2. Injuries to the facial region-blunt and penetrating. Flashcards
Maxillofacial Injuries - causes
May be due to road traffic accidents, assaults, bullet injuries or
sport injuries
Maxillofacial Injuries - Classification 1/2
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.
Maxillofacial Injuries - Classification 2/2
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.
Soft tissue Injuries - Types - (1) / 5
Lacerations, contusions, cut wounds, etc.
Soft tissue Injuries - Types - (2)/ 5
Eyelid injuries with black eyes.
Soft tissue Injuries - Types - (3)/ 5
Facial nerve injury: Primary repair is required.
Soft tissue Injuries - Types - (4)/ 5
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.
Soft tissue Injuries - Types - (5)/ 5
Lacrimal apparatus injury: Here the duct is sutured with a fine nylon thread in the canaliculus which is kept for 3 months.
Injuries to the Facial Bones - Types of Injuries 1-5/6
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
Infraorbital ecchymosis of the orbit is called
Panda sign.
Injuries to the Facial Bones - Types of Injuries - 6/6 MOST COMMON
Nose Fracture : Nasal bones are most commonly injured bones in face.
Nose Fracture: Patient Presentation
Patient presents with pain and swelling in the nose with deviation and displacement
Nose Fracture: Initial Treatment
Here reduction of the fractured nasal bones and nasal septum under general anaesthesia is done.
Nose Fracture: Later Treatment
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).
Nose Fracture: Procedure Tool
Procedure is done using Walsham’s and Asch’s forceps
Clinical Features of Facial Injuries -1/9
Localised swelling due to haematoma.
Clinical Features of Facial Injuries - 2/9
Facial oedema.
Clinical Features of Facial Injuries - 3/9
Bleeding with open wounds.
Clinical Features of Facial Injuries - 4/9
Asymmetry which is clinically confirmed by observing supraorbital ridges, nasal
bridge.
Clinical Features of Facial Injuries - 5/9
Localised tenderness.
Clinical Features of Facial Injuries - 6/9
Step deformity.
Clinical Features of Facial Injuries - 7/9
Trismus.
Clinical Features of Facial Injuries - 8/9
Diplopia.
Clinical Features of Facial Injuries -9/9
Features of associated injuries like intracranial, abdominal or thoracic injuries.
Facial Injuries - Investigations (2)
X-ray face.
CT scan of head and jaw.
Maxillofacial Injuries - General Treatment (6)
Suturing of soft tissues
Airway maintenance
Control of bleeding
Pain relief
Control of infection
Treating the individual fractures
Dislocation of the Mandible - Location
It occurs at temporomandibular joint.
Dislocation of the Mandible- Types - 1/2
Unilateral dislocation - common after trauma
Dislocation of the Mandible- Types - 2/2
Bilateral dislocation occurs during yawning and it is recurrent.
Dislocation of the Mandible- Clinical Features
Difficulty in opening the mouth with pain and tenderness over
the joint.
Dislocation of the Mandible- Treatment
Reduction of dislocation under general anaesthesia.
If there is associated fracture mandible, it should be dealt with accordingly
Fracture of the Mandible - Types - 1/2
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.
Fracture of the Mandible - Types - 2/2
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.
Fracture of the Mandible - Clinical Features (6)
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.
What is Coleman‘s sign.
Haematoma in the floor of the mouth
Fracture of the Mandible - Investigations (2)
X-ray of the mandible.
Orthopantomogram (OPG), CT head and face.
Fracture of the Mandible - Treatment (4)
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.
Open fixation is done by (3)
Interdental wiring.
Using arch bars.
Silver alloy or plastic caps
Fracture Middle Third Area - Includes :
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
Fracture Middle Third Area - Clinical Features (7)
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.
Fracture Middle Third Area - Investigations (2)
CT scan head.
X-ray skull.
Fracture Middle Third Area - Treatment (9)
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
