THÔNG TIN TÀI LIỆU
Identification of Specific Bony Injuries and Facial Neurologic Deficits Following airway stabilization and cervical spine protection, examination for specific bony injuries should be performed After careful observation for deformity and asymmetry, the clinician should palpate the facial bones in a systematic fashion ( Fig 107.1 ) Tenderness, crepitus, and “step off” are signs of underlying fracture Particular attention should be paid to the malar eminences, zygomatic arches, and superior and inferior orbital rims Assessment for a fracture of the maxilla can be performed by grasping and attempting to move the upper central teeth Any laxity of the maxilla or crepitus is suggestive of fracture External and intraoral palpation of the mandibular symphysis, body, angle, and ramus can help diagnose fractures in these areas Inspection of the mouth and oral cavity should also be performed to assess for injury to the maxilla and mandible Occlusal disharmony is an indication of mandibular and/or maxillary displacement Older children will be able to report if their bite “feels normal.” Opposing teeth that not come together, but that exhibit wear facets (smoothing of mammillations along the incisal surfaces of the teeth) suggest a traumatic malocclusion An inability to hold a tongue blade between occluded teeth on each side of the mouth is suggestive of a mandibular fracture Examination of the eyes should include the assessment of pupillary reactivity and size, examination of extraocular movements, visual acuity, and a thorough inspection for surrounding orbital injuries Orbital dystopia and/or enophthalmos are suggestive of a fracture of the orbit Examination of the nose should include documentation of focal tenderness, swelling and asymmetry, bleeding, or other nasal discharge, as well as the presence or absence of a septal hematoma
Ngày đăng: 22/10/2022, 13:50
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