2. Injuries to the facial region-blunt and penetrating.

Question 1

Maxillofacial Injuries - causes

Answer 1

May be due to road traffic accidents, assaults, bullet injuries or
sport injuries

Question 2

Maxillofacial Injuries - Classification 1/2

Answer 2

Fracture in maxillofacial region can be grouped as:

Fracture lower third that comprises mandible.

Fracture middle third that comprises maxilla, zygoma and nose.

Fracture upper third of the face involving part of the orbit, frontal bones.

Question 3

Maxillofacial Injuries - Classification 2/2

Answer 3

Fractures of the face which do not involve the dental occlusion— fractures of
zygoma and nose.

Fracture which involves the dental occlusion—fracture mandible and maxilla.

Question 4

Soft tissue Injuries - Types - (1) / 5

Answer 4

Lacerations, contusions, cut wounds, etc.

Question 5

Soft tissue Injuries - Types - (2)/ 5

Answer 5

Eyelid injuries with black eyes.

Question 6

Soft tissue Injuries - Types - (3)/ 5

Answer 6

Facial nerve injury: Primary repair is required.

Question 7

Soft tissue Injuries - Types - (4)/ 5

Answer 7

Parotid duct injury: Here primary anastomosis of the injured duct is done, with a fine polythene cannula is kept as a stent inside the duct which will be removed in 14 days.

Question 8

Soft tissue Injuries - Types - (5)/ 5

Answer 8

Lacrimal apparatus injury: Here the duct is sutured with a fine nylon thread in the canaliculus which is kept for 3 months.

Question 9

Injuries to the Facial Bones - Types of Injuries 1-5/6

Answer 9

Injuries to the maxilla.

Zygomatic bone injuries.

Mandibular bone fracture and mandibular dislocation.

Orbital bone fracture: Presents with diplopia, enophthalmous, sensory loss in the area of infraorbital nerve.

Infraorbital ecchymosis of the orbit

Question 10

Infraorbital ecchymosis of the orbit is called

Answer 10

Panda sign.

Question 11

Injuries to the Facial Bones - Types of Injuries - 6/6 MOST COMMON

Answer 11

Nose Fracture : Nasal bones are most commonly injured bones in face.

Question 12

Nose Fracture: Patient Presentation

Answer 12

Patient presents with pain and swelling in the nose with deviation and displacement

Question 13

Nose Fracture: Initial Treatment

Answer 13

Here reduction of the fractured nasal bones and nasal septum under general anaesthesia is done.

Question 14

Nose Fracture: Later Treatment

Answer 14

Later position is maintained by nasal packs from inside (which is removed in 7 days) and by a nasal plaster from outside (which will be kept for 14 days).

Question 15

Nose Fracture: Procedure Tool

Answer 15

Procedure is done using Walsham’s and Asch’s forceps

Question 16

Clinical Features of Facial Injuries -1/9

Answer 16

Localised swelling due to haematoma.

Question 17

Clinical Features of Facial Injuries - 2/9

Answer 17

Facial oedema.

Question 18

Clinical Features of Facial Injuries - 3/9

Answer 18

Bleeding with open wounds.

Question 19

Clinical Features of Facial Injuries - 4/9

Answer 19

Asymmetry which is clinically confirmed by observing supraorbital ridges, nasal
bridge.

Question 20

Clinical Features of Facial Injuries - 5/9

Answer 20

Localised tenderness.

Question 21

Clinical Features of Facial Injuries - 6/9

Answer 21

Step deformity.

Question 22

Clinical Features of Facial Injuries - 7/9

Answer 22

Trismus.

Question 23

Clinical Features of Facial Injuries - 8/9

Answer 23

Diplopia.

Question 24

Clinical Features of Facial Injuries -9/9

Answer 24

Features of associated injuries like intracranial, abdominal or thoracic injuries.

Question 25

Facial Injuries - Investigations (2)

Answer 25

X-ray face.

CT scan of head and jaw.

Question 26

Maxillofacial Injuries - General Treatment (6)

Answer 26

Suturing of soft tissues

Airway maintenance

Control of bleeding

Pain relief

Control of infection

Treating the individual fractures

Question 27

Dislocation of the Mandible - Location

Answer 27

It occurs at temporomandibular joint.

Question 28

Dislocation of the Mandible- Types - 1/2

Answer 28

Unilateral dislocation - common after trauma

Question 29

Dislocation of the Mandible- Types - 2/2

Answer 29

Bilateral dislocation occurs during yawning and it is recurrent.

Question 30

Dislocation of the Mandible- Clinical Features

Answer 30

Difficulty in opening the mouth with pain and tenderness over
the joint.

Question 31

Dislocation of the Mandible- Treatment

Answer 31

Reduction of dislocation under general anaesthesia.

If there is associated fracture mandible, it should be dealt with accordingly

Question 32

Fracture of the Mandible - Types - 1/2

Answer 32

At the neck of the condyle (35%), as it is the weakest point. The condyle is displaced in
front and medially often with dislocation. Painful jaw movement is the clinical features.
It may be unilateral or bilateral.

Question 33

Fracture of the Mandible - Types - 2/2

Answer 33

At the angle of the mandible: If fracture is upwards and inwards, it is impacted and
undisplaced. So it is a favourable fracture. If fracture is downwards and outwards, it gets
displaced and so it is an unfavourable fracture. It needs open reduction using wires.

Question 34

Fracture of the Mandible - Clinical Features (6)

Answer 34

Pain and tenderness in the lower jaw with bruising over the surface.

Haematoma in the floor of the mouth

Difficulty in opening the mouth, speech and swallowing.

Anaesthesia of the lower lip due to compression of inferior dental nerve.

Deranged dental occlusion.

Step deformity.

Question 35

What is Coleman‘s sign.

Answer 35

Haematoma in the floor of the mouth

Question 36

Fracture of the Mandible - Investigations (2)

Answer 36

X-ray of the mandible.

Orthopantomogram (OPG), CT head and face.

Question 37

Fracture of the Mandible - Treatment (4)

Answer 37

Antibiotics to prevent formation of osteomyelitis of the mandible.

Open fixation of the fracture segments using silver wires for 4–6 weeks.

Only fluid diet for 6 weeks.

Irrigation wash to the oral cavity to maintain the hygiene.

Question 38

Open fixation is done by (3)

Answer 38

Interdental wiring.

Using arch bars.

Silver alloy or plastic caps

Question 39

Fracture Middle Third Area - Includes :

Answer 39

Fracture middle third includes fracture maxilla, zygoma and nasal bones

a. Maxillae, zygomatic bones, palatine bones, nasal bones, lacrimal bones, inferior
conchae (one on each side).

b. The vomer, ethmoid and its attached conchae, pterygoid plates of sphenoid

Question 40

Fracture Middle Third Area - Clinical Features (7)

Answer 40

 Oedema face, subconjunctival haemorrhage, ocular ecchymosis.

Bleeding from the nose.

Diplopia due to trapping of the extra-ocular muscles in the fracture segments.

Anaesthesia of the cheek.

Trismus and malalignment of teeth.

Guerin‘s sign: Haematoma at greater palatine foramen.

Always patient should be examined and observed for CSF leak and intracranial injuries.

Question 41

Fracture Middle Third Area - Investigations (2)

Answer 41

CT scan head.

X-ray skull.

Question 42

Fracture Middle Third Area - Treatment (9)

Answer 42

It should be managed in a center for maxillofacial injuries.

Antibiotics.

Tracheostomy.

Associated zygoma and nasal fractures are reduced first.

Direct wire suturing of the zygomaticofrontal region.

Fixation of teeth in occlusion using eyelet wires, bars or cap splints.

Once reduced, fracture bones are immobilised using extra-oral rods called as Mount vernon box frame.

Initially intravenous fluids and blood transfusions are required. Later Ryle’s tube feeding is done.

Proper ophthalmic consultation is necessary when there are orbital injuries