EM · Maxillofacial and dental emergencies
Maxillofacial and dental emergencies
Also known as Facial fractures · Dental abscess · Ludwig angina · Deep neck space infection
Maxillofacial fractures (Le Fort classification), dental abscess, Ludwig's angina and other deep neck space infections with airway threat, descending necrotising mediastinitis and the emergency airway plan.
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Target exams
Red flags
- Woody floor-of-mouth swelling, tongue elevation, drooling or stridor = Ludwig until proven otherwise.
- Do not lie the patient flat for imaging when airway threat is present — secure the airway first.
- Descending necrotising mediastinitis carries high mortality; suspect it when odontogenic infection involves retropharyngeal, pretracheal or carotid spaces.
- Malocclusion is an early, sensitive sign of mandibular or maxillary fracture.
Fractures
Le Fort classification for midface[4]: I is a horizontal fracture separating the palate from the maxilla; II is pyramidal through the nasal bridge; III is craniofacial dissociation. All Le Fort patterns disrupt the pterygoid plates and can combine. CT evaluates blunt facial trauma: displaced zygomaticomaxillary-complex fractures and orbital fractures with muscle entrapment (diplopia risk) need surgical referral.[4]
Le Fort I
- Horizontal palate-to-maxilla
- Mouth opens but anterior segment moves
Le Fort II
- Pyramidal
- Nasal bridge + medial orbital wall
Le Fort III
- Craniofacial dissociation
- Entire midface mobile
References4ShowHide
- [1]Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig's angina: an evidence-based review Am J Emerg Med, 2021.PMID 33383265
- [2]Vieira F, Allen SM, Stocks RMS, Thompson JW. Deep neck infection Otolaryngol Clin North Am, 2008.PMID 18435993
- [3]Brajkovic D, Zjalić S, Kiralj A. Prognostic factors for descending necrotizing mediastinitis in deep neck infection Eur Arch Otorhinolaryngol, 2022.PMID 34542654
- [4]Hopper RA, Salemy S, Sze RW. Diagnosis of midface fractures with CT: what the surgeon needs to know. Radiographics, 2006.PMID 16702454