Suggested Readings and Key References Abramowicz S, Allareddy V, Lee MK, et al Hospital-based emergency department visits with pediatric burns: characteristics and outcomes Pediatr Emerg Care 2019 [Epub ahead of print] American Burn Association National Burn Repository Available online at http://www.ameriburn.org/resources_publications.php Accessed August 15, 2019 Jamshidi R, Sato TT Initial assessment and management of thermal burn injuries in children Pediatr Review 2013;34;395–404 Jeschke MG, Herndon DN Burns in children: standard and new treatments Lancet 2014;383:1168–1178 Kraft R, Herndon DN, Al-Mousawi AM, et al Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study Lancet 2012;379(9820):1013–1021 Palao R, Monge I, Ruiz M, et al Chemical burns: pathophysiology and treatment Burns 2010;36(3):295–304 Strobel AM, Fey R Emergency care of pediatric burns Emerg Med Clin North Am 2018;36(2):441–458 Thamm OC, Perbix W, Zinser MJ, et al Early single-shot intravenous steroids not affect pulmonary complications and mortality in burned or scalded patients Burns 2013;39(5):935–941 Tompkins RG Survival of children with burn injuries Lancet 2012;379(9820):983–984 World Health Organization Burns Available online at http://www.who.int/mediacentre/factsheets/fs365/en Accessed August 15, 2019 CHAPTER 105 ■ DENTAL TRAUMA ZAMEERA FIDA, ISABELLE I CHASE, BONNIE L PADWA GOALS OF EMERGENCY CARE Proper diagnosis and management of traumatic dental injuries (TDIs) are essential to improve prognosis Identifying which injuries require immediate referral to a dentist is important for emergency physicians Since dental injuries involve the head and neck, concomitant neurologic evaluation is an important aspect of emergency care Although the majority of injuries are the result of accidents, the patient’s history must be carefully reviewed in the context of the physical findings to determine if presenting injuries could be a result of nonaccidental trauma, that is, abuse KEY POINTS TDIs are common pediatric emergencies Neurologic assessment is an important part of management as injury has been sustained in the head and neck region Jaw fractures, avulsed and displaced teeth, and dental fractures with exposed nerves (pulp) require immediate referral to a specialist RELATED CHAPTERS Resuscitation and Stabilization A General Approach to the Ill or Injured Child: Chapter Medical, Surgical, and Trauma Emergencies Child Abuse/Assault: Chapter 87 ENT Trauma: Chapter 106 Facial Trauma: Chapter 107 Minor Trauma: Chapter 110 Dental Emergencies: Chapter 117 The Children’s Hospital of Philadelphia Clinical Pathway ED Pathway for Dental Trauma or Infection URL: https://www.chop.edu/clinical-pathway/dental-trauma-or-infectionclinical-pathway Authors: E Szydlowski, MD; M Herring, MD; K Castelo, CRNP; B Pagliaro, RN; H Giannakopoulos, DDS, MD; E Hajishengallis, DDS, PhD Posted: August 2019 ASSESSMENT OF TRAUMATIC DENTAL EMERGENCIES CLINICAL PEARLS AND PITFALLS In patients with TDIs, carefully assess for associated injuries to the CNS, cervical spine, orbits, and jaw Airway obstruction in the setting of facial trauma may be the result of an aspirated tooth or blood in the oral cavity and pharynx Mucosal ecchymoses at the floor of the mouth or vestibular area are highly suggestive of mandibular fractures Primary teeth in the process of exfoliation may be confused with TDI Be alert to the possibility of nonaccidental trauma (child abuse) if the history is not consistent with the observed injuries Current Evidence The most emergent concern in a child with dental trauma is to evaluate for associated facial injuries and airway obstruction Obstruction can result from accumulation of blood in the oral cavity and pharynx Alternatively, the etiology may be a tooth aspirated by a child, or a fractured mandible causing the tongue to fall backward against the posterior pharynx Beyond airway obstruction and life-threatening injuries, trauma to the jaw, dentition, or soft tissues requires careful evaluation and treatment Inadequate recognition and management of these injuries can lead to suboptimal cosmetic and functional outcomes Goals of Treatment The care of pediatric patients with maxillofacial and dental trauma should follow the basic tenets of emergency medicine, starting with evaluation and management of airway, breathing, and circulation, as well as neurologic compromise Once stabilized, the emergency physician should perform a thorough extraoral and intraoral examination to identify the presence of injury to the jaws, teeth, and surrounding soft tissue Identification of those injuries that require emergent care from a dentist is imperative Clinical Considerations Clinical Assessment Children with facial injuries are usually frightened and apprehensive The examination should be organized to include inspection and palpation of extra- and intraoral structures Appropriate analgesia can facilitate the examination; procedural sedation may be required in some cases Extraoral examination The extraoral examination should start with evaluating symmetry of the face in the anterior and profile views The clinician should carefully note the location and nature of any swollen or depressed structures, the color and quality of the skin, and the presence of lacerations, hematomas, ecchymoses, foreign bodies, or ulcerations Evaluation of the temporomandibular joints (TMJs) involves observation and gentle bilateral digital palpation while the mouth is opened and closed There should be equal movement on both sides without major deviations Mandibular deviation during function or limited mouth opening may signify TMJ injury or condylar fracture Range of motion should not be forced because it may increase the extent of injury The infraorbital rim should be palpated to ensure it is continuous and intact all the way to the inner canthus of the eye Examination continues across the zygoma to the nose, palpating for crepitus or mobility The clinician should inspect for lip competency (the ability of the lips to cover the teeth) because loss of competency may indicate displacement of the teeth from trauma Attention should focus on the mandible, feeling along the posterior border of the ramus and moving anteriorly along the body to the symphysis, palpating for any discontinuity, mobility, swellings, or point tenderness The child should be questioned and examined for any evidence of paresthesia (numbness) of the lips, nose, and cheeks, which may indicate a fracture through the bony foramen in which the nerve exits Figure 105.1 shows the main nerve supply to facial structures ... functional outcomes Goals of Treatment The care of pediatric patients with maxillofacial and dental trauma should follow the basic tenets of emergency medicine, starting with evaluation and management... to a dentist is important for emergency physicians Since dental injuries involve the head and neck, concomitant neurologic evaluation is an important aspect of emergency care Although the majority... presenting injuries could be a result of nonaccidental trauma, that is, abuse KEY POINTS TDIs are common pediatric emergencies Neurologic assessment is an important part of management as injury has been