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Severe facial injuries are associated with injuries to the brain, orbit, cervical spine, and lungs. Upon stabilization of life-threatening injuries during the primary survey, a thorough secondary survey should identify facial injuries that could affect the patient's normal appearance, vision, smell, mastication, and sensation.

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To help localize injuries, a thorough history should begin with questions directed toward whether the patient has vision changes, malocclusion, or facial numbness (Table 162-1). The physical examination begins with inspection, noting facial asymmetry, facial elongation, exophthalmos or enophthalmos, and periorbital or mastoid ecchymoses. Next, palpate the entire face, noting step-offs and tenderness that suggest fractures, and crepitus that suggests a sinus fracture. Finally, perform a focused and thorough examination of the eyes, nose, ears, and mouth, as described in Table 162-1.

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Table 162-1 Important Clinical Issues in Facial Trauma

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