Facial trauma , also called maxillofacial trauma , is a physical trauma to the face. Facial trauma may involve soft tissue injuries such as burns, lacerations and bruises, or facial bone fractures such as nasal fracture and jaw fracture, as well as eye injury trauma. Specific symptoms for this type of injury; for example, a fracture may involve pain, swelling, loss of function, or facial structure changes.
Facial injuries have the potential to cause damage and loss of function; for example, blindness or difficulty moving the jaw can occur. Although rarely life-threatening, facial trauma can also be lethal, as it can cause severe bleeding or airway disturbance; so the main concern in treatment is to make sure the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and sewing open wounds, ice, antibiotics and pain killers, moving the bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be required for other injuries such as traumatic brain injury, which usually accompany severe facial trauma.
In developed countries, the main cause of facial trauma is motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; But car accidents still dominate as causes in developing countries and are still a major cause elsewhere. So prevention efforts include awareness campaigns to educate the public about security measures like seat belts and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.
Video Facial trauma
Signs and symptoms
Facial bone fractures, such as other fractures, may be associated with pain, bruising, and swelling of surrounding tissue (such symptoms can occur in the absence of a fracture as well). Nasal fractures, the base of the skull, or upper jaw may be associated with severe nosebleeds. Nasal fractures may be associated with nasal deformities, as well as swelling and bruising. Deformity in the face, such as concave cheekbones or teeth that are not parallel to the right, indicate a fracture. Asymmetry may suggest facial fracture or nerve damage. People with mandibular fractures often experience pain and difficulty opening their mouths and possibly numbness in the lips and chin. With a Le Fort fracture, the midface can move relative to the rest of the face or skull.
Maps Facial trauma
Cause
Injury mechanisms such as falls, attacks, sports injuries, and vehicle accidents are a common cause of facial trauma in both children and adults. Blunt assaults, punches of fists or objects, are a common cause of facial injuries. Facial trauma can also be caused by wartime injuries such as shots and explosions. Animal attacks and work-related injuries such as industrial accidents are another cause. Vehicle trauma is one of the leading causes of facial injury. Trauma generally occurs when the face attacks the interior of the vehicle, such as the steering wheel. In addition, airbags can cause corneal blisters and lacerations (wounds) to the face as they spread.
Diagnosis
Radiography, network imaging using X-rays, is used to rule out facial fractures. Angiography (X-rays taken from the inside of a vein) can be used to locate the source of bleeding. However, the complex bone and tissue of the face can make it difficult to interpret plain radiography; CT scans are better for detecting fractures and checking soft tissue, and are often necessary to determine if surgery is necessary, but more expensive and difficult to obtain. CT scans are usually considered more definitive and better in detecting facial injuries than X-rays. CT scans are very likely to be used in people with multiple injuries requiring CT scans to assess other injuries.
Classification
Soft tissue injuries include blisters, lacerations, avulsions, bruises, burns and cold sores.
Common facial bone damage includes nasal bone (nose), upper jaw (bone that forms the upper jaw), and lower jaw (lower jaw). The mandible can be cracked in the symphysis, body, angle, ramus, and condoyle. The zygoma (cheekbones) and the frontal bone (forehead) are other sites for fractures. Fractures can also occur in the bone of the palate and the united ones form the orbit of the eye.
At the beginning of the 20th century, Renà ©  Le Fort mapped the typical location for facial fractures; this is now known as fracture Le Fort I, II, and III (right). Le Fort I fracture, also called GuÃÆ'  © rin or horizontal maxillary fracture, involves the maxilla, separating it from the roof of the mouth. Le Fort II fractures, also called pyramidal fractures in the maxilla, cross the nasal bone and the orbital edge. Le Fort III fractures, also called craniofacial dysfunction and transverse facial fractures, cross the front of the maxilla and involve the lacrimal bone, lamina papyracea, and orbital floor, and often involve the ethmoid bone, are the most serious. Le Fort fractures, which cause 10-20% facial fractures, are often associated with other serious injuries. Le Fort made a work-based classification with cadaveric skull, and the classification system has been criticized as imprecise and simple because most of the finger fractures of midface involve a combination of Le Fort fractures. Although most facial fractures do not follow the pattern described by Le Fort, the system is still used to categorize injuries.
Prevention
Measures to reduce facial trauma include laws that enforce the use of seat belts and public education to raise awareness about the importance of seat belts and motorcycle helmets. Efforts to reduce drunk driving are other preventive measures; changes to the law and its enforcement have been filed, as well as changes in public attitudes towards such activities. Information obtained from biomechanics studies can be used to design cars with a view toward preventing facial injuries. While seat belts reduce the number and severity of facial injuries that occur during collisions, air bags are not very effective to prevent injury. In sports, safety devices including helmets have been found to reduce the risk of severe facial injury. Additional extras such as a face shield can be added to a sports helmet to prevent orofacial injury (injuries to the mouth or face); Mouthguards are also used.
Treatment
The urgent need for treatment is to ensure that the airway is open and not threatened (eg by tissue or foreign matter), because airway compromises can occur quickly and secretly, and potentially deadly. The ingredients in the mouth that threaten the airway may be removed manually or using suction tools for that purpose, and additional oxygen may be provided. Facial fractures that threaten to disrupt the airway can be reduced by moving the bones back into place; this reduces bleeding and moves the bone out of the airway. Tracheal intubation (inserting a tube into the airway to aid breathing) may be difficult or impossible due to swelling. Nasal intubation, entering the endotracheal tube through the nose, can be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube can be forced through it and into the brain. If facial injury prevents oraotracheal or nasotracheal intubation, the airway may be placed to provide adequate airway. Although cricothyrotomy and tracheotomy can secure the airway when other methods fail, they are only used as a last resort because of potential complications and difficulty of the procedure.
Dressings can be placed over the wound to keep them clean and to facilitate healing, and antibiotics can be used in cases where infection is possible. People with contaminated wounds who have not been immunized against tetanus within five years may be given tetanus vaccinations. Laseration may require stitches to stop bleeding and facilitate wound healing with as little scarring as possible. Although it is not uncommon for bleeding from the maxillofacial region to be large enough to be life-threatening, it is still necessary to control such bleeding. Severe bleeding occurs as a result of facial trauma in 1-11% of patients, and the origin of this bleeding is difficult to find. Nasal packaging can be used to control nose bleeding and hematoma that may form on the septum between the nostrils. Such hematomas need to be dried. Light nasal fractures require nothing but ice and pain killers, while fractures with severe defects or associated laceration may require further treatment, such as moving the bone back into alignment and antibiotic treatment.
Treatment aims to improve the natural bone architecture of the face and leave as little scarring as possible. Fractures can be fixed with metal plates and screws that are generally made of Titanium. Resortbable material is also available; it is biologically degraded and removed over time but there is no evidence to support its use over conventional Titanium plates. Fractures can also be mounted in place. Bone transplantation is another option to improve bone architecture, to fill missing parts, and to provide structural support. Medical literature shows that early repair of facial injuries, within a few hours or days, results in better outcomes for function and appearance.
Surgical specialists who typically handle specific aspects of facial trauma are oral and maxillofacial surgeons. The surgeon is trained in comprehensive trauma management on the lower, middle and upper faces and must undergo a written and oral examination that includes the treatment of facial injuries.
Prognosis and complications
By itself, facial trauma rarely presents a threat to life; but are often associated with harmful injuries, and life-threatening complications such as airway obstruction may occur. The airways can be blocked due to bleeding, swelling of surrounding tissue, or structural damage. Burns to the face can cause tissue swelling and thus cause airway obstruction. Fractures such as a combination of the nose, upper jaw, and mandibular fracture may interfere with the airway. Blood from the face or mouth, if swallowed, can cause vomiting, which in itself can pose a threat to the airways as it has the potential to be aspirated. Because airway problems can occur late after the initial injury, it is necessary for health care providers to monitor the airway regularly.
Even when facial injuries are not life-threatening, they have the potential to cause disability and disability, with long-term physical and emotional outcomes. Facial injury can cause problems with eye, nose, or jaw function and can threaten vision. In the early 400 BC, Hippocrates was thought to have noted the connection between blunt face trauma and blindness. Injuries involving the eyes or eyelids, such as retrobulbar bleeding, may threaten vision; However, blindness after facial trauma is not common.
A cut on the face may involve the parotid tract. This is more likely if the wound crosses a line drawn between the tragus of the ear to the upper lip. The approximate location of the channel path is the middle third of this line.
Nerves and muscles may be trapped by broken bones; in these cases the bones need to be restored to their original place quickly. For example, an orbital floor fracture or the medial orbital wall of the eye may trap the medial rectus or inferior rectus muscle. In facial wounds, the tear duct and facial nerve may be damaged. Frontal bone fractures can interfere with frontal sinus drainage and can cause sinusitis.
Infection is another potential complication, for example when the debris is milled to abrasion and remains there. Bite injuries carry a high risk of infection.
Epidemiology
As many as 50-70% of people who survived the traffic accident experienced facial trauma. In most developed countries, violence from others has replaced vehicle collisions as the main cause of maxillofacial trauma; But in many developing countries traffic accidents remain a major cause. Increased use of seat belts and airbags has been credited with reducing the incidence of maxillofacial trauma, but mandibular fracture (jawbone) is not diminished by this protective action. The risk of maxillofacial trauma decreases by a factor of two using a motorcycle helmet. Decreased facial bone fractures due to vehicle accidents are thought to be caused by safety belts and drunken driving regulations, strictly enforced speed limits and use of airbags. In vehicle accidents, drivers and front seat passengers have the highest risk for facial trauma.
Facial fractures are distributed in fairly normal curves by age, with peak events occurring between the ages of 20 and 40, and children under 12 suffering from only 5-10% of all facial fractures. Most of the facial trauma in children involves laceration and soft tissue injury. There are several reasons for the lower incidence of facial fractures in children: the face is smaller in relation to the rest of the head, the children are more rare in some situations associated with facial fractures such as motor vehicle hazards and occupations, there is a lower proportion the cortical bone to the cancellous bone in the faces of the children, the less developed sinuses make the bones stronger, and the fat pads provide protection for the facial bones.
Head and brain injuries are commonly associated with facial trauma, especially the upper face; Brain injury occurs in 15-48% of people with maxillofacial trauma. Shared injuries can affect the treatment of facial trauma; for example they may appear and need to be treated before a facial injury. People with trauma above neck bone levels are considered at high risk for cervical spine injuries (spinal cord injuries) and special precautions should be taken to avoid spine movements, which can worsen spinal cord injuries.
References
Text cited
- Jeroukhimov I, Cockburn M, Cohn S (2004). "Facial trauma: Description of trauma care". In Thaller SR. Facial trauma . New York, N.Y: Marcel Dekker. ISBNÃ, 0-8247-4625-2 . Retrieved 2008-10-19 .
- Pediatric Emergency Medicine Textbook . Hagerstwon, MD: Lippincott Williams & amp; Wilkins. ISBNÃ, 0-7817-5074-1 . Retrieved 2008-10-19 .
- Seyfer AE, Hansen JE (2003). "Facial trauma". On Moore EE, Feliciano DV, Mattox KL. Trauma. Fifth Edition . McGraw-Hill Professional. pp.Ã, 423-24. ISBN: 0-07-137069-2. < span>
External links
- Gillies Archive at Queen Mary Hospital, Sidcup - Documents and pictures from the early days of reconstructive surgery for severe facial trauma experienced by soldiers in World War I.
Source of the article : Wikipedia
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