Face and Neck Injuries

Face and Neck Injuries

• Face and neck are frequently subjected to traumatic forces, resulting in soft tissue injuries and fractures to bones, which can be lifethreatening.
• Penetrating trauma to the neck can cause severe bleeding, and open injuries can allow air to enter the circulatory system and slow blood flow to the brain.
• Treatment objectives include preventing further injury, managing acute airway problems, and controlling bleeding.

Structural Anatomy

• The head is divided into the cranium and the face, with the facial skeleton composed of six major bones: nasal bone, two maxilla, two zygomas, and the mandible.
• The mandible forms the jaw and chin, and motion in the jaw occurs at the temporomandibular joint.
• The hyoid bone is a semicircular bone that floats in the superior aspect of the neck, just below the mandible.
• The anterior region of the neck includes the thyroid and cricoid cartilage, trachea, and numerous muscles and nerves.

Eye Anatomy

• The eye is a globe-shaped structure approximately 1 inch in diameter, located within the bony socket of the skull (orbit).
• The eye is held in place by loose connective tissue and several muscles, with the oculomotor nerve innervating the muscles and carrying parasympathetic nerve fibers.
• The optic nerve provides the sense of vision, and the orbit forms the base of the floor of the cranial cavity.
• The eyeball keeps its shape due to pressure from fluid contained within the two chambers: anterior chamber (filled with aqueous humor) and posterior chamber (filled with vitreous humor).
• The sclera is a protective film that covers the surface of the globe, and the inner surface of the eyelids and the exposed surface of the eye are covered by the conjunctiva.

Ear Anatomy

• The ear is a complex organ associated with hearing and balance, divided into three parts: external ear (composed of the pinna and external auditory canal), middle ear (containing three small bones: malleus, incus, and stapes), and inner ear (composed of bony chambers filled with fluid).

Injuries to the Head and Face

• Injuries can lead to partial or complete obstruction of the upper airway, with contributing factors including direct injuries to the nose and mouth, larynx and trachea, teeth or dentures, and swelling.
• Facial fractures occur when facial bones absorb the energy of a strong impact, with the magnitude of force required to fracture the maxilla producing closed head and cervical spine injuries.
• Signs of facial fractures include deep facial lacerations, pain over a bone, swelling, pain on palpation or crepitus, misalignment of teeth, and any obvious facial deformities or asymmetry.

Types of Facial Fractures

• Nasal fractures are the most common type of facial fracture, characterized by swelling, tenderness, and crepitus, and often complicated by the presence of an anterior or posterior nose bleed.
• Mandibular fractures result from massive blunt force trauma to the lower third of the face, with the fracture site commonly located at the angle of the jaw.
• Maxillary fractures occur with mechanisms that produce massive blunt facial trauma, classified into three types: LeFort 1 (horizontal fracture of the maxilla), LeFort 2 (involving the nasal bone and inferior maxilla), and LeFort 3 (fracture of all mid-facial bones).
• Orbital fractures can create double vision and loss of sensation above the eyebrow and over the cheek, with patients experiencing reduced sensation to areas innervated by the infraorbital nerve.
• Zygomatic or cheekbone fractures are common, resulting from blunt trauma, and signs and symptoms include a flattened appearance of the fractured side of the face, loss of sensation over the cheek, nose, and upper lip, and paralysis of upward gaze.

Assessment and Management

• When assessing patients with facial injuries, observe for hazards and threats to safety, take PPE and standard precautions, and consider the mechanism of injury.
• Identify and manage life threats in the primary survey, being aware of combative or aggressive behavior as a sign of closed head injury.
• Check for responsiveness and ensure a clear and patent airway, suctioning any blood, vomit, or fluid, and removing any foreign objects or teeth fragments from the patient's mouth.
• Consider inserting an appropriately sized airway adjunct if the patient is unresponsive, and call early for backup in case endotracheal intubation is needed.
• Perform a rapid full-body scan, looking for signs of injury, and maintain control of bleeding, noting the injury location and inspecting open wounds for foreign matter.

Face and Neck Injuries

• Face and neck are frequently subjected to traumatic forces, resulting in soft tissue injuries and fractures to bones, which can be lifethreatening.
• Penetrating trauma to the neck can cause severe bleeding, and open injuries can allow air to enter the circulatory system and slow blood flow to the brain.

Structural Anatomy

• The facial skeleton is composed of six major bones: nasal bone, two maxilla, two zygomas, and the mandible.
• The mandible forms the jaw and chin, and motion in the jaw occurs at the temporomandibular joint.
• The hyoid bone is a semicircular bone that floats in the superior aspect of the neck, just below the mandible.
• The anterior region of the neck includes the thyroid and cricoid cartilage, trachea, and numerous muscles and nerves.

Eye Anatomy

• The eye is a globe-shaped structure approximately 1 inch in diameter, located within the bony socket of the skull (orbit).
• The eye is held in place by loose connective tissue and several muscles, with the oculomotor nerve innervating the muscles and carrying parasympathetic nerve fibers.
• The optic nerve provides the sense of vision, and the orbit forms the base of the floor of the cranial cavity.
• The eyeball keeps its shape due to pressure from fluid contained within the two chambers: anterior chamber (filled with aqueous humor) and posterior chamber (filled with vitreous humor).
• The sclera is a protective film that covers the surface of the globe, and the inner surface of the eyelids and the exposed surface of the eye are covered by the conjunctiva.

Ear Anatomy

• The ear is a complex organ associated with hearing and balance, divided into three parts: external ear, middle ear, and inner ear.

Injuries to the Head and Face

• Injuries can lead to partial or complete obstruction of the upper airway, with contributing factors including direct injuries to the nose and mouth, larynx and trachea, teeth or dentures, and swelling.
• Facial fractures occur when facial bones absorb the energy of a strong impact, with the magnitude of force required to fracture the maxilla producing closed head and cervical spine injuries.

Types of Facial Fractures

• Nasal fractures are the most common type of facial fracture, characterized by swelling, tenderness, and crepitus, and often complicated by the presence of an anterior or posterior nose bleed.
• Mandibular fractures result from massive blunt force trauma to the lower third of the face, with the fracture site commonly located at the angle of the jaw.
• Maxillary fractures occur with mechanisms that produce massive blunt facial trauma, classified into three types: LeFort 1 (horizontal fracture of the maxilla), LeFort 2 (involving the nasal bone and inferior maxilla), and LeFort 3 (fracture of all mid-facial bones).
• Orbital fractures can create double vision and loss of sensation above the eyebrow and over the cheek, with patients experiencing reduced sensation to areas innervated by the infraorbital nerve.
• Zygomatic or cheekbone fractures are common, resulting from blunt trauma, and signs and symptoms include a flattened appearance of the fractured side of the face, loss of sensation over the cheek, nose, and upper lip, and paralysis of upward gaze.

Assessment and Management

• When assessing patients with facial injuries, observe for hazards and threats to safety, take PPE and standard precautions, and consider the mechanism of injury.
• Identify and manage life threats in the primary survey, being aware of combative or aggressive behavior as a sign of closed head injury.
• Check for responsiveness and ensure a clear and patent airway, suctioning any blood, vomit, or fluid, and removing any foreign objects or teeth fragments from the patient's mouth.
• Consider inserting an appropriately sized airway adjunct if the patient is unresponsive, and call early for backup in case endotracheal intubation is needed.
• Perform a rapid full-body scan, looking for signs of injury, and maintain control of bleeding, noting the injury location and inspecting open wounds for foreign matter.

This quiz covers the types and consequences of traumatic face and neck injuries, including soft tissue damage and fractures, as well as treatment objectives.