Differential Diagnosis for a 32-year-old Female with Facial Trauma
- Single most likely diagnosis
- Basilar skull fracture or facial fracture: Given the mechanism of injury (head butt to the right side of the face) and symptoms (right ear pain, headache, nausea, and black eye), a fracture is a plausible diagnosis. The presence of a black eye and the location of the pain suggest trauma to the facial bones or the base of the skull.
- Other Likely diagnoses
- Concussion: Although the patient denies loss of consciousness, a concussion is still possible, especially given the mechanism of injury and symptoms like headache and nausea.
- Periorbital hematoma: The black eye is a clear indication of trauma to the area around the eye, which could be causing some of her symptoms.
- Otalgia due to trauma: The right ear pain could be directly related to the trauma from the head butt, possibly causing a hematoma or other injury in the ear.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intracranial hemorrhage: Despite the absence of severe symptoms like vomiting, blurry vision, or loss of consciousness, an intracranial hemorrhage is a potentially life-threatening condition that must be considered, especially with a history of head trauma.
- Cavernous sinus thrombosis: This is a rare but potentially deadly complication of facial trauma, especially if there is an infection or significant trauma to the facial veins.
- Carotid artery dissection: Although less common, trauma to the neck or face can lead to dissection of the carotid artery, which is a medical emergency.
- Rare diagnoses
- Temporomandibular joint (TMJ) dislocation or injury: The mechanism of injury could potentially cause a TMJ injury, leading to jaw pain and dysfunction.
- Le Fort fracture: This is a type of facial fracture that could occur from significant trauma to the face, though it's less likely given the description of the injury.