A Textbook Case

​We went together, the med student and I, to check the eye complaint of a man who had been assaulted a few hours before. The student quickly decided we needed a facial CT to rule out a fracture. I asked him what kind of fracture he suspected; an orbital blowout fracture, he said.I asked the patient to look toward his nose, and a prominent lateral subconjunctival hemorrhage popped prominently into view. This is truly a red flag for a more complex midface fracture. Finding zygomatic arch tenderness, I wondered aloud if our patient had a zygomaticomaxillary complex fracture.There seems to be little need to have a framework to consider mid-face fractures these days. Most of us have ready access to a CT scanner, and a radiologist gives us our answer. I grew up medically in the era of plain facial films, however. We needed to have a mental schema to consider the bony blunt force injury to the face. I divide the face into thirds:Upper third: Above the eyebrows; rarely fractured in blunt trauma.Lower third: The mandible; often fractured, but clinical cues are helpful: two areas of pain, step off of teeth, inability to bite down on a tongue depressor.Middle third: Upper teeth to eyebrows; often fractured in simple and complex ways.Simple and complex can be defined as:Simple: Nasal fractures, blowout fractures (medial and inferior), and isolated zygomatic arch fracturesComplex: LeFort fractures and zygomaticomaxillary complex fracturesZygomaticomaxilla...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs