Trauma and Maxillofacial Injuries
Trauma and Maxillofacial Injuries
This domain tests prioritization in facial trauma: airway, cervical spine, hemorrhage, vision, and occlusion before definitive fixation. The exam favors ATLS sequencing and recognition of injuries that threaten life or sight.
Core rules
- Primary survey first: airway, breathing, circulation, disability, and cervical spine protection.
- Control hemorrhage, assess cranial nerves and visual acuity, and examine the occlusion and mandibular movement.
- Le Fort I, II, and III fractures are defined by the level of separation; suspect a condylar fracture with a shortened ramus or malocclusion.
- Orbital compartment syndrome presents with pain, proptosis, reduced vision, and afferent pupillary defect; lateral canthotomy is urgent.
- Dental avulsion: replant a permanent tooth promptly, handle by the crown, and use appropriate splinting; consider tetanus status.
Worked example
A patient has a parasymphysis fracture and a minimally displaced condylar fracture. Reasoning: restore occlusion first; parasymphysis fracture usually needs open reduction and internal fixation; a minimally displaced condyle may be managed closed with physiotherapy. The condyle must not be missed because it changes occlusion and rehabilitation.
Traps
Missing a condylar or cervical spine injury; delaying orbital canthotomy; leaving an avulsed tooth dry; treating infection with antibiotics without drainage; failing to document visual acuity.