1. Maxillofacial Trauma August 19, 2010 Jay Green Colin Del Castilho

2. Intro Soft tissue injuries – Case work – Case discussion – Regional anesthesia Bone/joint injuries – Case work – Case discussion

6. Intro stuff

8. Soft tissue injury cases

9. Case 1 48y male, intoxicated Fell striking cheek on the bar Laceration to anterior cheek Through-and-through

10. Case 2 18y hockey player “Too good” to wear a face mask High stick to the face Upper lip laceration Crosses vermillion border Involves muscular layer

11. Infraorbital nerve block

17. Case 3 25y female MVC, ejected Intubated by STARS on scene Swelling facial and periorbital Extensive abrasions to forehead with gravel/glass in wound

19. Ophthalmic (V 1 ) nerve block

22. Case 4 It’s June 28, 1997 35y male boxer Lac to right ear during fight Through cartilage Claims he was bitten Opponent says it was a punch

23. Ear field block

25. Case 5 12y female Skateboarding for the first time Fell Caught tongue between teeth Tongue laceration

26. Indications for tongue laceration repair (controversial) Midline Need hemostasis Large flap (>1cm or gaping) Avulsion/amputation Nonlinear laceration or U-shaped emedicine, EM Clinics of North America, Roberts & Hedges, Rosen

27. Inferior alveolar/lingual nerve block

32. Soft Tissue Injuries Questions?

33. Additional questions Q) What are indications for abx in facial trauma Bite wound Devascularized tissue Through-and-through buccal mucosa Cartilage involvement (nose/ear) Extensive contamination Open # # into sinus # with CSF leak

34. Additional questions Q) What is appropriate mgmt of pediatric peri-oral electrical burns? What is the concern here? Can result in severe cosmetic issues and microstomia Trivial looking initial wound may progress over days 5-21 days post-burn get eschar separation and can have lift-threatening labial artery bleeding NEED TO D/W plastics in the ED! Can d/c home with close watching and F/U ENT/plastics if not extensive initially Options: early surgery, oral splinting, delayed surgery

35. Additional questions Q) Management of subperichondral hematoma? Risk factor for cauliflower ear Needs needle aspiration Compressive dressing R/A in 24hrs to ensure hematoma has not re- accumulated

36. Additional questions Q) Describe appropriate ED management of eyelid lacerations. Superficial lacs can be repaired with 6-0 Ethilon Lid margin, canalicular, lacrimal involvement need ophtho/plastics

37. Quick break

38. Case 6 It’s 0100 Dude and his girlfriend come in She was “yawning” and mouth got stuck open

40. Case 7 16y male Tough guy Punched in the nose Swelling to nasal bridge Crooked nose? Hard to tell…

45. Case 8 22y female Squash player Hit in eye by ball Diplopia on up-gaze CT shows orbital floor blowout # without entrapment of EOM

47. Case 9 Same polytrauma as Case 3 Still intubated Bleeding into oropharynx & nasopharynx from ? You think her face is mobile

49. Case 10 35y female, fell down stairs Teeth don’t fit right Neck pain, no c-spine # No other injuries

51. Bone/Joint Injuries Questions?