Facial trauma

Significant closed head or facial trauma within 3 months Relative Contraindications... 

Pain from associated injuries (e.g., tongue lacerations, dislocated shoulder, head trauma, facial trauma)... 

The NG route is used most commonly for short-term (less than 1 month) enteral access. Some institutions prefer the OG route because of less damage to the sinuses the OG route is also useful in situations such as facial trauma, where nasopharyngeal damage prevents NG feeding. The major advantage of these routes is that the tubes can be placed quickly and inexpensively by the nurse at the bedside. 

Absolute contraindications to fibrinolytic therapy include (1) active internal bleeding (2) previous ICH at anytime (3) ischemic stroke within 3 months (4) known intracranial neoplasm (5) known structural vascular lesion (6) suspected aortic dissection and (7) significant closed head or facial trauma within 3 months. Primary PCI is preferred in these situations. 

OSHA regulation 29 CFR 1910.134(f) requires that any time a change has been made in the model, type, or size of the respirator, or any change in the employee status that may affect respirator faceseal has occurred, for example, facial trauma, a ht testing must be done. Interestingly, this test may be done with the employee s own respirator, or an identical surrogate respirator (i.e., exactly the same manufacturer, model, and size). Additionally, ht testing must be conducted and documented annually. 

In addition to an assessment of language and cognitive abilities, the physical examination also should assess motor, sensory, and reflex abnormalities and pupillary response, asymmetry, and posturing on neurologic examination. Because generalized seizures may cause physical injury, the patient should be examined for secondary injuries (e.g., tongue lacerations, shoulder dislocations, head trauma, and facial trauma). 

The recent introduction of cone-beam CT for facial and dental applications is an interesting development in this field. The technology is at an early stage of assessment but preliminary studies indicate that within this area of application its performance, both generally and in facial trauma, may be comparable to conventional MSCT in use (Heiland et al. 2004 SCARFE et al. 2006 Shi et al. 2006), with the attraction of dose efficiency (Tsiklakis et al. 2005 Ludlow et al. 2006). 

Although the value of 3D imaging to the surgeon is generally assumed, there have been relatively few studies attempting an objective evaluation. Experimental assessment has shown 3D to be superior to multiplanar reformatting in facial trauma with faster diagnostic assessment (Fox et al. 1995). In our... 

Fractures of the mandible head or neck carry a particular risk of cosmetic deformity and abnormal bite if not corrected into acceptable anatomical position. 3D CT is used, as in other examples of facial trauma, to display the spatial distribution of the fragments and their relation to the joint (Salvolini 2002). Mai-alignment of the mandibular condyle is particularly important to demonstrate or exclude, as are those fractures classed as unfavourable for stabilisation because of opposing muscle pull these fractures require operative fixation. Post operative imaging maybe helpful to confirm satisfactory positioning, or placement of bone grafts, and healing (Ray et al. 1993). 

Reuben A, Watt-Smith SR, Dobson D, Golding SJ (2005) A comparative study of evaluation of radiographs, CT and 3D reformatted CT in facial trauma what is the role... 

Saigal K, Winokur RS, Finden S, Taub D, Pribitkin E (2005) Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Fac Plast Surg 21 214-220... 

Traumatic injury to the eyeball may occur alone or in conjunction with more extensive facial trauma, and may be due to blunt or penetrating injury. MDCT is applied when facial periorbital edema is too strong to allow for visual inspection of the eyeball or when there is suspicion or evidence of bony involvement or presence of foreign bodies (Mueller-Forell and Pitz 2004). 

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