The Patient with Maxillofacial Injury
A 38-year-old man was hit by a car while riding his bicycle. According to witnesses, his head struck the hood of the car, and he was unconscious for approximately 5 min after the injury. On arrival in the emergency room, he was arousable and complaining of abdominal pain. His vital signs were: pulse 120/min, blood pressure 110/90 mmHg, respiratory rate 28/min, temperature 37°C. Physical examination showed marked facial edema, bilateral raccoon eyes, trismus, and jaw misalignment. His airway was unobstructed, and examination showed normal heart and lung function. He had diffuse abdominal tenderness, and abdominal lavage was positive for blood.
Other laboratory studies were unremarkable. Skull and facial x-rays revealed basilar and frontal bone fractures and multiple mandibular fractures, as well as left-sided LeFort HI and right-sided LeFort II fractures. Cervical films showed no fractures or dislocations of the spine. In addition, no fractured ribs or pneumothorax was noted on chest x-ray.
The patient was taken to the operating room for an exploratory laparotomy. An oral fiberoptic intubation was attempted but was unsuccessful because of intraoral bleeding. Therefore, the airway was secured via tracheostomy under local anesthesia. Subsequently, a laparotomy was performed under general anesthesia, and a ruptured spleen was removed. Arch bars were also placed at this time to stabilize the fractured lower jaw. A postoperative CT scan of the head revealed a left frontal contusion, a depressed frontal bone fracture, and air in the left temporal lobe. One week later the patient was scheduled for an open reduction and internal fixation of his skull and facial fractures.
KeywordsSkull Fracture Facial Fracture Mandibular Fracture Facial Skeleton Maxillofacial Trauma
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