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- Discuss the incidence of facial trauma
- Review facial anatomy and physiology
- Discuss assessment and treatment of the facial trauma patient
Facial trauma can result from a wide variety of blunt and penetrating mechanisms ranging from trivial to life-threatening, including motor vehicle collisions, violent altercations, falls from any height, person-to-person collisions, gunshots and stabbings, vehicle vs. pedestrian, vehicle vs. biker, fishhooks, animal bites, sports equipment like baseballs and hockey pucks, and falls secondary to seizures.
Geriatric and pediatric patients have their own unique mechanisms. Kids experience facial trauma running into walls, table and counter edges, other kids, and all sorts of stationary objects like playground equipment. Geriatric patients experience facial trauma secondary to falls because they lack the quick reaction time needed to protect themselves as they fall. We had a case where an 80-year-old male patient stood up quickly from his recliner, felt faint, lost his balance and fell forward, hitting his head on the floor. His face was the first point of impact. His nose was fractured and he had a profuse anterior nose bleed. He simply couldn't react fast enough to brace himself with an outstretched hand.
FACIAL TRAUMA SIGNIFICANCE
Facial bones help protect the brain; house important organs for sight, taste and smell; create the initial passages of the respiratory system; provide the first actions in the digestive process; and are the foundation for communication through facial expressions.1 While in many situations facial trauma only results in lacerations, abrasions or swelling, the results can be significant if it also involves:
- Damage to underlying bone structures
- Traumatic brain injury
- Subdural or epidural bleeding
- Intracranial hemorrhage
- Brain herniation
- Cervical spine injury
- Airway compromise.
A thorough initial assessment, detailed secondary assessment and ongoing monitoring are important to identify traumatic facial injuries, as well as injuries that may be causing or could cause ABC life threats.
FACIAL TRAUMA FREQUENCY
An estimated three million emergency department visits are made per year for facial trauma.2 Since most of them are relatively minor, many of those patients likely self-transport to the ED. As a result, EMS professionals are likely to see fewer than 1% of patients with facial trauma that is significant and/or accompanied by other traumatic injuries.2
Historically, motor vehicle collisions were the leading cause of facial trauma, but increased use of seat belts has seen the number decrease. However, EMS professionals are now likely to encounter MVC patients with less-severe facial pain and bruising secondary to air bag deployment. There may even be simple soft tissue wounds from eyeglasses being pushed into their face by the air bag. Nonetheless, motor vehicle collisions continue to be a leading cause of facial trauma for unrestrained occupants.
Specific types of facial fractures are associated with specific mechanisms and types of symptoms. For example, motor vehicle collisions, physical altercations and falls lead to about 85% of nasal fractures,3 which are the most common type of facial fracture. Fractures to the zygomatic bone are second most common and, predictably, like other facial fractures most often occur to men in their 20s.4,5 Men experience most types of trauma at a greater rate because of a combination of factors that include alcohol and drug intoxication, risk-taking and confrontational behavior, and lower use of safety devices like seat belts.