1. Maxillofacial Trauma MA (Cantab) FDS FRCS FRCS (OMFS)
Group Captain A J Gibbons RAF
MA (Cantab) FDS FRCS FRCS (OMFS)
Consultant Oral and Maxillofacial Surgeon
Peterborough NHS Foundation Hospital

2. Anatomical considerations
Airway
Protect sensory organs
Facial muscles
Mastication and speech
Plates

3. Incidence of Fractures
Condyle 35%
Angle 25%
Parasymphysis 22%
Frequently 2 fractures
N Jones Craniofacial Trauma Oxford University Press 1997

4. Airway Management Maxilla displaced Tongue Airway obstruction
Haemorrhage
Soft tissue swelling

7. Oedema

8. Primary injury Secondary injury Tertiary injury Flash burn
Blast Injuries
Primary injury
Secondary injury
Tertiary injury
Flash burn

9. Airway Management Posture Chin lift or jaw thrust Oral airway
Nasopharangeal
Intubate
Surgical

11. Tracheostomy

12. Breathing

13. Tooth in lung

14. Circulation

15. Neurological
Disability
Expose

16. Orbital Compartment Syndrome
Leads to ophthalmic artery occlusion
Lateral canthotomy & cantholysis
1. Clamp x 30 seconds
Decompress
4. Protect cornea
2. Cut cathus, cut canthal tendon
Emergency War Surgery Manual, 3rd Edition

17. History Head to toe Clean up Good records Re-evaluate
Secondary Survey
History
Head to toe
Clean up
Good records
Re-evaluate

18. “P” System of Examination
David David

19. Clinical Signs and Symptoms of Fractures
Pain
Swelling and bruising
Deformity
Loss of function
Abnormal mobility
Neurovascular disturbance
Deranged occlusion

20. Occlusion

21. Soft Tissue Injury Bone Injury Soft Tissue Loss Bone Loss Teeth
Assessment
Soft Tissue Injury
Bone Injury
Soft Tissue Loss
Bone Loss
Teeth

22. Views at 90 Degrees

23. Radiographs

24. CT

25. CT Head and C Spine Inform OMFS early
If facial injuries request face as well as head and c-spine

26. Initial Management Antibiotics Analgesia Tetanus
Clean and dress wounds
Maintain airway
Monitor

27. Early management of soft tissue injury
Debride
Preserve tissue
Primary closure
Delayed primary closure

28. Tatoos

29. Explore the wound tract

30. Outcome Variables Infection Occlusion Scars Mouth opening Nerve damage
Removal of plate

31. Nasal Fractures

32. Dental Pain

33. Treatment Pulpitis – Local aesthetic
Periapical infection – Antibiotics, analgesics, drain infection

34. Gibbons’ Rules Systematic examination
Midface trauma check eyes and nose
CT head and neck think face
Clean soft tissues thoroughly