Pediatric emergency medicine trisk 3286 3286

Stabilization of the airway is the primary concern for children with facial
trauma.
Computerized tomography is the optimal imaging study for suspected
facial fractures.
Prompt recognition of extraocular muscle entrapment associated with
orbital floor fractures is critical to prevent muscle ischemia and fibrosis.
Displaced nasal bone fractures should be repaired within 7 days of
injury.
Fast-absorbing plain gut sutures have demonstrated similar cosmetic
performance to nonabsorbable sutures for the repair of facial
lacerations.

GOALS OF EMERGENCY THERAPY
Stabilization of the Airway
While injuries sustained as a result of facial trauma are rarely life threatening,
patients who have sustained enough force to cause significant facial injury may
have other associated serious injuries. Stabilization of the airway is therefore the
primary concern in the management of facial injuries in children. Airway
obstruction may result from blood in the mouth, loose teeth, and pharyngeal
edema. Thus, the airway should be cleared and examined for patency. Loss of
support of subglottic musculature can result from severe mandibular fractures,
and the tongue can fall posteriorly and occlude the airway in a patient with a
depressed mental status. An oral or nasal airway may serve as an adjuvant to
positioning in order to achieve airway patency. Tracheal intubation may be
required if the airway remains unstable. Cricothyrotomy or tracheostomy may be
necessary if these measures fail to secure the airway but should be attempted only
as a last resort because of the technical difficulty and complications associated
with such procedures, particularly in young children.

Cervical Spine Protection
Up to 10% of patients with maxillofacial trauma have an associated cervical spine

injury. Patients with tenderness of the cervical spine, impaired sensorium, focal
neurologic deficits, or major distracting injury should be placed in a hard cervical
collar until an injury to the cervical spine can be excluded.