Clinical Assessment of the Trauma Patient

Abstract

Facial injuries result from physical trauma to the face and can manifest themselves with various symptoms such as lacerations, ecchymosis, epistaxis, and eye injuries and fractures of the facial bones. These injuries require prompt evaluation and treatment in order to reduce morbidity, minimize disfigurement and loss of function, as well as prevent potential mortality resulting from bleeding and airway interference. It is important to systematically evaluate the patient with facial trauma and establish an accurate and detailed diagnosis before proceeding to definitive care. One should adhere to general trauma management principles and perform a primary and secondary survey to identify potential difficulties with airway, breathing, circulation, neurological function, and any concomitant injuries, as 50–70 % of patients with facial trauma will also have concomitant injuries to other organ systems. Cervical spine injuries can be seen in 4–10 % of patients with a facial fracture, while up to 20 % of patients with a cervical spine injury may have associated facial fractures. Nearly 18–45 % of patients with a facial fracture may have an associated closed head injury. The Advanced Trauma Life Support (ATLS) principles should guide the initial assessment of the facial trauma patient, and once life-threatening injuries have been ruled out or stabilized, a thorough and comprehensive physical examination should ensue to identify maxillofacial injuries. Appropriate radiographic examinations should follow extensive clinical evaluation to confirm suspected injury, delineate the extent of trauma, and guide definitive treatment.