion (Black Eye) | Results from a blow to the eye region. Symptoms include swelling, pain, and discolouration around the eye. Internal ocular structures may be damaged. |
Orbital Floor Fracture (Blow-Out Fracture) | Fracture of the orbital floor, usually from direct impact. Symptoms include eye pain, blurred vision, and difficulty moving the eye. Fat or orbital tissue may prolapse. |
Facial Nerve Injuries | |
Facial Paralysis | Can be caused by direct trauma, infections, or compression of the facial nerve. Symptoms include weakness or paralysis on one side of the face, difficulty closing the eye, and facial expression changes. |
Management Protocol
Initial Evaluation
Clinical History and Physical Examination: Identify the cause of trauma, assess the extent of injuries, and check for airway compromise or damage to vital structures.
Immobilisation: If a fracture or dislocation is suspected, immobilise the jaw to prevent further movement.
Diagnostic Imaging
X-rays: To evaluate fractures and bone displacements. Specific views of the facial bones and jaw may be required.
CT Scan: For detailed assessment of complex fractures and internal structure damage.
Initial Treatment
Pain Management: Administer analgesics and anti-inflammatory drugs as necessary.
Laceration Treatment: Clean and suture cuts and assess for deep injuries.
Compression and Elevation: To control haematomas and reduce swelling.
Surgical Intervention
Fractures and Dislocations: Surgery may be needed to align and stabilise fractured bones, particularly in severe cases.
Ocular Injuries: Assessment and possible surgical intervention to treat orbital fractures and eye damage.
Follow-up and Rehabilitation
Facial Rehabilitation: May include physical therapy to restore facial function and aesthetics.
Continuous Monitoring: To ensure proper recovery and prevent long-term complications.
Each facial injury requires thorough evaluation to address both immediate consequences and to prevent functional and aesthetic sequelae.
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