When taking a history, the EP must document the mechanism and circumstances of the injury (e.g. interpersonal violence, road traffic accident) as well as the presence or absence of head injury symptoms, such as loss of consciousness, amnesia and vomiting.

Further specifics need to be considered when acquiring the history for the following injuries:

ZMC and zygomatic arch injuries

For injuries of the ZMC and zygomatic arch, the history must also include:

  • Visual disturbance – indicating possible orbital or globe injury
  • Alteration in bite or difficulty moving the jaw – suggests mandible, maxilla or zygomatic arch injury
  • Sensory disturbance to the cheek and upper gum – a sign of infraorbital nerve injury

Nasal injury

For nasal injury, the history must include:

  • Previous nasal injury/deformity – often a perceived nasal deformity is pre-existing
  • Epistaxis – this may be extensive with nasal trauma but a history of epistaxis alone is not predictive of a new nasal deformity [7]
  • Anticoagulant medication – may complicate the management of post-traumatic epistaxis
  • Any persistent nasal discharge since the injury – this symptom may indicate a nasoethmoid injury with CSF leak

Facial injury and abuse

The EP must also be aware of the association between facial injury and the abuse of children, women and vulnerable adults. If doubt exists, for example, a delayed presentation or mismatch between the history and examination findings, then seek advice from a senior EM or paediatric clinician.

Learning bite

Consider carefully whether the history of injury corresponds with your findings on examination. A second opinion should be sought for any discrepancy found.