Back to leedsth.nhs.ukEMIBank Website
3 General Surgery
3.2 Maxillofacial
Facial Fracture
- The most common are the mandibular fracture, (which is usually clinically apparent), ZMC or malar fracture (which takes some practice to recognise) and maxillary fracture.
- Check 5 and 7th nerve function (the infra orbital nerve is frequently injured in Max Fax trauma)
- Check for defects of external ocular movements, and check that the palate is stable.
- If a facial fracture is present and displaced, the Max Fax Dr should be informed. If a fracture is undisplaced, bring the patient back to the next Facio-Maxillary Clinic .
- T-M joint dislocations should be reduced in A&E with the help of midazolam.
- Malar fracture are Easily missed. Usually follows a punch to the face. The patient has a tender cheek, maybe deformity, often local numbness affecting the upper teeth, and sometimes a subconjunctival bleed. Ask for facial X-rays. You may see a fluid level in the maxillary sinus and you may see the fracture. Refer to the Maxillo-facial surgeons.
Facial wounds
- Require very careful suturing. Even contaminated wounds can usually be closed primarily under antibiotic cover, provided adequate surgical toilet is carried out.
- Don't excise skin. Use steristrips where possible. Histo-acryl glue is also valuable, though not near the eyes.
Nasal injury
- Fractured nasal bones are common. Diagnose on history and appearance; initial X-rays are not required. Send to the "Nasal fracture" clinic the following Monday, advising the patient to bring a photograph with them of their facial appearance before the nose was injured.
- Do not alter this procedure because the patient is involved in litigation; your clinical diagnosis is quite sufficient for any medico-legal process.
Maxillofacial Care Pathways
MAXILLOFACIAL CLINICS
Monday PM: Mr Russell
Tuesday PM: Mr Loukota
Wednesday AM: Mrs Fisher
Thursday AM: Mr Fabbroni
Thursday PM: Mr Ong
Other times can be arranged where necessary.
Please note that early review is desirable.
Bleep the SHO to organise a clinic appointment.
Please Fax Notes to 89-37296
Please give radiographs to patient to bring to clinic where appropriate
Other numbers: Locals Leeds Dental Institute 89-36225
Maxillofacial Out-Patients 89-36223
Contact SHO, middle grade or consultant if any problems or queries.
Maxillofacial Care Pathways
FACIAL LACERATIONS
Lacerations appropriate for LA.
Daytime: Contact maxillofacial SHO
Out of hours and weekends: Contact maxillofacial SHO.
Lacerations requiring GA.
Admit, IVI, fast, consider starting IV antibiotics - Inform maxillofacial SHO
Contact SHO, Middle grade or Consultant if any problems or queries.
Maxillofacial Care Pathways
NASO-ORBITO-ZYGOMATIC FRACTURES (NOZ#)
Visual Acuity OK. No other injuries.
- Next Maxillofacial Clinic (early review)
- Antibiotics if laceration or Hx surgical emphysema
Visual Acuity Impaired
- Ophthalmology referral, contact maxillofacial for review
Significant Traumatic Facial Swelling (with no other injury)
- Maxillofacial Review/Referral
NOZ# and Head Injury
- Head Injury Obs, contact maxfax for review
N.B. Children with diplopia need immediate referral, not a clinic appointment.
Contact SHO, Middle grade or Consultant if any problems or queries.
Maxillofacial Care Pathways
MANDIBULAR FRACTURES
Isolated Condylar Fracture
- Analgesia, Soft Diet, Next Clinic Review
Fracture of Tooth Bearing Area
- Admit, IVI, Fast, IV amoxicillin and metronidazole (or suitable alternatives if allergic)
- Inform maxillofacial SHO
Contact SHO, middle grade or consultant if any problems or queries.
Maxillofacial Care Pathways
CERVICO-FACIAL INFECTIONS
Mild swelling, mild cellulitis or Hx of intermittent/meal-time swelling. No signs of systemic sepsis.
- Antibiotics, early clinic review
Moderate Swelling, Cellulitis, no airway compromise
- Fast, IV antibiotics, admit
- Inform maxillofacial SHO
Anything else please contact maxillofacial SHO for review.
Urgent referral with significant swelling, potential airway problem, marked trismus, orbital cellulitis.
Don’t forget infection of odontogenic origin is common and consider Oral Panoramic Radiograph.
Contact SHO, Middle grade or Consultant if any problems or queries.