Injury to the teeth and the supporting alveolar bone occurs quite frequently,especially among children. Other more severe injuries to the soft and skeletal tissues of the orofacial area commonly arise through road traffic accidents, sporting activities, and interpersonal violence. Such violence where guns and other missiles are used may lead to extensive tissue destruction with high morbidity.
Injuries of the tissues in the maxillofacial area can at first appear daunting, but it is important to follow the basic principles of resuscitation: secure the airway, maintain breathing, and ensure circulation as a priority.
Management of All Orofacial Injuries
- Stabilize as appropriate and maintain the airway.
- Administer tetanus toxoid and maintain an airway.
- Give analgesics: Ibuprofen 400mg orally 8 hourly.
- If in level 4, refer to a higher levels for appropriate management.
Management of Jaw Fracture and Severe Soft Tissue Injuries
Mandibular fractures may present with swelling, pain and loss of function due to the derangement of occlusion: antimicrobial and analgesics cover is then mandatory.
- Give amoxicillin 500 mg orally 8 hourly+metronidazole 400mgh orally 78 hourly
- Fopr anal;gesia, give ibuprofen 400mg orally 8 hourly.
- Ensure that the fractured fragments are adequately bandaged: Use of a crepe bandage around the jaw and over the head should minimize fragment movement.
- Order an orthopantomogram, as this is the most useful radiographic investigation and should reveal the nature and severity of the fracture.
- Refer the patient for specialist surgical management
Primary care for gunshot and missile-associated injuries entails the control of haemorhage, surgical toilet, and suturing. Appropriate packing with antiseptic dressings (povidone iodine 10%) may be indicated in deep cavitation injuries where there is severe tissue loss.
Cost-Effective Solutions to Trauma of the Orofacial Tissues
IMPORTANT:Do not be too aggressive at the primary surgical toilet procedure. Useful tissue may be salvaged by employing multiple staged procedures. This facilitates easier reconstructive procedures afterwards.
- For all severe injuries of the mid and lower face, protect the cervical spine. Hence choose any imaging investigation carefully. Where feasible and available, a CT scan of the full neck and cranium may be the most useful primary investigation.
- Avoid unnecessary plain radiographic views.
Criteria for the Admission of a Patient with a Craniofacial injury
- Prolonged loss of consciousness reported.
- Clinicians are not able to predict the consciousness status.
- There is evidence of severe blood loss necessitating replacement.
- There is a persistent/recurrent headache.
- There is massive oedema in the facial region and especially in the floor of the moth.
- Any condition that may adversely influence the stability of the airway.
- Evidence of general confusion of the patient.
- Clinicians must use discretion to evaluate the minimum criteria that will necessitate the admission of an injured patient for appropriate management.