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Facial fractures and lacerations

Emergency referrals

Advise patient to present to the Royal Brisbane and Women's Hospital Department of Emergency Medicine.

For emergency referrals the on-call Oral and Maxillofacial Registrar must be contacted through Royal Brisbane and Women's Hospital switch (07) 3646 8111 to obtain appropriate prioritisation and treatment advice. Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Oral and Maxillofacial Clinic Fax: (07) 3646 3545

  • Fracture and/or laceration with:
    • Compound and full thickness lacerations
    • Uncontrolled haemorrhage
    • Acute or potential airway compromise
    • Compound fracture and unstable fracture
  • Fronto-orbital fracture
  • Frontal sinus fracture
  • Orbital fracture
  • Orbito-zygomatico-maxillary fracture
  • Mid-facial complex
    • Le Fort l, ll and lll level fracture o    Zygomatico-maxillary fracture o   Zygomatic arch fracture
    • Nasal/Naso-ethmoidal fracture
    • Dentoalveolar fracture
  • Mandibular
    • Body/Ramus fracture
    • Temporo-mandibular fracture
    • Dentoalveolar fracture
  • Undisplaced mandibular fracture without mobility
  • Zygoma fracture
  • Undisplaced zygomatic fractures (within 72 hours)

Triage and management guideline

Priority

Emergency Department

Examples

Fracture and / or laceration with:

  • Compound and full thickness laceration
  • Uncontrolled haemorrhage
  • Acute or potential airway compromise
  • Compound and unstable fractur

Evaluation

Refer all significant injuries

Referral to include;

  • Standard history and examination findings

For all Category 1 Facial Fractures
Consider:

  • Broad spectrum antibiotics
  • Assessment for associated head and cervical injuries
  • Ophthalmological assessment (if applicable)
  • Neurosurgical and Neurological assessment (if applicable)

Referral to include;

  • Standard history, examination findings
  • Imaging – Plain x-ray and CT Scan axial and coronal (to include base of skull)
  • Please call the Oral and Maxillofacial Registrar on call via (07) 3646 8111

 

Priority

Category 1

Examples

  • Fronto-orbital fracture
  • Frontal sinus fracture
  • Orbital fracture
  • Orbito-zygomatico-maxillary fracture

Evaluation

Referral to additionally include comment on the following key points:

  • Swelling around eye
  • Numbness over cheek
  • Bony steps around orbit
  • Intra-oral bony protrusion
  • Trismus
  • Limitation of eye movements
  • Conjunctiva and sclera bleed
  • Vision

 

Mid-facial complex

  • Le Fort l, ll & lll level fracture
  • Zygomatico-maxillary fracture
  • Zygomatic arch fracture
  • Nasal / Naso-ethmoidal fracture
  • Dentoalveolar fracture

Referral to additionally include comment on the following key points:

  • Mal-occlusion (dentition)
  • Mobility of the upper jaw / mid-face complex
  • Mobility of the bridge of the nose
  • Bony steps around orbits
  • Diplopia

 

Mandibular

  • Body / Ramus fracture
  • Temporo-Mandibular fracture
  • Dentoalveolar fracture

Referral to additionally include comment on the following key points:

  • Anatomical location of fracture
  • Mal-occlusion (dentition)
  • Swelling
  • Trismus
  • Neuro-sensory changes
  • Lacerations of the soft tissues & gums Referral to additionally include the following investigations:
  • OPG / PA Mandible and may include CT Scan

 

  • Undisplaced mandibular fracture without mobility (within 24 hours – otherwise refer to the Emergency Department)

Referral to additionally include comment on the following key points:

  • Mal-occlusion
  • Swelling
  • Trismus (ability to open mouth)
  • Sensory loss
  • Lacerations of the soft tissues & gums Referral to additionally include the following investigations:
  • OPG (if available)

 

  • Zygoma fracture
  • Undisplaced zygomatic fractures (within 72 hours)

Referral to additionally include comment on the following key points:

  • Swelling around eye
  • Numbness over cheek
  • Bony steps around orbit
  • Intra-oral bony protrusion
  • Trismus
  • Limitation of eye movements
  • Conjunctiva & sclera bleed
  • Vision

Referral requirements

A referral may be rejected without the following information.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org

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