MINORS MANUAL
Traumatic brain injury (TBI) associated with facial injury occurs when trauma affects both the facial bones and the skull and brain, potentially compromising both brain function and facial structure integrity.
This type of injury is commonly seen in motor vehicle accidents, falls from heights, or severe assaults and can result in serious neurological consequences, including brain haemorrhage, facial fractures, and loss of consciousness.
Diagnosis
The diagnosis of TBI associated with facial injury involves a thorough neurological and physical evaluation of the patient. A neurological examination should include assessing the Glasgow Coma Scale (GCS) to determine the level of consciousness.
Additionally, signs of facial fractures (such as asymmetry, pain, crepitus, bruising) should be assessed, and imaging studies like CT scans of the skull and face are essential to evaluate the extent of bone fractures and possible intracranial injuries, such as haemorrhage or cerebral oedema.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Basal skull fracture | Battle’s sign (retroauricular haematoma), CSF otorrhoea or rhinorrhoea |
Concussion | Temporary neurological dysfunction without structural damage on CT |
Epidural haematoma | Loss of consciousness followed by a lucid interval and rapid neurological deterioration |
Subdural haematoma | Progressive neurological symptoms, headache, altered mental state |
Emergency Management
Initial airway, breathing, and circulation (ABC) assessment: In TBI patients, always prioritise airway management. If the facial injury compromises the airway, early intubation should be considered.
Cervical spine immobilisation: Due to the possibility of associated cervical spine injury, immobilise the cervical spine until fractures are ruled out.
Control facial haemorrhage: Apply direct pressure to control significant facial bleeding. In cases of massive bleeding or open fractures, consider applying dressings or urgent surgical intervention.
Neurological evaluation (Glasgow Coma Scale): Monitor the patient’s neurological status and watch for signs of deterioration, such as unequal pupils, seizures, or progressive loss of consciousness.
CT scan: Perform a CT scan of the skull and face to assess for facial fractures, intracranial haemorrhage, cerebral oedema, or other brain injuries.
Antibiotic prophylaxis: In open facial fractures, initiate prophylactic antibiotics to prevent infections, especially in fractures communicating with the sinuses or oral cavity.
Fluid management and intracranial pressure control: If cerebral oedema is present, ensure adequate cerebral perfusion and consider using mannitol or hypertonic saline to manage elevated intracranial pressure.
Definitive Treatment
Definitive treatment includes the surgical stabilisation of facial fractures and neurosurgical intervention in cases of intracranial haemorrhage or complex skull fractures. Displaced facial fractures or those involving the orbit, maxilla, or mandible may require open reduction and internal fixation (ORIF).
In patients with severe TBI, intensive care unit (ICU) monitoring is essential to control intracranial pressure and prevent secondary complications, such as infections or irreversible brain damage.
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