Maxillofacial Injuries

Maxillofacial injuries can be complex and multi-specialty involvement in their management may be needed. Injury can involve the skin and soft tissues as well as resulting in fractures. Acute and long-term psychological problems can result from maxillofacial trauma and disfigurement. The first human face allograft was successfully performed in 2006 in France and has potential for use in facial reconstructive surgery secondary to maxillofacial trauma. 

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany facial trauma.

In developed countries, the leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere. Thus prevention efforts include awareness campaigns to educate the public about safety measures such as seat belts and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.

Abdominal Injuries

Abdominal trauma is a leading cause of morbidity and mortality among all age groups. Identification of serious intra-abdominal pathology is often challenging. Many injuries may not manifest during the initial assessment and treatment period. Mechanisms of injury often result in other associated injuries that may divert the physician's attention from potentially life-threatening intra-abdominal pathology.

Abdominal trauma is a leading cause of morbidity and mortality among all age groups. Identification of serious intra-abdominal pathology is often challenging. Many injuries may not manifest during the initial assessment and treatment period. Mechanisms of injury often result in other associated injuries that may divert the physician's attention from potentially life-threatening intra-abdominal pathology.

Injury to intra-abdominal structures can be classified into 2 primary mechanisms of injury–compression forces and deceleration forces.Compression or concussive forces may result from direct blows or external compression against a fixed object (eg, lap belt, spinal column). Most commonly, these crushing forces cause tears and subcapsular hematomas to the solid viscera. These forces also may deform hollow organs and transiently increase intraluminal pressure, resulting in rupture. This transient pressure increase is a common mechanism of blunt trauma to the small bowel.

Deceleration forces cause stretching and linear shearing between relatively fixed and free objects. These longitudinal shearing forces tend to rupture supporting structures at the junction between free and fixed segments. Classic deceleration injuries include hepatic tear along the ligamentum teres and intimal injuries to the renal arteries. As bowel loops travel from their mesenteric attachments, thrombosis and mesenteric tears, with resultant splanchnic vessel injuries, can result. The liver and spleen seem to be the most frequently injured organs, although reports vary. Small and large intestines are the next most injured organs, respectively. Recent studies show an increased number of hepatic injuries, perhaps reflecting increased use of CT scanning and concomitant identification of more injuries.