Cervical Spine and Facial Injury Assessment

Cervical Spine Injuries

• Cervical Spine Injury: Axial loading is the primary mechanism of injury, often resulting from head-down contact.
• Cervical Dislocation: Disarticulation at the facet joint, most often affecting the 4th, 5th, or 6th vertebrae.
• Cervical Vertebrae Fracture: Most common in the 4th, 5th, and 6th vertebrae, caused by axial loading combined with neck flexion or sudden forced hyperextension.
• Spinal Shock: Initiated within 30–60 minutes of injury. It involves mechanical and biochemical ischemia of neural tissues. It consists of two phases: primary (actual structural damage) and secondary (pathophysiological cascade of injury starting shortly after the initial trauma).
• Cervical Sprain: Injury to the major supporting tissues of the neck, specifically the anterior or posterior longitudinal ligaments.
• Brachial Plexus Neuropraxia (Stinger): Stretching or compression of the brachial plexus, occurring when the head or neck is forced laterally while the shoulder is depressed.
• Cervical Stenosis: Spinal stenosis resulting from the narrowing of the spinal canal.

Face, Ear, Eye, and Nose Injuries

• Skull Fracture: Signs and symptoms include raccoon eyes, Battle's sign, severe headache, and hemotympanum.
• Facial Fractures: Zygomatic complex fractures present with red sclera, a flattened cheek, bony crepitus, and a lower eyeball position.
• Maxillary Fracture (Le Fort Fracture): Characterized by pain, swelling, malocclusion, and diplopia.
• Mandible Fracture: Typically fractures at the frontal angle, resulting in deformity, loss of occlusion, pain with biting, and bleeding around the teeth.
• TMJ Dysfunction: Disk-condyle derangement (disk is positioned anteriorly) leading to headaches, earaches, vertigo, inflammation, and neck pain.
• Epistaxis (Bloody Nose): Caused by a direct blow, sinus infection, high humidity, allergies, a foreign body, or facial injury. Symptoms generally include bleeding from the anterior aspect of the septum, which is usually minimal and resolves spontaneously.

Dental Injuries

• Subluxation: Injury to the tooth-supporting structures resulting in a loose tooth without displacement.
• Luxation: Displacement of the tooth in a direction other than axially.
• Intrusion: The tooth is forced superiorly into the socket, appearing as a "short tooth."
• Extrusion: Partial displacement of the tooth out of its socket, appearing as a "long tooth" with no injury to the socket.
• Avulsion: The tooth is completely knocked out of its socket.