THÔNG TIN TÀI LIỆU
displaced fractures D: The infraorbital rims, zygomatic bodies, and maxilla are palpated and examined from the top of the head to determine depressions and fracture displacement E: The nasal bone and maxilla are examined for stability and possible fracture displacement F: The nose is examined intranasally to determine the placement of the nasal septum and the possible displacement of nasal bones or disruption of nasal mucosa G: The occlusion is observed to determine any disturbances of normal teeth relations H: The mandible is palpated and then retracted to determine sites of discomfort and possible mandibular fractures Neurologic examination of the face should include evaluation of both sensory and motor functions All three branches of the trigeminal nerve should be evaluated for sensation Anesthesia of the cheek suggests injury to the infraorbital nerve, whereas anesthesia of the lower teeth and lower lip suggests inferior alveolar nerve involvement The facial nerve should be evaluated by asking the patient to wrinkle the forehead, close and open the eyes fully, smile, show his or her teeth, and close the mouth tightly Determination of Appropriate Imaging Modality The use of radiography in the evaluation and management of children with facial trauma should be considered if there is a concern for fracture based on history and physical examination The complexity of bony and soft tissue facial structures can make the interpretation of plain radiographs difficult In addition, plain radiographs are often inadequate to determine whether a patient requires operative intervention Computed tomography (CT) has mainly replaced plain radiographs in the definitive assessment of bony facial injuries because it has a greater ability to detect fractures and associated displacement as well as visualize soft tissue structures Axial views demonstrate fractures of the anterior and posterior walls of the frontal sinus, medial and lateral orbital walls, posterior wall of the maxillary sinus, zygomatic arches, and mandible Coronal views demonstrate fractures of the ethmoid, sphenoid, and paranasal sinuses; orbital floors and infraorbital rims; the nasoethmoid region; and mandibular condyles and symphyses Coronal imaging requires hyperextension of the neck and thus requires prior exclusion of a cervical spine injury Three-dimensional CT imaging can help guide operative repair Despite their limitations, there are specific plain radiograph views that may be of utility for the evaluation of facial fractures in children The Waters view (occipitomental) is used to visualize the midface region: the orbital rims and floor of the orbit, nasal bones, zygoma, and maxilla This view may be particularly useful in patients suspected of having a blowout fracture of the orbit, as well as for detecting fluid in the maxillary sinus The Caldwell view supplements the Waters view for the evaluation of the upper two-thirds of the face, including
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