Ep 220 Facial Injuries: Assessment, Management and Disposition

Facial trauma management in the emergency department requires a systematic, top-down approach that prioritizes airway stability and hemorrhage control over immediate imaging. While CT scans are standard for diagnosing complex fractures, physical examination remains the most critical tool for identifying life-threatening injuries like retrobulbar hematomas or airway-obstructing mandible fractures. Key clinical pearls include assessing for extraocular muscle entrapment through ocular motility tests, identifying septal hematomas to prevent cartilage necrosis, and utilizing simple maneuvers like tongue-tethering for airway support. Distinguishing between urgent surgical needs—such as ocular compartment syndrome or open mandible fractures—and injuries that can safely wait for swelling to subside is essential for appropriate disposition. Proper sinus precautions, including avoiding nose-blowing, are vital to prevent orbital cellulitis and emphysema in patients with mid-face fractures.