Initial evaluation and management of facial trauma in adults
- Ryanne J Mayersak, MD, MS
Ryanne J Mayersak, MD, MS
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- Oregon Health & Science University
- Section Editor
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
The face is vital to human appearance and function. Facial injuries can impair a patient's ability to eat, speak, interact with others, and perform other important functions. Studies suggest that disfiguring facial injuries can have severe psychological and social consequences [1-9]. The treatment of facial injuries must first focus on threats to life, but important secondary considerations are function and long-term cosmesis.
The basic anatomy, clinical manifestations, and acute management of facial trauma in adults will be reviewed here. Eye injuries, pediatric facial trauma, and other aspects of facial trauma management are discussed separately. (See "Open globe injuries: Emergent evaluation and initial management" and "Orbital fractures" and "Retinal detachment" and "Oropharyngeal trauma in children" and "Nasal trauma and fractures in children" and "Jaw fractures in children".)
Sports like football, baseball, and hockey account for a high percentage of facial injuries among young adults [10-16]. Severe injuries often occur as a result of motor vehicle collisions, including those involving motorcycles and all-terrain vehicles, as well as interpersonal and domestic violence [17-20]. Other mechanisms include falls, animal bites, and recreational activities. Among combatants, facial injuries occur from gunshot wounds and other explosive or incendiary devices . Facial trauma sustained from gunshot wounds or explosions is associated with greater morbidity and higher mortality rates [22,23]. Associated head and cervical spine injuries are common in patients with significant facial trauma .
ANATOMY, PHYSIOLOGY, AND MECHANISM
The face is anatomically complex. It includes skin, muscles responsible for both gross motor function (eg, mastication) and subtle facial expression, a complex bony structure, and vital sensory organs. Injuries to the face may compromise the patient's ability to breathe, see, speak, hear, and eat, and may involve damage to the central nervous system.
●Bones – The posterior portions of the face form the anterior wall of the calvaria. Thus, the face lies in close proximity to the central nervous system. The anterior facial skeleton is composed of the frontal bone, nasal bones, zygomas, maxillary bones, and mandible (figure 1 and figure 2). The sphenoid, ethmoid, lacrimal, vomer, and temporal bones lie deeper within the facial structure, providing support and sites for muscular attachments, including the muscles used for chewing, speaking, and swallowing.
The temporomandibular joint (TMJ) is the only joint of the face and it engages in complex motions. The condyle of the mandible rotates and translates anteriorly (ie, moves forward) when the mouth opens. A meniscus, which overlies the condyle, maintains the joint and enables motion. The meniscus and the condyle form a hinged joint, allowing rotation, while the meniscus and the temporal bone form a sliding joint, allowing translation.
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- ANATOMY, PHYSIOLOGY, AND MECHANISM
- PATHOPHYSIOLOGY OF INJURY
- PREHOSPITAL MANAGEMENT
- HISTORY AND PHYSICAL EXAMINATION
- Initial assessment
- General examination
- Examination of specific body parts
- DIAGNOSTIC IMAGING
- Cerebrovascular injury
- Facial injury
- Ocular and orbital injury
- Nasal injury
- Mandibular injury
- GENERAL MANAGEMENT OF ACUTE INJURIES
- Facial injuries associated with cerebrovascular trauma or intracranial hemorrhage
- Prophylaxis against infection
- SPECIFIC INJURIES
- Oral lacerations
- Dental injury
- Temporomandibular joint
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS