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domingo, 8 de septiembre de 2013

Trauma Maxilofacial

EB Medicine - February 2008
Author: Charles Stewart, MD, FACEP, FAAEM
Director of Research, Department of Emergency Medicine,
University of Oklahoma, Oklahoma Institute of
Disaster and Emergency Medicine, Tulsa, OK
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Peer Reviewers: James F. Fiechtl, MD
Assistant Professor, Department of Emergency Medicine, 
Vanderbilt University Medical Center
 Stephen J. Wolf, MD
Director, Residency in Emergency Medicine, 
Denver Health Medical Center, Denver, Colorado

"Among the myriad injuries seen in the emergency department, facial trauma is one of the most common. Trauma to the maxillofacial area mandates special attention. Due to their close proximity and frequent involvement, the vital structures in the head and neck region must be evaluated whenever the head and face are injured. Additionally, the psychological impact of disfigurement associated with facial and maxillary trauma can be devastating. Given the broad variety of facial injuries and potential concomitant complications, management can be challenging even for the most experienced clinicians.
Goals in the treatment of facial injuries include a return of normal ocular, masticatory, and nasal function, restoration of speech, rapid bone healing, and an acceptable facial and dental esthetic result. With ever-increasing sophistication in imaging, emergency providers can rapidly diagnose small facial fractures. However, subtle complex facial fractures with CSF leaks, temporal bone fractures, and cranial nerve injuries can remain undiagnosed. These missed or delayed diagnoses can lead to significant morbidity or death.
The goal of this article is to assist the emergency physician in the initial management of patients who have sustained a facial injury. Since the emergency physician is rarely involved in operative decisions, there is no effort to discuss the surgical treatment of these fractures and soft tissue injuries beyond the initial stabilization. This article does not discuss pure ocular or lid lesions."