Craniomaxillofacial Trauma.

Question 1

What are the three distinct regions of the maxillofacial skeleton?

Answer 1

The upper face, midface, and lower face

Question 2

What are the main components of the upper facial skeleton?

Answer 2

The frontal bone, supraorbital rims, and lateral orbital elements.

Question 3

What does the midface region of the maxillofacial skeleton include?

Answer 3

The medial, inferior, and inferolateral orbit, as well as the nasal complex, zygomata, and maxilla.

Question 4

What forms the lower facial skeleton?

Answer 4

The mandible and its associated temporomandibular joints

Question 5

What are the vertical buttresses of the facial skeleton?

Answer 5

The nasomaxillary (medial), zygomaticomaxillary (lateral), pterygomaxillary, and posterior mandibular

Question 6

What do the vertical buttresses of the facial skeleton support?

Answer 6

They support the bones of the midface and lower face

Question 7

What are the horizontal buttresses of the facial skeleton?

Answer 7

The frontal, zygomatic, maxillary, and mandibular

Question 8

What does the frontal bone comprise in the facial skeleton? upper facial

Answer 8

The upper facial skeleton, including the contour of the forehead, superior orbital rim, and orbital roof.

Question 9

What are the types of frontal sinus fractures?

Answer 9

Anterior table fractures (anterior wall) and posterior table fractures (posterior wall), or both

Question 10

What clinical signs are often present in patients with frontal bone injuries?

Answer 10

Lacerations over the forehead or eyebrows with associated edema.

Question 11

What injury might isolated upper eyelid ecchymosis suggest?

Answer 11

An orbital roof injury.

Question 12

Why is rhinorrhea a worrisome finding in patients with frontal sinus fractures?

Answer 12

It suggests a complex injury involving the posterior table of the frontal sinus with associated dural injury

Question 13

How can the presence of cerebrospinal fluid (CSF) in nasal drainage be confirmed?

Answer 13

With a beta-2-transferrin test.

Question 14

What symptom might a patient with dural injury and posterior table fractures describe?

Answer 14

Salty nasal drainage.

Question 15

Do isolated anterior table fractures of the frontal sinus without significant displacement typically require surgery?

Answer 15

No

Question 16

What types of anterior table fractures of the frontal sinus require multidisciplinary management?

Answer 16

Displaced injuries, especially those involving the nasofrontal outflow tracts or posterior table fractures.

Question 17

What should clinicians consider in patients with posterior table fractures of the frontal sinus?

Answer 17

likelihood of intracranial vascular injury and dural injury with cerebrospinal fluid leak

Question 18

What finding on a CT scan is suggestive of a posterior table injury?

Answer 18

Pneumocephalus

Question 19

What is a pericranial flap used for?

Answer 19

Obliteration of the frontal sinus, repair of dural injuries, coverage of hardware, and as a base for skin grafting.

Question 20

What is the treatment for depressed anterior wall fractures that cause deformity?

Answer 20

Open reduction and internal fixation

Question 21

What is required when a fracture causes obstruction of the nasofrontal duct?

Answer 21

Complete removal of the mucosa and obliteration of the duct with a bone graft, or removal of the posterior wall and cranialization of the sinus.

Question 22

What should be done for displaced posterior wall fractures?

Answer 22

may require exploration and repair due to possible dural injuries

Question 23

What are common clinical symptoms of facial fractures? Mid Facial

Answer 23

Double vision, decreased vision, periorbital edema, and ecchymosis.

Question 24

What facial symptoms may occur with nasal or zygomatic fractures?

Answer 24

Nasal bleeding/congestion, cheek or upper lip swelling, and facial asymmetry due to loss of nasal or zygomatic projection.

Question 25

What dental-related symptom can occur with facial fractures?

Answer 25

Malocclusion (misalignment of the teeth).

Question 26

What neurological symptom suggests an infraorbital nerve injury?

Answer 26

Paresthesia (numbness or tingling) to the lower eyelid, cheeks, and upper lip

Question 27

What four areas should be systematically assessed in patients with midfacial injuries?

Answer 27

The nasal complex, orbit, zygoma, and maxilla.

Question 28

How do nasal bone fractures typically present?

Answer 28

With swelling, tenderness to palpation over the nasal root, and associated crepitus.

Question 29

What is the importance of intranasal examination in midfacial injuries?

Answer 29

to assess the position of the septum, identify sources of intranasal bleeding, and check for septal hematoma

Question 30

What are common complaints of patients with zygomatic injuries?

Answer 30

Cheek swelling, loss of cheek projection, cheek numbness, and difficulty opening their mouth (trismus).

Question 31

What does trismus in a patient with zygomatic injury suggest?

Answer 31

Impingement of the zygomatic arch on the temporalis muscle/coronoid process of the mandible, indicating a displaced zygomatic arch fracture or zygomaticomaxillary complex (ZMC) injury.

Question 32

What symptoms are commonly associated with maxillary fractures?

Answer 32

Intranasal and/or intraoral bleeding, malocclusion, dental/dentoalveolar injury, or facial asymmetry.

Question 33

How are injuries of the nasal region commonly classified?

Answer 33

isolated nasal bone/septal fractures and more complex naso-orbito-ethmoid (NOE) fractures

Question 34

What should be evaluated radiographically in nasal bone fractures?

Answer 34

The degree of displacement, laterality, associated soft tissue swelling, septal deviation, and septal hematoma.

Question 35

What type of injuries cause naso-orbito-ethmoid (NOE) fractures?

Answer 35

Higher energy injuries that involve the nasal bones and the inferior medial orbital wall (comprised of ethmoid bones).

Question 36

What is telecanthus, and what causes it in NOE fractures?

Answer 36

Telecanthus is an increased distance between the medial canthi, caused by damage to the medial canthal tendons.

Question 37

What types of injuries are orbital injuries commonly associated with?

Answer 37

Nasal injuries, frontal bone injuries, and zygomaticomaxillary injuries

Question 38

Which walls of the orbit are most frequently involved in isolated orbital fractures?

Answer 38

The orbital floor and medial wall

Question 39

What complications may arise from isolated orbital fractures?

Answer 39

Entrapment of extraocular muscles, herniation of periorbital soft tissues into ethmoid or maxillary sinuses, and globe injuries.

Question 40

Why is muscle entrapment in orbital fractures a surgical emergency?

Answer 40

It can cause extraocular movement restriction, oculocardiac reflex (sinus bradycardia), severe nausea, and eye pain

Question 41

What test should be performed preoperatively and postoperatively to assess eye movement in orbital fracture patients?

Answer 41

Forced duction testing to assess for restricted eye movements

Question 42

What bones does the zygoma articulate with?

Answer 42

The frontal bone, maxilla, lateral wing of the sphenoid bone, and the temporal bone via the zygomatic arch.

Question 43

What characterizes a complete ZMC (zygomaticomaxillary complex) fracture?

Answer 43

Disruption of all four articulations, potentially resulting in displacement of the zygoma, loss of cheek projection, or facial widening

Question 44

What distinguishes incomplete ZMC fractures from complete fractures?

Answer 44

Incomplete fractures involve one or more articulations but not all four.

Question 45

What are Le Fort I fractures?

Answer 45

Fractures that separate the maxilla from the remainder of the midface

Question 46

What are Le Fort II fractures, also known as pyramidal fractures?

Answer 46

Fractures that separate the maxilla and nasal complex from the surrounding midfacial structures

Question 47

What are Le Fort III fractures, also known as craniofacial dysjunction?

Answer 47

Fractures that separate the midface from the skull base entirely

Question 48

What are common symptoms of maxillary fractures?

Answer 48

Midfacial swelling, pain, and a subjective complaint of malocclusion.

Question 49

What are common physical findings in patients with maxillary fractures?

Answer 49

Malocclusion, intraoral or midfacial ecchymoses, maxillary mobility, and facial paresthesia related to the infraorbital or nasopalatine nerves.

Question 50

What is a characteristic feature of all Le Fort fractures?

Answer 50

Injury to the pterygoid plates

Question 51

What are the functional surgical indications for naso-orbito-ethmoid (NOE) fractures?

Answer 51

Cerebrospinal fluid rhinorrhea, persistent epistaxis, disruption of the nasolacrimal system, and medial orbital entrapment

Question 52

What are the aesthetic surgical indications for NOE fractures?

Answer 52

Displaced NOE complex and telecanthus (increased distance between the medial canthi)

Question 53

When should cerebrospinal fluid leaks be repaired in NOE fractures?

Answer 53

If they have not resolved with conservative measures and time

Question 54

How should displaced and widened NOE bones be managed?

Answer 54

reduced and either splinted or fixated to restore proper position and normal intercanthal distance (about 30 mm).

Question 55

What are two surgical approaches to reduce a displaced zygomatic arch?

Answer 55

Temporal Gillies incision or intraoral Keen incision

Question 56

What structure is often sufficient to stabilize the zygomatic arch after reduction?

Answer 56

The periosteum surrounding the arch

Question 57

What is the first step in the surgical correction of maxilla fractures?

Answer 57

To obtain appropriate centric occlusion.

Question 58

How is centric occlusion held in place during maxilla fracture surgery?

Answer 58

temporary maxillomandibular fixation (MMF)

Question 59

What structures are involved in lower facial skeletal injuries?

Answer 59

The mandible and its associated alveolar housing.

Question 60

What symptoms might a patient with mandibular trauma report?

Answer 60

Altered bite, intraoral bleeding, and lower lip or tongue paresthesia.

Question 61

What physical signs are often seen in patients with mandibular trauma?

Answer 61

Intraoral laceration, fractured teeth, and sublingual hematoma (associated with dentate mandible injuries)

Question 62

What is a common finding in patients with subcondylar fractures?

Answer 62

Deviation of the mandible to the side of the fracture when opening their mouth

Question 63

What is a characteristic presentation of bilateral subcondylar fractures?

Answer 63

An anterior open bite.

Question 64

What is the first step in mandibular fracture repair?

Answer 64

Establishing appropriate centric occlusion and centric relation

Question 65

How can mandibular fractures be managed?

Answer 65

Through a combination of maxillomandibular fixation (MMF) and rigid internal fixation

Question 66

How are displaced mandibular fractures typically treated?

Answer 66

With open reduction and internal fixation, either through an intraoral or external approach

Question 67

What is the best skin graft donor site for facial reconstruction?

Answer 67

The region above the clavicle, as the color and texture of the skin there match the facial skin.

Question 68

What type of flap is often required for facial defects greater than 5 cm?

Answer 68

Large fasciocutaneous rotation flaps from the cervical and deltopectoral region