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Facial, Dental, Ear, Nose, and Throat Emergencies

Facial, Dental, Ear, Nose, and Throat Emergencies. Sinusitis Bell’s Palsy Trigeminal Neuralgia. Facial Lacerations Soft Tissue Injuries Mandibular Fractures Maxillary Fractures Zygomatic Fractures. FACIAL EMERGENCIES. Dental Odontalgia Tooth Eruption Pericoronitis Fractures Tooth

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Facial, Dental, Ear, Nose, and Throat Emergencies

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  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

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