Management of Craniofacial Injuries: A Primer for Residents

Abstract

Craniofacial injuries can occur in a significant proportion in traumatic brain injury patients and can be associated with many other concomitant life-threatening systemic injuries i.e. limbs fractures, chest injuries, spinal injuries and orbital injuries. An understanding of the presentations of craniofacial injuries, associated systemic injuries and patterns of traumatic brain injuries is crucial for improving care, survival and recovery of these patients. In present article we discuss the approach to craniofacial injuries which is based on time tested principles of surgery a good understanding of surgical anatomy, detailed history, accurate yet elaborative clinical evaluation, appropriate radiological investigations and decision to select management protocol for a given case. Evaluation of these patients should include a coordinated and systematic examination to aim to evaluate of all areas and all the residents while examining these patients in emergency room should remember that facial swelling, altered sensorium, restless patient, presence of endotracheal and nasogastric tube can obscure the detail examination and distort the facial appearance.

Massive Penetrating Craniofacial Trauma due to Polyvinyl Chloride Pipe

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] These injuries can lead to minor penetrating entry wounds to massive external wounds associated with extensive tissue damage. [1][2][3][4][5][6][7][8][9][10][11][12] The extent of injuries depends on the size, shape, velocity (low vs. high) of penetrating object, site, and area of contact at the time of impact. 19,20 As we observed in the presented case, if a person is involved in motor vehicle accident, the associated fall can add to the extent and severity of injuries.…”

“…21 The mainstay of treatment of a patient with craniofacial trauma includes stabilizing the vital parameters, safeguarding the airway against aspiration, detailing clinical history, and examining to rule out other associated life-threatening injury (including injuries to the airway and craniofacial region). 2,17,[21][22][23] After that a detail evaluation of the wounds is mandatory to assess the extent of tissue damage and plan the surgical management in order to avoid delayed complications. Thin slice CT scan of the brain and face will help estimate the extent of soft tissue, any skull fracture, presence of intracranial hematomas, and bony injuries.…”

“…Thin slice CT scan of the brain and face will help estimate the extent of soft tissue, any skull fracture, presence of intracranial hematomas, and bony injuries. 2,17,20,21,[24][25][26][27][28][29][30][31][32][33] It will also show (if the material is radiopaque) the size, number, and trajectory of the penetrating material. [30][31][32]34 In presence of metallic foreign bodies, the CT scan shows metal artifacts and can be difficult to interpret.…”

“…17,46 The outcome of patients with penetrating craniofacial injuries depends not only on the extent of injuries to the craniofacial skeleton but also on the injuries to the brain parenchyma (skull fracture with underlying contusions/hematoma and any diffuse axonal injury). 2,17 In absence of major injuries (particularly injury to the vascular and neural structures), the prognosis of penetrating craniofacial injuries is good. 17,47…”

“…Penetrating craniofacial trauma can lead to a wide spectrum of injuries and can be challenging to manage. [1][2][3][4][5][6][7][8][9] In addition to massive injury to the facial tissue and craniofacial skeleton, there may be retained foreign-body fragments that will add to the difficulty in the management of these patients. [1][2][3][4][5][6][7][8][9][10][11][12] We present a case of man who sustained massive penetrating craniofacial injuries due to polyvinyl chloride (PCV) pipe and discuss the management.…”