Facial Trauma and Neck Trauma Points.pptx

ENT Trauma, Facial Trauma, Neck Trauma

1. ENT Trauma Points

2. Questions from LeFort Fractures CSF rhinorrhoea is seen in Le Fort 2 &3 . Nasotracheal intubation is contraindicated in Le Fort 2 & 3 . Hallmark of ALL Le Fort # is traumatic pterygomaxillary junction separation # of pterygoid plates is MANDATORY Le Fort 1 (Transverse #) also known as: Guerin # Horizontal Maxillary # Floating Palate Le Fort 2 ( Pyramidal #) Le Fort 3 ( Cranio -facial dysjunction ) PANDA FACIES is seen after Le Fort 2 #

3. Key Distinguishing Features of Le Fort #s

4. Le Fort I : The fracture extends through the piriform aperture superior to the maxillary alveolar ridge, then propagating through the anterior, medial, and posterolateral maxillary sinus walls. Le Fort II : The fracture involves the posterolateral maxillary sinus wall and anterior maxillary wall, extending through the inferior orbital rim into the orbital floor, medial orbital wall, and the region of the nasofrontal suture. Le Fort III : The fractures extend through the nasal bridge, medial orbital wall, posterior orbital floor, and lateral orbital wall near the frontozygomatic suture. The zygomatic arch is always fractured.

5. The most commonly injured area is zone 2, which can easily be accessed surgically. However, in zones 1 and 3 injuries, exposure & vascular control are more difficult to achieve.

6. Hemorrhage Shock Classification (ATLS 9th edition) (Estimated blood loss based on patient's initial presentation)

7. Hard and Soft Signs of Major Aerodigestive or Neurovascular Injury ( Sperry 2013 ) Any patient with  hard signs of injury should be expeditiously brought to the operating room  for further management. Hard signs associated with 90% rate of major injury  ( Evans 2018 ) Delays should only occur for securing the unstable airway Can apply direct pressure to bleeding wounds en route Do not take these patients to CT scan