Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIII: Maxillofacial Wounds and Injuries

Diagnosis

United States Department of Defense

To be certain that wounds which are not obvious are not overlooked, patients with maxillofacial injuries require careful roentgenologic and local examination, including inspection and palpation. Cervical spine fracture must be ruled out by X-rays.

Both the injured and intact sides of the head and face are examined comparatively to detect contusion, swelling, emphysema, tenderness, areas of analgesia, and distortion of bony landmarks. The surgeon should examine particularly for asymmetry of the level of the eyeballs and the presence of diplopie, periorbital hematoma, and edema, all of which are indicative of orbital floor fracture. Otorrhea and rhinorrhea of cerebrospinal fluid origin indicate fractures involving the sphenoidal and ethmoidal bones of the tegmen. Temporomandibular function is noted, as is the integrity of the palate and buccal sulci and the alignment of the upper and lower teeth.

Wounds within the oral cavity suggest segmental dental alveolar fractures or damage to the body of the mandible. The open-mouth or so-called gagging facies usually is caused by fractures of the mandibular ramus or by condylar dislocation, but it may also result from a horizontal fracture of the maxilla, higher level midface fractures, displaced teeth, or hematoma formation around a posterior fragment of the mandible.  

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Operational Medicine 2001

Health Care in Military Settings

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