Facial, Dental, Ear, Nose, and Throat Emergencies

1. Facial, Dental, Ear, Nose, and Throat Emergencies

2. Sinusitis • Bell’s Palsy • Trigeminal Neuralgia • Facial Lacerations • Soft Tissue Injuries • Mandibular Fractures • Maxillary Fractures • Zygomatic Fractures FACIAL EMERGENCIES

3. Dental • Odontalgia • Tooth Eruption • Pericoronitis • Fractures Tooth • Subluxed/Avulsed Tooth • Dental Abscess • Ludwig’s Angina • Trench Mouth • Ear • Acute OE • Acute OM • Ruptured Tympanic Membrane • FB • Meniere’s Disease • Labyrinthitis DENTAL AND ENT EMERGENCIES

4. Nose • Rhinitis • Epistaxis • Nasal Fracture • FB • Throat • Pharyngitis • Tonsillitis • Laryngitis • Fractured Larynx • Peritonsilar Abscess • FB DENTAL AND ENT EMERGENCIES

5. FACIAL

6. Nature of Injury/History • Bleeding • Airway Obstruction • Loss of Consciousness • Sensory Deficits/ Changes • Medical /Surgical History • Physical Assessment Assessment

7. Psychosocial Responses • Stress Factors • Behavioral responses Assessment

8. Diagnostic Procedures • Radiological • Facial Bones • Water’s View • Skull series • C-spine • CXR • CT Assessment

9. Diagnostic Procedures • Laboratory • Cultures • Coags • ABGs • T&C Assessment

10. ABC • Control Bleeding • Fluid and Electrolyte Balance • Prevent Further CNS complications • Control Pain • Relieve Anxiety • Education Priorities

11. Pediatric • 6-7 year: primary eruption of teeth • Head is larger proportionally than adult’s • Neck muscles are relatively weaker for large head mass • Always explain and be honest • Limitations in verbal expression • Facial bones are more pliable and softer Age-related Pearls

12. Geriatric • Age-related changes • Decreased vital capacity • Diminished ability to cough • Visual acuity changes • Diminished hearing • Loss of short-term memory • Muscle atrophy • Chronic Disease • Delayed responses • Medications Age-related Pearls

13. Inflammation of mucous membranes • Maxillary sinus most common • Frequently follows URI • Other causes: • allergies • dental • infections • trauma • polyps Sinusitis

14. Symptoms • Pain/Pressure • Fever or not • HA • Decreased appetite • Nasal congestion • Nasal voice • Red, swollen mucosa • Purulent nasal drainage • Conjunctivitis • Tenderness to palpation • Puffy eyes • Bad breath (esp. children) Sinusitis

15. Treatment • Decongestants • Antibiotics • HOB elevated • Apply heat • Room vaporizer • Severe: hospitalization IV antibiotics Surgery Education • Should improve 3-4 days • Vaporizer, steam bath • Increase fluids • Avoid smoking • “Rebound congestion” Sinusitis

16. Paralysis of all facial muscles on one side of face • Usually unilateral • Swelling of facial nerve as a result of virus or immunodeficiency disease • > 40 yrs • Usually self-limiting • Complete resolution in 80-90% of cases Bell’s Palsy

17. Symptoms • Rapid, acute onset • Hx of Virus? • Unilateral facial weakness/paralysis • Retro auricular and/or facial discomfort • Drooling • Dysphagia • Inability to close eye on affected side • Decreased lacrimation • Drooping of mouth • Speech difficulty • Positive corneal sensation /negative blink • Inability to wrinkle forehead Bell’s Palsy

18. Diagnostics • Exclude other diseases Bell’s Palsy

19. Treatment/Education • Explain this disease • Not a stroke • Recovery within 3 weeks • Artificial tears • Eye patch • Gentle manual closure of eye • Not contagious • Keep face warm, avoid drafts • Possible analgesics and steroids • Moist heat • Facial muscle exercises Bell’s Palsy

20. Fifth cranial nerve • Usually second and third division – maxillary and mandibular areas • Brief, recurrent paroxysms of excruciating facial pain • > 40 yrs and female • Right side affected more often than left Trigeminal Neuralgia

21. Symptoms • Electrical shock type pain • Unilateral • Minimal to no sensory loss • Painful paroxysms precipitated by touching of trigger zone Diagnosis • History and physical exam • Exclude other diseases Trigeminal Neuralgia

22. Treatment • Tegretol, Dilantin, analgesics • Surgical interventions Education • Majority of patients respond to medical therapy within 48 hrs • 25-50% eventually will require surgical intervention • Avoid cold exposure (iced drinks, winds, swimming) • Side effects of medications Trigeminal Neuralgia

23. Lacerations • Abrasions • Puncture wounds • Contusions • Avulsions • Range from simple isolated injury to those accompanied by airway obstruction, edema, hemorrhage, facial trauma, and multisystem injuries Facial lacerations and soft tissue injuries

24. Symptoms/ Assessment • MOI • Facial asymmetry/swelling • Pain/tenderness • Foreign bodies • Motor and sensory deficits Diagnosis • Rule other S/S of more extensive facial injures, CNS injury, and multisystem injury • Radiographs • CT • Cultures Facial lacerations and soft tissue injuries

25. Treatment • Control bleeding • Irrigate wounds copiously • Clean intact skin and wound edges • Replace tissue flaps • Td • Analgesics • Ice to area of trauma, not to avulsed part • Suture • Anesthetic • Lido with epi unless contrindicated • Restraint • Lighting • Scissors to cut hair / never shave or cut eyebrows Facial lacerations and soft tissue injuries

26. Education • Wound care Facial lacerations and soft tissue injuries

27. One of the most frequently fractured facial bone • TMJ dislocation may accompany • Fight and crashes most common causes Mandibular Fractures

28. Symptoms/Assessment • MOI • Pain/point tenderness • Malocclusion • Facial asymmetry • Bleeding around mouth • Numbness of lower lip • Trismus • Edema/hematoma • Ruptured tympanic membrane • Mobility of fracture fragments • Ecchymosis in floor of mouth • Sunlingual edema Mandibular Fractures

29. Diagnostics • PA, lateral, oblique skull films • Waters’ • CT Mandibular Fractures

30. Treatment • Ensure patent airway • Prevent aspiration of blood, teeth, bone fragments, etc • Control bleeding • Have emergency airway equipment readily available Ice • Analgesics • Surgical reduction/wiring • Antibiotics • ½ and ½ peroxide and water • Td Mandibular Fractures

31. Education • S/S infection • Mechanical soft diet • Use a straw • Drink plenty of liquids Mandibular Fractures

32. Less common than mandibular • Usually associated with other multisystem injuries • LeFort I, II, III • Common causes: fight and crashes Maxillary Fractures

33. Symptoms/Assessment • MOI • Pain/tenderness • Swelling • Asymmetry/distortion • Infraorbital mobility/paresthesia • Ecchymosis • Epistaxis • Malocclusion • Visual disturbances • CSF rhinorrhea • Subconjuctival hemorrhage • Midface maxillary mobility • S/S of intracranial, spinal, or multisystem injuries Maxillary Fractures

34. Diagnostics • Waters’ view • Individual facial films • CT scan Maxillary Fractures

35. Treatment/Education • Ensure airway patency • Prevent aspiration • Positioning – Fowler’s/Semi-Fowlers • Emergency intubation available • Control bleeding • Cold packs to face • Definitive treatment • Open reduction • Internal wiring • Antibiotic prophylaxis • Hospital admission • Td • Support and reassurance Maxillary Fractures

36. Causes: Fight, Crash, and Falls • Tripod fractures • Frequently associated with orbital floor fractures – blow-out fractures Zygomatic Fractures

37. Symptoms/Assessment • MOI • Pain/point tenderness • Bleeding • Edema • Pain with jaw movement • Visual disturbances/diplopia • Facial asymmetry • Epistaxis • Subjunctival hemorrhage • Paresthesia of cheek, nose, upper lip of affected side • SQ emphysema Zygomatic Fractures

38. Diagnosis • Waters’ view • Submentovertical view Zygomatic Fractures

39. Treatment/Education • Analgesia • Position and elevate head • Ice • Definitive treatment • Open reduction • Internal wire fixation • Hospital admission • Explanations and reassurance Zygomatic Fractures

40. DENTAL AND ENT EMERGENCIES

41. History • Bleeding • Obstructed Airway • Swelling/Edema • Asymmetry/ Dislocation • Fever/Chills • Nausea/Vomiting • Drooling • Facial numbness • Dysphasia/Dysphagia • Foul odor and taste in mouth • Loss of hearing • Tinnitis or vertigo • Trismus • Discharge/Drainage ASSESSMENT

42. Itching • Neck pain • HA • Medical History • HTN • CAD • Atherosclerosis • Neuro diseases • Dental/ENT surgery and/or infections • CA • Smoking • Diabetes ASSESSMENT

43. Radiology • Chest • Waters’ • CT scan • Laboratory • Cultures • CBC • Sed rate • Coags • ABGs DIAGNOSTICS

44. ABCs • Control Bleeding • Fluid Volume • Pain control • Anxiety • Definitive Treatment • Prevent Complications • Education PRIORITIES

45. Pediatric • 85% of FB aspirations < 3 y/o • Boys twice as likely than girls • Persistent cough or chronic wheezing may be indicative of aspirated FB • In 20-38% of esophageal ingestions there are no symptoms • Abrupt onset of respiratory and pulmonary symptoms suggest FB ingestion. • Irritability and lack of feeding in infants may be potential S/S of ENT/Dental emergencies Age-Related Pearls

46. Geriatric • Difficulty in mastication • Loss of sensation • Progressive hearing loss • Most dental and ENT emergencies in the elderly is related to falls, visual changes, MVCs, and assaults Age-Related Pearls

47. Dental

48. Toothache / Dental caries • Sharp to throbbing • If left untreated, will eventually lead to necrosis • Prevention is best treatment Odontalgia

49. Symptoms • Pain in diseased tooth • May be referred to gum line, jaw, temple, ear, neck • More intense nocturnal pain • Heat or cold stimulus • Tooth discoloration • Foul breath Diagnostics • Rule out abscess Odontalgia

50. Treatment • Topical anesthetic • Antibiotics • Analgesic Education • Preventative hygiene • Follow-up with dentist Odontalgia