History

Obtain a history regarding the injury from the patient, witnesses, and prehospital care providers. It is important to determine the mechanism and time of injury and to assess for loss of consciousness. Allergies and tetanus status are standard inquires.

The following three "face-oriented" questions are essential: (1) "How is your vision?" (2) "Is any part of your face numb?" and (3) "Are your teeth meeting normally?" These questions target eye involvement, injury to facial nerves, and alignment of central and lower face.

Question the patient regarding vision, diplopia, and whether there is pain with eye movement. Monocular double vision occurs with lens dislocation or with corneal or retinal injury, whereas binocular double vision implies dysfunction of the extraocular muscles or nerves. Pain on eye movement suggests injury to the orbit or globe.

There should be a high index of suspicion for domestic violence. If the mechanism of injury is not an MVC, ask women about domestic violence. Although a victim of domestic violence may tell the triage nurse that they fell or "ran into a door," most patients reveal the true etiology if directly questioned by a physician. Child abuse and elder abuse are important considerations when patients at the extremes of age present with facial trauma. More than half of all abused children are injured in the head, face, mouth, or neck.9

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