Initial Assessment

The initial assessment of a patient with a facial injury must start with an ABCDE approach. The airway is of particular concern, either from direct injury or from complications of local trauma, i.e. bleeding/swelling.

In facial injuries, associated head and neck injury must also be considered. In one study, nearly 3% of alert patients with a facial fracture and no neurological deficit had an intracranial haemorrhage on CT scan [5]. Other studies have found up to 10% of patients with a facial fracture, most commonly the nose and ZMC, have an associated significant cervical spine injury 6, 21. Midface injuries are associated with C5-7 disruption, whilst lower face trauma is more associated with C1-4 disruption.

Learning bite

The EP must seek to rule out occult head and cervical spine injury in all patients with facial injury. All maxillofacial trauma patients should be considered high risk for cervical spine injuries.