5.1 Q Trauma Maxillofacial Trauma Em Cameron P94

Front 1

Regarding maxfac trauma, which is incorrect
1 >20% of head neck and facial injuries in women are due to domestic violence
2 mobility of midfacial maxillary fractures is assessed by grasping the anterior maxilla with thumb and index finger while stabilising the forehead at the nasal bridge
3 objective impairment in visual acuity is the most sensitive single predictor of eye injury
4 malocclusion, pain on biting, loss of bite strength and limitation of jaw movement are a good indicators of jaw fracture

Back 1

3 INCORRECT - SUBJECTIVE impairment (not objective)

Front 2

What are the features of base of skull fracture?

Back 2

Periorbital bruising
Postauricular bruising
Haemotympanum
CSF otorrhoea

Front 3

Which fracture site and nerve would produce
1 sensory changes in lower lip and lower alveolar margin?
2 sensory changes in upper lip, upper alveolar margin

Back 3

1 maxilla, alveolar nerve branches of infra orbital nerve
2 mandibular canal, inferior alveolar nerve injury (branch mandibular nerve)

Front 4

Regarding facial trauma which is incorrect
1 the association between facial injury and cervical spine injury is well established
2 the association between facial injuries and intracranial injuries is more frequent than facial and C-spine injury
3 the major cause of death from facial trauma is asphyxia from up airway obstruction
4 anterior traction on fractured mandible or mobile section of maxilla may relieve airway obstruction
5 significant mid facial injuries in a stable patient are an indication for considering surgical tracheostomy in OT

Back 4

1 incorrect, questionable association

Front 5

Regarding facial trauma which is incorrect
1 traumatic facial haemorrhage is life threatening in 5% of mid facial fractures
2 the evidence for prophylactic antibiotics in most injuries is weak
3 fractures other than undisplaced nasal, maxilla or zygomatic arch fractures require acute maxfac review
4 most mandibular fractures do not require internal fixation
5 the most common orbital floor fracture is as part of a zygomaticomaxillary fracture, rather than an orbital blowout fracture

Back 5

4 INCORRECT - most do

Front 6

Answer the following regarding orbital blowout fractures
1. Definition
2 mechanism
3 possible examination findings
4 radio graphic findings

Back 6

1 fracture of orbital floor without fracture of orbital margin
2 increased intraorbital pressure (eg via fist or ball) disrupting weak orbital floor
3 enopthalmos, differing pupil levels, diplopia and impairment upward gaze, intraorbital hypo, hyper or paraesthesia
4 emphysema orbit, maxillary sinus collection, teardrop sign of herniated contents 'hanging' into maxillary sinus

ALL orbital floor or margin fractures require referral

Front 7

Describe the Le Fort classification
Which is most common
Which require urgent reduction?
Most midface fractures are combinations with different patterns on each side of the face T/F

Back 7

Midface fractures
I - only maxilla at level nasal fossa
II - maxilla, nasal bones, medial aspect orbit. MOST COMMON
III - separates midface from base of cranium, base of nose, ethmoids, across orbits, zygomatic arches

II AND III - may require urgent reduction to improve airway and arrest haemorrhage. Midface mobility can occur, skull base fractures are associated, and CSF rhinorrhea can occur

T

Front 8

Which is CORRECT? Regarding nasal fractures
1. Displaced nasal fractures should be reduced in 10-14 days
2. Imaging is usually required for nasal fractures
3 persistant epistaxis and CSF rhinorrhoea are common with simple nasal fractures
4 epistaxis and exclusion of nasal haematoma are immediate priorities

Back 8

1 incorrect 7-10
2 usually not required
3 common with nasoETHMOIDAL fractures
4 CORRECT

Front 9

Regarding TMJ dislocation which is INCORRECT
1 differential diagnosis includes extra pyramidal dystonia
2 post reduction x rays are required
3 manual reduction in ED under sedation is appropriate
4 avoiding wide opening of the mouth post reduction for 1-2 weeks, soft diet for several days is important

Back 9

2 incorrect - not always necessary

Front 10

Regarding penetrating injuries to the face which is incorrect
1 maxillary entry sites are more likely to require a emergency airway than mandibular sites
2 shotgun and stab wounds typically produce less damage than gunshot wounds
3 central nervous system injuries are common and CT head and or cervical spine should be performed with CT facial bones
4 angiography is necessary 40% of the time and is indicated with proximity to major vessels or the skull base
5 ocular trauma is the most common complication of penetrating facial trauma

Back 10

1 INCORRECT - mandibular entry more likely to require emergency airway

Front 11

Significant facial trauma and a compromised or deteriorating airway - options of management

Back 11

Controversial. Consider immediate surgical airway