Facial/Dental Trauma

Table of Contents

Aliases

None noted

Patient Care Goals

  1. Preservation of a patent airway
  2. Preservation of vision
  3. Preservation of dentition

Patient Presentation

Inclusion Criteria

Isolated facial injury, including trauma to the eyes, nose, ears, midface, mandible, dentition

Exclusion Criteria

  1. General Trauma [see General Trauma Management guideline]
  2. Burn trauma [see Burns guideline]

Patient Management

Assessment

  1. Patient medications with focus on blood thinners/anti-platelet agents
  2. ABCs with particular focus on ability to keep airway patent
    1. Stable midface
    2. Stable mandible
    3. Stable dentition (poorly anchored teeth require vigilance for possible aspiration)
  3. Bleeding (which may be severe – epistaxis, oral trauma, facial lacerations)
  4. Cervical spine pain or tenderness [see Spinal Care guideline]
  5. Mental status assessment for possible traumatic brain injury [see Head Injury guideline]
  6. Gross vision assessment
  7. Dental avulsions
  8. Any tissue or teeth avulsed should to be collected
  9. Lost teeth not recovered on scene may be in the airway
  10. Overall trauma assessment
  11. Specific re-examination geared toward airway and ability to ventilate adequately

Treatment and Interventions

  1. Administer oxygen as appropriate with a target of achieving 94-98% saturation – use ETCO2 to help monitor for hypoventilation and apnea
  2. IV access, as needed, for fluid or medication administration
  3. Pain medication per the Pain Management guideline
  4. Avulsed tooth:
    1. Avoid touching the root of the avulsed tooth. Do not wipe off tooth
    2. Pick up at crown end. If dirty, rinse off under cold water for 10 seconds
    3. Place in milk or saline as the storage medium. Alternatively, an alert and cooperative patient can hold tooth in mouth using own saliva as storage medium
  5. Eye trauma:
    1. Place eye shield for any significant eye trauma
    2. If globe is avulsed, do not put back into socket. Cover with moist saline dressings and then place cup over it
  6. Mandible unstable:
    1. Expect patient cannot spit/swallow effectively and have suction readily available
    2. Preferentially transport sitting up with emesis basin/suction available (in the absence of a suspected spinal injury, see Spinal Care guideline)
  7. Epistaxis – squeeze nose (or have patient do so) for 15 minutes continuously
    1. Commercial nasal clamps are acceptable
  8. Nose/ear avulsion:
    1. Recover tissue if it does not waste scene time
    2. Transport with tissue wrapped in dry sterile gauze in a plastic bag placed on ice
    3. Severe ear and nose lacerations can be addressed with a protective moist sterile dressing

Notes – Facial/Dental Trauma