Further Inpatient Care
- Patients with NOE fractures generally require admission to monitor for a CSF leak and observe for signs of meningitis or brain abscess, which are known complications.
- Patients with zygomatic arch fractures who have significant trismus or inability to open the mouth may require admission for observation because of potential problems with aspiration or airway obstruction from vomiting.
- Patients with tripod fractures with eye involvement generally require admission to ophthalmology.
- Patients with Le Fort fractures may require admission for further workup prior to open reduction and internal fixation. Patients also may need a short admission if arch wires are used, because of the risk of obstruction or aspiration should they vomit. During the hospital stay, teach patients how to remove the crossband so the mouth can be opened if they need to vomit.
- Patients with multiple traumas should be admitted to a surgeon with trauma experience to coordinate care of all injuries.
- The incidence of posttraumatic stress disorder is high in patients with facial injuries, and consultation with a psychiatrist should be considered.[14]
Further Outpatient Care
- Patients with simple nasal fractures can be discharged home with follow-up in 5-7 days when edema has decreased. Avoid delaying follow-up care, because fracture healing may begin prior to a necessary reduction. Give patients epistaxis instructions and instruct to return if clear fluid from nose is noted.
- Patients with simple zygomatic arch fractures, without trismus or mouth opening problems, can be discharged home with proper follow-up care.
- Patients with tripod fractures without eye involvement can be discharged home with appropriate follow-up care.
Inpatient & Outpatient Medications
- Facial fractures tend to be very painful. Provide adequate analgesia, including oral opioids and NSAIDs. If nasal packing is used, antibiotics are generally used to prevent toxic shock.
Transfer
- If appropriate specialists are not available, transfer the patient to a higher-level hospital. This is particularly important in patients with multiple injuries.
Deterrence/Prevention
- Use of seatbelts and airbags can reduce incidence of facial injuries in motor vehicle accidents. Use of helmets with facial guards can reduce injury in motorcycle accidents and in accidents in such sports as skiing, snowboarding, hockey, and football.
Complications
- Continued CSF leaks can occur, although most stop by 2-3 weeks after the injury.
- Meningitis and abscesses are serious infections that can occur when a CSF leak is present. Observe patients closely for signs and symptoms.
- Sepsis
- Scars and facial deformity
- Injury to infraorbital nerve in tripod and Le Fort II fractures that extends through the infraorbital foramen where the nerve exits
- Posttraumatic stress disorder[14]
Patient Education
- If band arch wires are placed, teach patients how to release the crossband in an emergency.
- Give instructions for epistaxis if this has occurred.
- Discuss the risk of posttraumatic stress disorder.[14]
- For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center and Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education articles Black Eye.
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Javadrashid R, Khatoonabad M, Shams N, Esmaeili F, Jabbari Khamnei H. Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures. Dentomaxillofac Radiol. Dec 2011;40(8):486-91. [Medline].
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