Facial Trauma

Impacted 2

Step 1: View clinicals

A 23-year-old man presents following a head-on collision with another vehicle, while driving at a moderate speed. He was not wearing a seatbelt at that time. He sustained multiple superficial cuts over his face and blunt trauma to the right midface, and now complains of pain and double vision upon vertical eye movements. His history is negative for headache, neck pain, vomiting, loss of consciousness, ENT bleeding, hearing impairment, vertigo or tinnitus. His medical, surgical, and family histories are unremarkable, and he is not on any medications.


Step 2: Order all relevant investigations

X-ray cervical spine

No abnormalities are noted.

Plain X-ray skull

Fluid is visualized in the right maxillary sinus. No other abnormalities are noted.

CT B/L orbits

There is a minimally displaced right-sided orbital floor fracture with significant soft tissue entrapment. A small amount of herniated tissue and air-fluid level seen in the right maxillary sinus. The left orbit appears normal.

MRI Brain

You realize that MRI imaging of the brain is not indicated here.


Step 3: Select appropriate management

Steroids
Antibiotics
Discourage nose blowing
Watchful waiting


Score: ★★☆