C 1.12 MANAGEMENT OF DENTO-ALVEOLAR TRAUMA AND FAMILIARITY WITH THE MANAGEMENT AND TREATMENT OF FRACTURES OF THE JAWS AND FACIAL SKELETON

Question 1

Radiographic Assessment of Dental Trauma

Answer 1

2 views in parallax
vertical - LCPA and USO - good for anterior teeth
horizontal - LCPA x 2 - good for posterior teeth
Provide aid to diagnosis
Act as a baseline for follow up
CXR (PA and R lateral), abdominal AP XR or soft tissue lateral and AP views of the larynx and pharynx if concerns about inhalation or swallowing of tooth fragments

Question 2

Radiographic Assessment of Mandibular Fractures

Answer 2

PA Mandible and OPG
If suspect high condylar fracture - OPG and Reverse Towne’s
if suspect coronoid fracture - 0degrees OM view
Features :
- radiolucent lines (may be two if through both buccal and lingual cortices)
- radiopaque lines (if superimposition of the two fracture portions)
- step deformity at lower border or occlusal plane
Note: extend of displacement depends on - direction and strength of fracturing force, direction of fracture line and relevant muscle attachments to each fragment and their action on the bone
Favourable fracture - muscles hold fractured portions together.
Unfavourable fracture - muscles pull fractured portions apart. (e.g. bucket handle)
Due to limitations in 2D imaging, 2 views needed. Minimally displaced fractures may not be seen at all.

Question 3

Radiographic Assessment of Mid-Face Fractures

Answer 3

Le Fort fractures - 0 degrees OM and 30degrees OM, +/- CT/CBCT
Tear-drop sign
Fluid level in antrum
Diplacement of fractures

Question 4

Mid facial fracutres

Answer 4

Le Fort I - bilateral detachement of alveolar process and palate
Le Fort II - pyramidal subzygomatic fracture of maxilla
Le Fort III - high-level suprazygomatic fracture of the maxilla
Zygomatic complex fractures:
- zygoma depressed with fractures at several sites
- fracutres of zygomatic arch
Fractures of naso-ethmoidal complex
Fractures of orbit, including:
- fracture of orbital rim
- orbital blow out fracture

Question 5

Bones of the neurocranium

Bones of midface

Answer 5

Neurocranium - frontal, sphenoid, temporal

Midface -

Question 6

Signs and symptoms of midface fractures

Answer 6

Facial swelling, - oedema, haematoma, emphysema, deformity
SCH
oro-nasal bleeding,
periorbital palpable crepitating bony contour
displacement of the globe - hyper (superior), hypo (inferior), eno (medial), exophthalmos (distal) (? Retrobulbar haemorrage?)
displacement of medical canthal tendon
comprimised ocular motility
diplopia
sensory deficit - V2
pain
occlusal disturbance
CSF leakage (if ant. skull base fracture)

Question 7

Eye Examination for midface fractures

To look at with George

Answer 7

Visual acuity (ensure know current visual defects ?glasses) - snellen -
Visual fields
Ocular motility
Binocular vision
Globe position - straight instrument and examination from above
Pupillary reaction
Relative afferent pupillary defect (RAPD)
Intraocular pressure