A silent but lethal injury associated with facial trauma.

Without a careful evaluation of all patients with major facial injuries and a thorough search for possible associated injuries, traumatic transection of the aorta may be easily missed, if the patient survives the first 24 hours after injury. Any patient subjected to sudden deceleration injury, particularly following automobile or motorcycle accidents, should be evaluated carefully for traumatic aortic rupture. Patients with associated chest trauma should have chest x-rays in the emergency room, and repeat chest films several hours later should be obtained to identify subsequent development of a widening mediastinum. Proper management of possible aortic transection should include arteriograms when appropriate and prompt surgical intervention when indicated. All patients with major injuries should be thoroughly evaluated by a trauma team so that associated injuries may be quickly recognized and treated.