Sequential examination for facial trauma

Sequential steps in examination for facial fractures.
(A-D) For each region, palpate for point tenderness, step-offs, discontinuity, and instability:
(A) Supraorbital ridges (keep the patient's head steady).
(B) Infraorbital ridges using the index, middle, and ring fingers to identify areas of point tenderness.
(C) Zygomatic arches on each side.
(D) Infraorbital rims, zygomatic bodies, and maxilla (examiner at the top of the head). In this position, also evaluate for proptosis.  
(E) Check teeth for malocclusion.
(F) Palpate and retract the mandible to identify sites of tenderness and possible fracture.
(G) Examine the nasal bone and maxilla for stability and possible fracture.
(H) Use an intranasal speculum to evaluate for nasal septal hematoma, septal deviation, or nasal mucosal disruption due to adjacent fracture.