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Spinal examination The overlying skin should be inspected (e.g. for possible penetrating wounds) and the entire spine must be palpated. A formal spinal log roll must be performed to achieve this ( Figure 30.12 ). Significant swelling, tenderness, palpable steps...

Spinal neuroanatomy The spinal cord extends from the foramen magnum to the L1/ L2 level, where it ends as the conus medullaris in adults (lower in children) ( Figure 30.8 ). Below this level lies the cauda equina. ). If Figure 30.9 illustrates a cross-section...

Spinal stability Spinal stability is the ability of the spine to withstand phys iological loads with acceptable pain, avoiding progressive deformity or neurological deficit. The spine can be divided into three columns: anterior, middle and posterior ( Figure 3...

Subaxial cervical spine (C3–C7) The pattern of lower cervical spine injury depends on the mechanism of trauma. These include compression fractures (hyperflexion), burst fractures (axial compression), facet subluxation/dislocation injuries (distraction–flexion)...

The secondary injury Haemorrhage, oedema and ischaemia result in a biochemical cascade that causes the secondary injury . This may be accen tuated by hypotension, hypoxia, spinal instability and/or persistent compression of the neural elements. Management of ...

Thoracic and thoracolumbar fractures The system developed by the AO (Arbeitsgemeinschaft für Osteosynthesefragen) can be used to classify these fractures. There are three main injury types, A, B and C, with increasing instability and risk of neurological inju...

cord injury Pressure ulcers Many are preventable. Patients should be turned regularly on an appropriate mattress to minimise the risk of skin breakdown. Pain and spasticity Neurogenic pain is common. Once reflex activity returns following cord injury , spastici...

CLASSIFICATION OF FACIAL INJURIES Bony injury Maxillofacial bone fractures can be divided into several types: simple (isolated single), compound (communicates through the skin or oral/nasal mucosal surfaces), comminuted (multiple fragments), complicated (with ...

CLINICAL ASSESSMENT History The history should include the mechanism of injury , past medical history and the postinjury events; it should be obtained directly from the patient and from witnesses and the first responding emergency services if required. Knowled...

Dental injuries The first permanent teeth usually erupt around the age of 6 /uni00A0 years; usually lower incisors are followed by upper incisors. Between the ages of 6 and 13, the primary (deciduous) denti tion is expected to be exfoliated and replaced by per...

EMERGENCY ASSESSMENT AND MANAGEMENT Maxillofacial injuries that require hospital attendance are common and are most frequently related to trips and falls, road tra ffi c accidents (RTAs), taking part in sports and inter personal violence. Initial assessment requ...

Examination Primary survey The primary survey is aimed at protection of the airway , control of bleeding, restoration and maintenance of the circulation Coma Scale (GCS) score, with cervical spine control. The head and neck region should be inspected, with ...

FURTHER READING Brennan PA, Schliephake H, Ghali GE, Cascarini L. Maxillofacial surgery , 3rd edn. London: Elsevier, 2017. Newlands C, Kerawala C. Oral and maxillofacial surgery , 3rd edn. Oxford Specialist Handbooks in Surgery . Oxford: Oxford Medical Publica...

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Investigations The nature of the injury sustained will determine the specific investigations required to facilitate diagnosis. Systemic inves - tigations may include routine haematology and biochemistry investigations, and imaging requests such as cervical spi...

Isolated nasal and nasoethmoidal fractures Isolated nasal bone fractures are common, and the full extent of the deformity may not be apparent for several days after injury . A follow-up appointment 1 week after the initial assess ment is important (when the s...

Learning objectives To understand and identify potentially life-threatening • injuries to the face, head and neck To safely perform a systematic examination of facial • injuries, and describe the basic classi /f_i cation of soft-tissue and bony injuries Learni...

Mandibular fractures Fractures of the mandible are common in the context of facial injury and may frequently involve multiple sites. The common est fracture patterns are parasymphysis and angle fractures, or parasymphysis and condylar fractures (contralatera...