The importance of oral examination facial trauma: recognition of the Guerin sign in Le Fort 1 injuries

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Key Clinical Message

Facial Trauma is common. The emergency physician should conduct a thorough examination of the oral tissues. A laceration in the palate can be easily missed and should be elicited. Failure to identify a split palate can result in severe dentofacial deformity.

What Clinical Sign is Shown Below?

Guerin's sign is bruising in the palate in the region of the greater palatine arteries. We present a patient who sustained blunt facial trauma and as a result had a mobile maxilla and a severe malocclusion. An associated laceration in the palate pointed to a split palate confirmed on CT. This is a reminder to clinicians, especially those working in acute medicine to conduct thorough examination of the oral tissues. A laceration in the palate can be easily missed and should be looked for as part of a systematic examination. Intraoperative management may change depending on the fracture pattern and displacement.

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Conflict of Interest

None declared.

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