Management by Divisions Division I above supraorbital rim

• high risk of intracranial complications and frontal sinus injuries

• Management: complete neurological exam, facial and brain CT, Neurosurgical consultation for intracranial complications, manage frontal sinus fractures as described above

Division II: supraorbital rim to commissure of lips

• consider parotid duct and facial nerve injuries (see p. 477)

• disrupted globes require Ophthalmology evaluation for possible repair, otherwise consider enucleation to prevent sympathetic ophthalmoplegia (autoantibodies stimulated by globe injury may result in blindness in opposite seeing eye)

• Management: complete neurological, oropharyngeal, and ophthal-mological exam; CT of brain, orbits, and paranasal sinus; manage maxillary fractures as above

Division III: commissure of lips to hyoid bone

• Mandibular Angle Plane (MAP): vertical plane from angle of mandible to base of skull, if injury crosses this plane must consider carotid sheath injury

• Management: management similar to neck division I and III (exploration versus endoscopy), panorex, angiography (if wound crosses MAP)

Was this article helpful?

0 0

Post a comment