ࡱ>  2416789:;89:;<=7 ,bjbjUU Q7|7|[(ljjjjf8 lfK9NN"pp ! ! !6666-$778$: <X8 ! " ! ! !8"jjpc9""" !j8p6" !6"h"['46B R@6f,!6690K96G="G=6"X&@jjjjAH 323 Facial Injuries Laboratory Materials: Gloves, Penlights, Cotton Tip Applicators. Otoscopes, Tuning Forks, Reflex Hammers Jaw History Primary complaint Mechanism of injury Direct blow Lateral blow Inferior blow Pain Sensations Crepitation Tingling Loose teeth Altered bite Observation Obvious deformity Swelling Signs of trauma Malocclusion of teeth Symmetry Jaw movement Physical Examination Palpation Tenderness Swelling Deformities Crepitation Movements Active Passive Resistive Temporomandibular Joint History Previous injury, symptoms, characteristics Mechanism of injury Acute Direct trauma Indirect trauma Chronic Malocclusion Muscular imbalance Muscular overload Psychologic or emotional factors Dental/oral habits (bruxism, clenching) Postural & work related habits (singing, phone use) Intracapsular diseases (infections, arthritis, necrosis, tumors) Developmental abnormalities (hypermobility, hypomobility, joint irregularities) Observation Anterior view Head & cervical alignment Jaw position & TMJ symmetry Facial features Lateral view Head & neck position Jaw position Top view Facial symmetry Tests in Sitting Mandible movements Depression Active Resisted Elevation Active Resisted Passive elevation & depression Lateral excursions (deviations) Active Resisted Passive Protrusion Active Resisted Retrusion Active Resisted Passive Special tests Jaw reflex Chvostek test Sensation tests TMJ palpations Auscultations Nose History Primary complaint Mechanism of injury Direction of force Pain Sensations Crepitation Air passage difficulty/obstruction Observation, from above, laterally, below Symmetry Ecchymosis Epistaxis Foreign body Swelling Deformity Rhinorrhea Physical Examination Utilize examination light Swelling Deformities Nasal Examination check nasal passages occlude 1 nostril with finger ask pt. to breathe in & out with mouth closed repeat other side should be able to breathe easily with no sound check nasal passages use nasal speculum & light to inspect nasal cavity view nasal mucosa & turbinates for color, foreign bodies, & abnormal masses nasal septum should be in midline, straight, normally thicker anteriorly than posteriorly asymmetry may indicate deviated septum Palpation Tenderness Swelling Deformities Crepitation Abnormal Movements Passive Ear History Primary complaint Mechanism of injury Pain location, type, timing Sensations Tinnitus Vertigo Loss of hearing Observation Hemorrhage Foreign body Otorrhea Swelling Infection ? Inflammation Blanching of skin Physical Examination good lighting, positioning & cooperation Palpation palpate ear & skull Tenderness Swelling Deformities Stress Painful Passive movements Auditory canal examination Use otoscope or penlight to view while distracting auricle superiorly & posteriorly Ear Examination Auditory canal examination using otoscope canal eardrum (tympanic membrane) transparency (usually pearly gray) blockage excessive wax swelling redness Hearing tests Whispered voice test Mask hearing in 1 ear with finger Stand 12-24 away Whisper 1 or 2 syllable words very softly Ask pt. to repeat spoken words If not heard, repeat with ( loudness Repeat for other ear Should be 50% correct in responses Ticking watch test Position non-electric watch 6 from ear Slowly move toward ear to be tested Ask pt. to tell when ticking is heard Measure distance to give some idea of pt.s ability to hear high-frequency sound Weber test Place base of vibrating tuning fork on midline vertex of pt.s head Ask pt. if sound is heard equally well in both ears or better in 1 ear If sound is lateralized, which ear? Repeat while occluding 1 ear with finger Should be heard better in occluded ear Rinne test Place base of vibrating tuning fork against pt.s mastoid bone Examiner counts /times interval with watch Ask pt. to tell when sound is no loner heard & examiner notes # of seconds Examiner quickly positions a still-vibrating tine 0.5 to 0.8 from auditory canal & ask pt. to tell when sound is no longer heard Compare # of seconds sound heard by bone conduction & by air conduction Air-conducted sound should be heard twice as long as bone-conducted sound Schwabach test Compares pt.s & examiners hearing by bone conduction Examiner alternately places vibrating tuning fork against pt.s & examiners mastoid process until sound is no longer heard by one Should hear for equal amounts of time Conductive hearing loss implies pt. experiences reduction of all sounds rather than difficulty in interpreting sounds Sensorineural or perceptual hearing loss indicates pt. has difficulty interpreting sounds heard Teeth History Primary complaint Mechanism of injury Pain Sensations Crepitation Observation Bleeding around teeth Loosened or shifted Chipped, cracked, broken, or dislodged Malocclusion Physical Examination (Using gloved fingers, cotton tipped applicators, penlight) Palpation Tenderness Swelling Deformities Crepitation Stress Abnormal movements Eye History Primary complaint Mechanism of injury Blunt object vs. sharp object Pain Discharge Sensations Burning Visual loss Something in eye Observation Foreign body Abrasion Increased tearing Laceration Pupil equality Red eye Black eye Hyphema Diplopia Physical Examination Palpation Tenderness Swelling Deformities Examination of Conjunctiva Lining Have patient look downward Grasp eyelashes & tarsal plate near edge, pull gently downward Place cotton-tipped applicator just above tarsal plate of lid, while holding eyelashes pull lid over the applicator Hold edge of everted lid against upper ridge of orbit & examine the area for abrasions or presence of foreign body. DO NOT push against eyeball. Lid will return when released when looking upward & blinking. Painful Movements Active in 6 cardinal movements (right & left, up & down, left & up, right & up, left & down, right & down) Visual Function Acuity Peripheral vision Accommodation (near, mid, far) AH 323 Facial Injuries Secondary Survey _____ History ___________________________________________________________________________________ _____ Primary complaint _______________________________________________________________________ _____ Mechanism of injury ______________________________________________________________________ _____ Pain ___________________________________________________________________________________ _____ Sensations (numbness, crepitation, dizziness, tinnitus, loss of hearing, burning, tingling, loose teeth, visual loss, something in eye)__________________________________________________________________ _____ Observation _______________________________________________________________________________ Jaw _____ Obvious deformity _______________________________________________________________________ _____ Swelling _______________________________________________________________________________ _____ Signs of trauma __________________________________________________________________________ _____ Malocclusion of teeth _____________________________________________________________________ _____ Symmetry ______________________________________________________________________________ _____ Jaw Movement __________________________________________________________________________ Nose _____ Epistaxis _______________________________________________________________________________ _____ Foreign body ____________________________________________________________________________ _____ Swelling _______________________________________________________________________________ _____ Deformity ______________________________________________________________________________ _____ Rhinorrhea _____________________________________________________________________________ Ear _____ Hemorrhage ____________________________________________________________________________ _____ Foreign body ____________________________________________________________________________ _____ Otorrhea _______________________________________________________________________________ _____ Swelling _______________________________________________________________________________ _____ Infection or inflammation __________________________________________________________________ _____ Blanching of the skin _____________________________________________________________________ Teeth _____ Bleeding around teeth _____________________________________________________________________ _____ Chipped, cracked, broken or dislodged ________________________________________________________ _____ Malocclusion ___________________________________________________________________________ _____ Loosened or shifted _______________________________________________________________________ Eye _____ Foreign body ____________________________________________________________________________ _____ Abrasion _______________________________________________________________________________ _____ Increased tearing _________________________________________________________________________ _____ Laceration ______________________________________________________________________________ _____ Pupil equality & symmetry _________________________________________________________________ _____ Red eye ________________________________________________________________________________ _____ Black eye ______________________________________________________________________________ _____ Hyphema _______________________________________________________________________________ _____ Diplopia _______________________________________________________________________________ _____ Palpation _________________________________________________________________________________ _____ Tenderness _____________________________________________________________________________ _____ Swelling _______________________________________________________________________________ _____ Deformities _____________________________________________________________________________ _____ Crepitation _____________________________________________________________________________ _____ Stress ____________________________________________________________________________________ _____ Temporomandibular joint movement _________________________________________________________ _____ Abnormal movements _____________________________________________________________________ PAGE  PAGE 2  EMBED Word.Picture.6  @A78Z,[,\,b,c,d,f,g,m,n,o,p,q,t,u,,,,,, jJ!}6 UjJ!}6 UVmHnHu jU0JmHnHu0J j0JUCJjUmHnHu5CJ jr5CJ"# $6?Oen{ & F & F & F & F$a$[,t,, 5IO]mu$e & F & F & F ^ ` & F & F"7DM]n   (  & F & F & F & F & F( 2 9 B J X c q  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