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Chapter 16: Face and Related Structure Pathologies

Clinical Examination of Facial Injuries

Examination Map HISTORY

Location of Pain

Onset

Activity and Injury Mechanism

Symptoms

INSPECTION

Inspection of the Ear

Auricle

Tympanic membrane

Periauricular area

Inspection of the Nose

Alignment

Epistaxis

Septum and mucosa

Inspection of the Throat

Respiration

Thyroid and cricoid cartilage

Inspection of the Face and Jaw

Bleeding

Ecchymosis

Symmetry

Muscle tone

Inspection of the Oral Cavity

Lips

Teeth

Tongue

Lingual frenulum

Gums

Palpation

Palpation of the Anterior Structures

Nasal bone

Nasal cartilage

Zygoma

Maxilla

Temporomandibular joint

Periauricular area

External ear

Teeth

Mandible

Hyoid bone

Cartilages

Palpation of the Lateral Structures

Temporalis

Masseter

Buccinator

FUNCTIONAL ASSESSMENT

Ear

Hearing

Balance

Nose

Smell

Temporomandibular Joint

Range of motion

Tracking

NEUROLOGICAL EXAMINATION

Cranial Nerve Assessment

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUE TESTS

Ear Pathologies

Auricular hematoma

Tympanic membrane rupture

Otitis externa

Otitis media

Nasal Pathologies

Throat Pathologies

Facial Pathologies

Mandibular fracture

Zygoma fracture

Maxillary fracture

LeFort fracture

Dental Conditions

Tooth fracture

Tooth luxation

Dental caries

Temporomandibular Joint Dysfunction

Inspection

image Inspection Findings 16-1: Use of an Otoscope for Inspection of the Ear and Nose

image

(A) An otoscope with a speculum that fits snugly within the ear canal without causing pain is used to inspect the tympanic membrane. The speculum needs to be placed only slightly into the ear canal to view the structures. Visualization is improved when the pinna is pulled upward and backward (some clinicians prefer to pull the earlobe downward). (B) The use of an otoscope to view the nasal passage.

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Patient Position Seated or standing
Position of Examiner Positioned to easily access the patient's ear or nose
Evaluative Procedure

Select and fit a speculum on the otoscope that will fit snugly into the opening.

When inspecting the ear, open the auditory canal by gently pulling upward and backward on the pinna or downward on the earlobe. Gently insert the speculum into the ear. Deep penetration is not necessary.
Positive Test

Ear: Reddened and/or bulging tympanic membrane; fluid buildup behind the tympanic membrane; fluid in the ear canal; ruptured tympanic membrane

Nose: Deviation or deformity of the nasal passage(s)
Implications

Ear: A reddened and/or bulging tympanic membrane is indicative of middle ear infection (acute otitis media). Fluid behind the tympanic membrane (otitis media effusion) is not necessarily indicative of an infection. Fluid in the ear canal may represent otorrhea, or leakage of cerebrospinal fluid, and is associated with a skull fracture. A ruptured tympanic membrane may result from a blow to the ear.

Nose: Fracture, deviated septum
Comments Cerumen may obscure the tympanic membrane. To clear cerumen, gently flush the ear with hydrogen peroxide or warm water. Do not do this if a tympanic membrane rupture is suspected.
Evidence Absent or inconclusive in the literature

Inspection of the Ear

FIGURE 16-1

Laceration of the external ear. This injury requires suturing to prevent permanent deformity of the ear.

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