A 45-year-old female is brought to the ED following a high-speed motor vehicle collision. She presents with severe facial swelling, malocclusion, and respiratory distress. On examination, you note raccoon eyes, clear fluid dripping from the nose, lengthening of the midface, and mobility of the entire maxilla and zygomatic complex when grasped. What is your primary concern, and what immediate action should be taken?
Immediate neurosurgical consult for potential brain injury
Controlling hemorrhage from facial lacerations
Airway compromise requiring immediate intubation
Ordering an immediate CT scan for surgical planning
The correct answer is airway compromise requiring immediate intubation. The patient's presentation strongly suggests a Le Fort III fracture, which involves complete separation of the facial bones from the cranial base. This severe maxillofacial trauma can lead to rapid airway obstruction due to bleeding, edema, and mechanical displacement of structures.
While CT imaging is crucial for definitive diagnosis and surgical planning, it is not the primary concern in this scenario. The patient's respiratory distress indicates an impending airway emergency that requires immediate intervention.
Although controlling hemorrhage is important in maxillofacial trauma, the description doesn't indicate active severe bleeding that would take precedence over airway management.
While clear fluid dripping from the nose suggests a cerebrospinal fluid leak due to a dural tear, addressing this is not the most urgent concern when faced with potential airway compromise. Management of such leaks typically occurs after airway stabilization and complete trauma evaluation.
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BCEN CEN
Maxillofacial and Ocular Emergencies
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