Browse categories and answer follow-up questions to refine your symptom profile.
History
Mechanism and context
Mechanism and context
Blunt trauma
Sharp object
Fall
Assault
Sports injury
MVC
Animal bite
Contamination source
Glass exposure
Metal exposure
Dirt exposure
Dental mechanism
Tooth to hard surface impact
High velocity projectile
Time from injury
Last oral intake if procedural sedation possible
Onset
Onset
Exact time of injury
Immediate bleeding
Delayed swelling
Delayed pain
Provocation/Palliation
Provocation and palliation
Worse with jaw movement
Worse with chewing
Worse with facial expression
Worse with talking
Relief with pressure dressing
Relief with ice
Relief with analgesics
Quality
Quality
Sharp pain
Throbbing pain
Dental sensitivity to cold
Dental sensitivity to biting
Numbness
Paresthesia
Region/Radiation
Region and radiation
Specific facial subunit location
Lip involvement
Vermilion border involvement
Eyelid involvement
Nasal involvement
Intraoral involvement
Tooth specific location
Maxillary tooth
Mandibular tooth
Radiation to ear
Radiation to temple
Severity
Severity
Pain score
Bleeding severity
Functional limitation
Trismus severity
Timing
Timing
Persistent bleeding
Intermittent bleeding
Progressive swelling
Worsening pain
Symptoms improving
Associated symptoms
Associated symptoms
Headache
LOC
Amnesia
Vomiting
Neck pain
Visual change
Diplopia
Eye pain
Epistaxis
CSF rhinorrhea concern
Malocclusion
Loose teeth
Tooth missing
Chipped tooth
Oral bleeding
Facial weakness
Facial numbness
Dysphagia
Dyspnea
Aspiration concern
Tooth injury specifics
Tooth injury specifics
Primary tooth
Permanent tooth
Avulsion
Extrusion
Lateral luxation
Intrusion
Subluxation
Crown fracture
Enamel only
Enamel dentin
Pulp exposure
Root fracture concern
Alveolar ridge injury concern
Time out of socket if avulsed
Storage medium used
Dry time estimate
Wound specifics
Wound specifics
Length estimate
Depth estimate
Bite wound concern
Through and through lip laceration
Foreign body concern
Crush component
Devitalized tissue concern
Prior wound care
Irrigation performed
Topical products used
Alarm Features
Airway and bleeding threats
Airway and bleeding threats
Stridor
Drooling
Voice change
Expanding neck or floor of mouth swelling
Uncontrolled hemorrhage despite pressure
Hemodynamic instability
Eye and orbital threats
Eye and orbital threats
Vision loss
Severe eye pain
Hyphema
Globe rupture concern
Proptosis
Entrapment signs
Severe diplopia
Neuro and head injury threats
Neuro and head injury threats
GCS less than 15
Focal neurologic deficit
Seizure
Repeated vomiting
Severe worsening headache
Basilar skull fracture signs
Facial fracture threats
Facial fracture threats
Malocclusion with instability
Open facial fracture
Significant trismus
Midface instability
CSF rhinorrhea concern
Laceration complexity threats
Laceration complexity threats
Eyelid margin involvement
Canthal tendon involvement
Lacrimal system involvement
Vermilion border misalignment
Through and through cheek with parotid duct concern
Facial nerve motor deficit
Exposed cartilage
Exposed bone
High risk patient factors
High risk patient factors
Immunocompromised state
Diabetes with poor control
Anticoagulation
Bleeding disorder
Significant contamination
Human bite
Medications
Current meds and bleeding risk
Current meds and bleeding risk
Warfarin
DOAC
Heparin products
Antiplatelets
NSAID use
Herbal bleeding risk
Allergies and anesthesia considerations
Allergies and anesthesia considerations
Local anesthetic allergy history
Latex allergy
Chlorhexidine sensitivity
Antibiotic allergies
Recent meds and infection risk
Recent meds and infection risk
Recent antibiotics
Chronic steroids
Biologics
Chemotherapy
Analgesic options and contraindications
Analgesic options and contraindications
Acetaminophen contraindications
NSAID contraindications
Opioid risk factors
Diet
Intake and procedural considerations
Intake and procedural considerations
Last solids
Last liquids
Nausea or vomiting
Aspiration risk factors
Dental and wound related exposures
Dental and wound related exposures
Recent alcohol use
Energy drink caffeine exposure
Poor nutrition concerns
Dehydration concerns
Review of Systems
Head and neck
Head and neck
Headache
Neck pain
Dysphagia
Odynophagia
Voice change
Eyes
Eyes
Vision change
Diplopia
Photophobia
Eye pain
ENT and oral
ENT and oral
Epistaxis
Rhinorrhea
Tooth pain
Tooth sensitivity
Malocclusion
Trismus
Neuro
Neuro
LOC
Confusion
Weakness
Numbness
Infection and systemic
Infection and systemic
Fever
Chills
Malaise
Collateral History and Family History
Collateral source and reliability
Collateral source and reliability
Witness report
EMS report
Caregiver report
Intoxication affecting reliability
Family and bleeding risk
Family and bleeding risk
Bleeding disorders
Hemophilia (D66)
Von Willebrand disease (D68.0)
Dental history context
Dental history context
Recent dental procedures
Orthodontic appliances
Baseline dental health
Prior avulsions or fractures
Risk Factors
Infection and wound healing
Infection and wound healing
Diabetes mellitus (E11.9)
Immunosuppression
Smoking
Poor oral hygiene
Malnutrition
Bleeding and anticoagulation
Bleeding and anticoagulation
Anticoagulant use
Antiplatelet use
Liver disease (K76.9)
Known coagulopathy
Injury pattern risks
Injury pattern risks
High energy mechanism
Assault related facial fractures
Glass related foreign body
Animal or human bite exposure
Special populations
Special populations
Pediatrics
Older adult fall risk
Pregnancy
Homelessness impacting wound care
Limited follow up access
Differential Diagnosis
Life threatening
Life threatening
Airway compromise from facial or oral swelling (R06.00)
Progressive floor of mouth swelling
Stridor or voice change
Uncontrolled hemorrhage (R58)
Persistent bleeding despite pressure
Anticoagulation present
Globe rupture (S05.3)
Irregular pupil
Seidel positive
Retrobulbar hematoma (H05.2)
Proptosis
Decreased vision
Intracranial hemorrhage (I62.9)
LOC
Focal deficit
Cervical spine injury (S12.9)
Midline neck tenderness
Neuro deficit
Common
Common
Simple facial laceration (S01.81)
Clean edges
No deep structure involvement
Contaminated laceration (S01.81)
Dirt or saliva exposure
Delayed presentation
Lip laceration (S01.511)
Vermilion border involvement
Through and through possible
Dental concussion or subluxation (S03.2)
Tender to percussion
No displacement
Crown fracture enamel or dentin (S02.5)
Chipped tooth
Sensitivity
Less common
Less common
Facial nerve injury (S04.50)
Weakness of brow raise
Weakness of smile
Parotid duct injury (S09.8)
Cheek laceration over duct course
Salivary leakage
Nasolacrimal duct injury (S01.11)
Medial canthus laceration
Epiphora
Alveolar process fracture (S02.4)
Segment mobility
Multiple teeth moving together
Mandibular fracture (S02.6)
Malocclusion
Trismus
Past Medical History
Relevant chronic conditions
Relevant chronic conditions
Diabetes mellitus (E11.9)
Bleeding disorders (D68.9)
Seizure disorder (G40.909)
Alcohol use disorder (F10.20)
Immunocompromised state
Prior procedures and baseline function
Prior procedures and baseline function
Prior facial surgery
Prior dental surgery
Dental implants
Orthodontic devices
Baseline occlusion and bite
Vaccination status
Vaccination status
Tetanus status
Rabies risk context if animal bite
Hepatitis B status if human bite exposure
Physical Exam
Vitals and general
Vitals and general
Fever
Tachycardia
Hypotension
Toxic appearance
Active bleeding
Airway and breathing
Airway and breathing
Stridor
Voice quality
Drooling
Work of breathing
Oral cavity swelling
Face and scalp laceration exam
Face and scalp laceration exam
Location by facial subunit
Length and depth estimate
Wound edge viability
Contamination
Foreign body visible
Hematoma
Tissue loss
Through and through involvement
Hemostasis and perfusion
Hemostasis and perfusion
Capillary refill
Skin perfusion
Persistent oozing after pressure
Pulsatile bleeding
Eye exam
Eye exam
Visual acuity
Pupils and RAPD
Extraocular movements
Diplopia with gaze
Hyphema
Conjunctival laceration
Corneal abrasion concern
Eyelid margin involvement
Nose and midface
Nose and midface
Septal hematoma
Nasal deformity
Epistaxis source
Midface stability
Infraorbital numbness
Oral cavity and dental
Oral cavity and dental
Mucosal lacerations
Gingival lacerations
Tooth count compared to baseline
Missing tooth location
Tooth mobility grade
Tenderness to percussion
Crown fracture visible
Pulp exposure visible
Alveolar ridge step off
Occlusion
Malocclusion
Trismus measurement
Jaw and mandible
Jaw and mandible
Mandibular tenderness
Step deformity
Pain with closed fist bite test if cooperative
TMJ tenderness
Neuro and cranial nerves
Neuro and cranial nerves
Mental status
Facial sensation V1
Facial sensation V2
Facial sensation V3
Facial motor function
Smile symmetry
Brow raise symmetry
Eye closure strength
Cervical spine and secondary survey
Cervical spine and secondary survey
Midline tenderness
ROM limitation
Neuro deficits in extremities
Other injuries
Lab Studies
Hemorrhage and anticoagulation
Hemorrhage and anticoagulation
CBC if significant bleeding
INR if warfarin
PT if liver disease concern
aPTT if heparin exposure
Infection and systemic illness
Infection and systemic illness
WBC if infection concern
CRP if deep infection concern
Blood cultures if septic physiology
Procedural and disposition support
Procedural and disposition support
Pregnancy test in reproductive age when imaging or sedation possible
Glucose if diabetes or altered mental status
Type and screen if major hemorrhage
Imaging
Scoring Systems
Scoring systems relevant to associated injuries
Canadian CT Head Rule use when minor head injury criteria met
Canadian CT Head Rule avoid when age under 16 years
NEXUS C spine criteria for low risk cervical spine clearance
Canadian C spine rule when alert and stable trauma patient
MRI
MRI selective indications
Suspected salivary gland injury with unclear anatomy
Suspected soft tissue foreign body not seen on other imaging
Contraindications
Non compatible implanted devices
Metallic orbital foreign body concern
CT
CT indications and protocols
CT maxillofacial without contrast for suspected facial fracture
CT head without contrast for concerning head injury features
CT cervical spine if high risk criteria
Contrast considerations
Contrast allergy history
Renal impairment risk assessment local protocol dependent
Interpretation pearls
Orbital floor fracture with entrapment concern
Mandible fracture at angle and condyle common sites
Ultrasound
Ultrasound and POCUS
Soft tissue foreign body detection in superficial wounds
Abscess versus hematoma when swelling unclear
Ocular ultrasound avoid if globe rupture concern
Interpretation pitfalls
Air artifact limiting foreign body detection
Radiolucent materials false negatives
Special Tests
Bedside wound and eye tests
Bedside wound and eye tests
Fluorescein staining for corneal abrasion
Seidel test for aqueous leak
Eversion of eyelids for foreign body
Dental and occlusion tests
Dental and occlusion tests
Tooth mobility assessment by tooth
Percussion tenderness
Cold sensitivity history correlating with dentin or pulp injury
Occlusion check with bite together and articulation paper if available
Salivary duct and nerve screening
Salivary duct and nerve screening
Parotid duct course evaluation with cheek lacerations
Saliva expression from Stensen duct papilla
Facial nerve motor mapping by branches
Document baseline before local anesthesia
ECG
When ECG matters
ECG indications
Syncope associated with injury
Chest pain associated with trauma
Significant stimulant intoxication concern
ECG red flags affecting disposition
ECG red flags affecting disposition
Ischemic changes
High grade AV block
Ventricular arrhythmia
Prolonged QT with medication exposure
Assessment
Problem representation
Problem representation
Facial laceration complexity
Simple superficial
Deep with possible tendon nerve duct involvement
Contamination level
Clean
Dirty
Bite related
Dental trauma category
Avulsion
Luxation
Crown fracture
Root or alveolar fracture concern
Severity and risk stratification
Severity and risk stratification
Hemodynamic stability
Airway risk
Eye injury risk
Facial fracture risk
Infection risk factors present
Follow up reliability
Complications to exclude
Complications to exclude
Foreign body retained
Facial nerve injury
Parotid duct injury
Lacrimal system injury
Mandible fracture
Alveolar ridge fracture
Globe injury
Plan
First 5 minutes workflow
First 5 minutes workflow
Escalate to resuscitation area if airway compromise signs
Continuous monitoring if significant bleeding or sedation anticipated
Two large bore IV if hemorrhagic shock concern
Immediate direct pressure for active bleeding
Massive hemorrhage protocol activation local protocol dependent
Analgesia and anxiolysis
Analgesia and anxiolysis
Acetaminophen PO 1000 mg once
Maximum adult total 4000 mg per 24 hours
Ibuprofen PO 400 mg once
Avoid NSAID if high bleeding risk
Oxycodone PO 5 mg once for severe pain
Avoid opioid if significant intoxication or respiratory risk
Local anesthesia and blocks
Local anesthesia and blocks
Lidocaine 1 percent without epinephrine maximum 4.5 mg per kg
Lidocaine 1 percent with epinephrine maximum 7 mg per kg
Bupivacaine 0.25 percent maximum 2.5 mg per kg
Supraorbital nerve block for forehead lacerations
Infraorbital nerve block for upper lip and midface
Mental nerve block for lower lip and chin
Hemostasis and wound prep
Hemostasis and wound prep
Direct pressure for 10 to 15 minutes without peeking
Topical tranexamic acid 500 mg in 5 mL soaked gauze for mucosal bleeding local protocol dependent
Irrigation volume targets
At least 50 to 100 mL per cm laceration length as practical
Remove devitalized tissue selectively
Avoid aggressive debridement on face due to cosmetic risk
Foreign body management
Foreign body management
Plain radiograph for radiopaque foreign body suspicion
Ultrasound for superficial radiolucent foreign body suspicion
Avoid blind probing near eye and major vessels
Closure strategy
Closure strategy
Timing
Primary closure typical within 24 hours on face if well cleaned
Delayed primary closure if gross contamination or high infection risk
Layered closure for deep wounds
Deep absorbable suture for dead space reduction
Skin closure options
5-0 or 6-0 nylon for facial skin typical
Fast absorbing gut for low tension pediatric facial wounds local protocol dependent
Vermilion border alignment priority
First stitch at vermilion border with 6-0 nylon typical
Lip through and through closure in layers
Mucosa absorbable
Muscle absorbable
Skin nonabsorbable or fast absorbable based on follow up
Antibiotics prophylaxis
Antibiotics prophylaxis
Indications
Bite wounds
Through and through lip laceration with oral contamination
Grossly contaminated wounds
Open fractures
Amoxicillin clavulanate PO 875 mg 125 mg twice daily
Duration 3 to 5 days prophylaxis typical local protocol dependent
Penicillin allergy option
Doxycycline PO 100 mg twice daily plus metronidazole PO 500 mg twice daily local protocol dependent
Avoid doxycycline in pregnancy and young children local protocol dependent
Tetanus and rabies
Tetanus and rabies
Tetanus update based on immunization status and wound type local protocol dependent
Human bite bloodborne exposure counseling and prophylaxis local protocol dependent
Animal bite rabies risk assessment local protocol dependent
Dental trauma immediate management
Dental trauma immediate management
Avulsed permanent tooth reimplantation as soon as possible if feasible
Do not reimplant primary tooth
Handling
Touch crown only
Avoid touching root
Cleaning
Gentle rinse with saline if dirty
Avoid scrubbing
Storage media if not reimplanted
Milk
HBSS if available
Saline
Buccal vestibule if cooperative and low aspiration risk
Splinting needs urgent dental or OMFS follow up
Systemic antibiotics for avulsed permanent tooth local protocol dependent
Dental fracture and luxation management
Dental fracture and luxation management
Enamel dentin fracture cover exposed dentin with temporary dental dressing if available
Pulp exposure urgent dental management within 24 hours
Luxation and subluxation soft diet and dental follow up within 24 hours
Suspected alveolar fracture urgent OMFS or dental evaluation
Reassessment loop
Reassessment loop
Repeat bleeding check after hemostasis steps
Repeat neuro exam after analgesia and before discharge
Repeat eye exam if pain or vision complaints change
Wound perfusion reassessment after closure
Disposition
Consult and transfer criteria
Consult and transfer criteria
Ophthalmology
Globe injury concern
Eyelid margin laceration
Lacrimal system injury concern
OMFS or ENT
Mandible fracture concern
Alveolar ridge fracture concern
Parotid duct injury concern
Plastic surgery
Complex facial laceration with tissue loss
Vermilion border complex injuries if provider not comfortable
Dentistry urgent
Avulsed permanent tooth
Pulp exposure
Admission indications
Admission indications
Airway compromise risk
Uncontrolled bleeding
Open facial fracture needing operative management
Severe infection or deep space infection concern
Inability to manage pain or oral intake
Observation pathway criteria
Observation pathway criteria
Sedation recovery needs
Evolving swelling needing serial exams
Social barriers preventing safe discharge
Discharge criteria
Discharge criteria
Hemostasis achieved
No airway concerns
Eye injury excluded or addressed
Neuro status at baseline
Pain controlled with oral meds
Follow up arranged and reliable
Discharge Instructions
Copy discharge instructions
You were treated for a facial cut and or dental injury
Keep the wound clean and dry for the first 24 hours
After 24 hours gentle soap and water daily
Apply a thin layer of petrolatum to keep the wound moist
Avoid hydrogen peroxide and alcohol on the wound
If you have stitches on the face removal is usually 3 to 5 days unless told otherwise
If absorbable stitches were used they will dissolve on their own
Mouth cuts
Rinse with salt water after meals
Soft diet until pain improves
Dental injury
Soft diet and avoid biting on the injured tooth
Dental follow up within 24 hours if tooth was loose or chipped
If a permanent tooth was knocked out and reimplanted urgent dentist visit today
Medicines
Take acetaminophen as directed on the bottle
Take ibuprofen as directed unless you were told to avoid it
If antibiotics were prescribed take all doses until finished
Activity
Avoid sports or activities that could hit the face until cleared
Return to the ER now if
Trouble breathing
Bleeding that does not stop with 15 minutes of firm pressure
Worsening swelling of the tongue floor of mouth or neck
New vision change or severe eye pain
Fever
Pus drainage or spreading redness
Severe headache repeated vomiting confusion or weakness
A tooth becomes very loose or you cannot close your teeth normally
References
Guidelines and key sources
Guidelines and key sources
International Association of Dental Traumatology guidelines for traumatic dental injuries 2020
American Academy of Pediatric Dentistry guideline on management of acute dental trauma 2020
ACEP clinical policy for adult mild traumatic brain injury 2023
NICE head injury assessment and early management guideline 2023
CDC tetanus prophylaxis guidance updated 2024
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.