Emergency Medicine Book

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Maxillofacial Injury

Aka: Maxillofacial Injury, Maxillofacial Trauma, Maxillary Fracture, Le Fort Fracture, Le Fort's Fracture, Fracture of Face Bones, Facial Fracture
  1. See Also
    1. Secondary Trauma Evaluation
    2. Head Trauma
    3. Neck Vascular Injury in Blunt Force Trauma
    4. Cervical Spine Trauma
    5. Basilar Skull Fracture
  2. History
    1. Le Fort was a French surgeon studying cadaver skulls he Traumatized in the late 1800s to early 1900s
  3. Types
    1. Le Fort Fracture Type 1
      1. Horizontal Fracture between the teeth and the Palate
    2. Le Fort Fracture Type 2
      1. Pyramidal Fracture from the the mid-Maxillary Sinus, through the inferior orbital rim to the Nasal Bridge
    3. Le Fort Fracture Type 3
      1. Vertical Fracture through the Maxillary Sinus lateral aspect and horizontal through the orbits
      2. Fracture includes the medial and lateral orbital walls
  4. Associated Conditions
    1. Head Trauma including Intracranial Hemorrhage
    2. Basilar Skull Fracture
    3. Cervical Spine Trauma
    4. Neck Vascular Injury in Blunt Force Trauma
    5. Eye Trauma
      1. Evaluate for Diplopia and Visual Acuity
    6. Epistaxis
  5. Imaging
    1. CT Maxillofacial
      1. Includes orbits, Maxilla, sinuses and Mandible
    2. Have a low threshold for contiguous imaging
      1. CT Head
      2. CT Cervical Spine
  6. Management
    1. Cervical Spine precautions
    2. ABC Management is paramount
      1. Ensure a patent and secure airway
      2. Avoid Nasogastric Tube, posterior Nasal Packing, nasal intubation (risk of Basilar Skull Fracture)
      3. Surgical airway (Cricothyroidotomy) may be needed
    3. Perform a complete Trauma Exam
      1. Neurologic Exam with careful Cranial Nerve exam
      2. Extraocular Movement, Pupil Reactivity, and ocular exam
      3. Evaluate for signs of Neck Vascular Injury in Blunt Force Trauma
  7. Resources
    1. Radiopaedia
      1. https://radiopaedia.org/articles/le-fort-fracture-classification
    2. University of Iowa
      1. https://medicine.uiowa.edu/iowaprotocols/facial-fracture-management-handbook-lefort-fractures
  8. References
    1. Karic, Shannon and Kiel (2019) Crit Dec Emerg Med 33(11):12-3

Maxillary Fractures (C0024953)

Definition (MSH) Fractures of the upper jaw.
Concepts Injury or Poisoning (T037)
MSH D008440
SnomedCT 157179009, 263156006
English Fractures, Maxillary, Maxillary Fracture, Maxillary Fractures, Fracture, Maxillary, Fractured maxilla, Maxillary Fractures [Disease/Finding], fracture maxillary, maxillary fractures, fractures maxilla, maxilla fracture, maxillary fracture, fracture maxilla, fractured maxilla, fracture of maxilla (diagnosis), Maxillary fracture, Maxilla--Fractures, Fracture of maxilla, Fracture of upper jaw, Fracture of maxilla (disorder), fracture; jaw, upper jaw, fracture; maxilla, jaw; fracture, upper jaw, maxilla; fracture
Dutch gebroken maxilla, fractuur; kaak, bovenkaak, fractuur; maxilla, kaak; fractuur, bovenkaak, maxilla; fractuur, Fracturen, maxilla-, Fractuur, maxilla-, Maxillafracturen, Maxillafractuur
French Maxillaire fracturé, Fractures du maxillaire supérieur, Fractures du maxillaire
German gebrochener Oberkiefer, Frakturen, Oberkiefer-, Oberkieferfrakturen
Italian Osso mascellare fratturato, Fratture della mascella
Portuguese Maxila fracturada, Fraturas Maxilares
Spanish Maxilar fracturado, fractura de maxilar superior (trastorno), fractura de maxilar superior, Fracturas Maxilares
Japanese 上顎骨折, ｼﾞｮｳｶﾞｸｺｯｾﾂ
Swedish Överkäksfrakturer
Czech maxila - fraktury, Zlomená maxila
Finnish Yläleukaluun murtumat
Russian CHELIUSTI VERKHNEI PERELOMY, ЧЕЛЮСТИ ВЕРХНЕЙ ПЕРЕЛОМЫ
Polish Złamania szczęki górnej, Złamania szczęki
Hungarian Maxilla-törés
Norwegian Overkjevebrudd, Maksillebrudd, Overkjevefrakturer, Maksillefrakturer
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Maxillofacial Injuries (C0024961)

Definition (MSH) General or unspecified injuries involving the face and jaw (either upper, lower, or both).
Concepts Injury or Poisoning (T037)
MSH D008446
English Injuries, Maxillofacial, Injury, Maxillofacial, Maxillofacial Injuries, Maxillofacial Injury, MAXILLOFACIAL INJ, INJ MAXILLOFACIAL, Maxillofacial Injuries [Disease/Finding], injury maxillofacial, injuries maxillofacial, maxillofacial injuries, maxillofacial injury
Swedish Ansikts- och käkskador
Czech maxilofaciální poranění
Finnish Yläleuan ja kasvojen vammat
Russian CHELIUSTNO-LITSEVYE TRAVMY, ЧЕЛЮСТНО-ЛИЦЕВЫЕ ТРАВМЫ
French Lésions traumatiques maxillofaciales, Blessures maxillofaciales, Blessures maxillo-faciales, Traumatisme maxillofacial, Traumatisme maxillo-facial, Traumatismes maxillo-faciaux, Traumatismes maxillofaciaux
Croatian MAKSILOFACIJALNE OZLJEDE
Polish Urazy twarzy i szczęk, Urazy twarzoczaszki, Urazy twarzowo-szczękowe
Japanese 顎顔面外傷, 外傷-顎顔面, 上顎顔面損傷, 顎顔面損傷
Norwegian Kjeve- og ansiktsskader, Maxillofaciale skader
Spanish Lesiones Maxilofaciales, Traumatismos Maxilofaciales
Portuguese Lesões Maxilofaciais, Traumatismos Maxilofaciais
German Maxillofaziale Verletzungen
Italian Lesioni maxillofacciali
Dutch Letsel, maxillofaciaal, Letsels, maxillofaciale, Maxillofaciaal letsel, Maxillofaciale letsels
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fracture of face bones (C0159321)

Concepts Injury or Poisoning (T037)
ICD9 802
SnomedCT 157176002, 269058002, 157182004, 207802005, 27477003
English Fracture of bone of face, Fracture of facial bone NOS, fracture of facial bone (diagnosis), fracture of facial bone, Facial bones fracture, bones facial fractures, fracture of facial bone (non-specific), Fracture;face bone(s), fracture facial bones, Fracture of facial bone NOS (disorder), Fracture of bone of face (disorder), Fracture of face bones, Fracture of facial bone, Fracture of face bones (disorder), Fracture of facial bones, face bone; fracture, fracture; face bone, Fracture of face bones, NOS, Fracture of facial bones, NOS, fractured facial bone
Italian Frattura delle ossa della faccia
Dutch fractuur aangezichtsbeenderen, aangezichtsbeenderen; fractuur, fractuur; aangezichtsbeenderen, aangezichtsbotbreuk
French Fracture des os du visage, Fracture des os de la face
German Fraktur von Gesichtsknochen, Frakturen von Gesichtsknochen
Portuguese Fractura de ossos da face, Fractura dos ossos da face
Japanese 顔面骨の骨折, 顔面骨骨折, ｶﾞﾝﾒﾝｺﾂｺｯｾﾂ, ｶﾞﾝﾒﾝｺﾂﾉｺｯｾﾂ
Czech Zlomenina obličejových kostí
Hungarian Arccsontok törése
Spanish fractura de hueso de la cara, SAI (trastorno), fractura de huesos de la cara, fractura de los huesos de la cara (trastorno), fractura de hueso de la cara, SAI, fractura de los huesos de la cara, fractura de huesos de la cara (trastorno), fractura de los huesos faciales, Fracture of facial bone NOS, Fractura de los huesos de la cara
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Le Fort's fracture (C0272464)

Concepts Injury or Poisoning (T037)
ICD10 S02.41
SnomedCT 48407005
English Le Fort's fracture, NOS, Le Fort fracture, LeFort fracture (diagnosis), skull fracture malar / maxillary / upper jaw lefort, LeFort fracture, Le Fort's fracture, Le Fort's fracture (disorder), fracture; Le Fort
Dutch fractuur; Le Fort
Spanish fractura de Le Fort (trastorno), fractura de Le Fort
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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