Take a listen to our OMFS superstar and Chair of Dentistry, Dr. Johua Segal, discuss facial trauma in the ED with our very own superstar, Dr. Anand Swaminathan.

https://www.statenislandem.com/only-in-staten/hbdeeg4b0753psh3yv1aimcaz0rvq9

Facial Trauma Learning Points:

- Look to get a CT scan of the maxillofacial bones based on mechanism, external signs of trauma, diplopia, or signs of ocular entrapment

-Excessive nasal discharge in the setting of facial trauma is a concerning finding.

- Traumatic subconjunctival hemorrhage is concerning and you should have a higher alert for a possible orbital floor fracture.

- Indications for emergency facial consultation include persistent epistaxis, nasal septal hematoma, significant or concerning lacerations, exposed cartilage, orbital entrapment

- Binocular double vision has you concerned for entrapment while monocular diplopia is worrisome for an injury to the eye itself.

- Antibiotics should be given to patients with fractures with sinus involvement, open fractures, bite wounds, and penetrating trauma.

-Sinus precautions are done to prevent subcutaneous emphysema. These include avoiding nose blowing, sneezing, straining/heavy lifting, and avoiding pressure changes (e.g. swimming, flying, scuba diving, blowing up balloons). Patients should also keep their head elevated.

-Delayed surgery or secondary reconstruction on facial trauma patients can be very challenging. Early consult is beneficial for most complex facial fractures.