Ch 67 - Mandibular and Maxillofacial Fractures Flashcards
How does the mandible differ from other bones in regards to bone healing?
It does not have a medullary cavity and has no haematopoietic cells
How do the maxillofacial bones differ from other bones in regards to bone healing?
Very thin bone, therefore has an increased surface area of bone compared to the volume it occupies giving a relatively greater vascularity and rapid healing
Is removal of teeth for fracture repair recommended?
No
- Shown to have an increased frequency of complications
- Not advised unless teeth are fractures or loose and cannot be stabilised
What predisposes a fracture to infection?
- Bone fragment motion and subsequent implant loosening interfere with revascularisation and healing and predispose to infection
What are the three primary buttresses of the maxillofacial skeleton?
Rostral/medial
- nasomaxillary
Lateral
- Zygomaticomaxillary
Caudal
- lacrimal
- palatine
- pterygoid
Facial frame can be reconstructed utilising 2 of 3 buttresses. Caudal buttress is inaccessible
What are the two main goals of maxillaryfacial fracture repair?
- Proper dental occlusion
- Rigid skeletal fixation
List 2 options of endotracheal intubation when occlusion needs to be assessed intraoperatively
- Pharyngostomy
- Transmyelohyoid orotracheal intubation
What are the recommended approached to the mandibular body and to the TMJ?
- Body: ventral approach
- TMJ: Lateral approach (Ramus dorsal to the TMJ does not require repair)
What is the recommended approach for a maxilofacial fracture?
- Dorsal midline for nasal (best way to avoid neurovascular structures and for exposing buttresses)
- Gingival incision parallel to dental arcade
- Incision directly over fracture if necessary
What are the basic priniciples of mandibular and maxillofacial fractures?
- Mandibular reconstruction first (from caudal to rostral)
- Followed by lateral and then medial maxillofacial buttresses
- Anatomic reconstruction used for simple fractures
- Occlusion used for comminuted fractures or fracture gaps
How many wires must be placed for effective intraosseous wiring?
At least 2!
- One along tension side
- Second stabilisation wire to neutralise shear and rotation forces
List some general guidelines from intraosseous wire placement
- 18 - 20g wire (1.0 - 1.25mm)
- Cross perpendicular to fracture line
- Hand drilling (easier to avoid teeth)
- Holes 5-10mm from fracture
- Orienting drill holes towards the fracture line (facilitates positioning and tightening)
What form of wire tightening is best suited to maxillofacial fractures?
Twist method, maintian at least three twists
List some methods to prevent over-riding of fragments when using intraosseous wiring in the mxillofacial skeleton
- Skewer pin
- K-wire on outer surface of bone as an internal splint
List some methods of attempting to minimise the risk of premature pin loosening in mandibular ESF application
- Fixation pins through both mandibles to engage 4 cortices (only possible in rostral 2/3)
- Type 2 ESF (rostral 2/3)
- Single arched connecting bar lateral to both mandibles and rostral to jaw
- Multiple fixation pins (at least 2-3 per major fragment)
- Positive-profile threaded pins
- Acrylic connecting bar
Name the following instruments
- A-C: Martin bending pliers
- D-F: Synthes miniplate benders
- G - ALPS plate benders
What implant is this?
uniLOCK, DePuy Synthes
- locking reconstruction plate which can be a good option as a larger ventral stabilisation plate
