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A1-G Surg Note Trauma > Craniomaxillofacial Trauma. > Flashcards

Craniomaxillofacial Trauma. Flashcards

1
Q

What are the three distinct regions of the maxillofacial skeleton?

A

The upper face, midface, and lower face

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2
Q

What are the main components of the upper facial skeleton?

A

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

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3
Q

What does the midface region of the maxillofacial skeleton include?

A

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

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4
Q

What forms the lower facial skeleton?

A

The mandible and its associated temporomandibular joints

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5
Q

What are the vertical buttresses of the facial skeleton?

A

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

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6
Q

What do the vertical buttresses of the facial skeleton support?

A

They support the bones of the midface and lower face

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7
Q

What are the horizontal buttresses of the facial skeleton?

A

The frontal, zygomatic, maxillary, and mandibular

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8
Q

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

A

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

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9
Q

What are the types of frontal sinus fractures?

A

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

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10
Q

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

A

Lacerations over the forehead or eyebrows with associated edema.

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11
Q

What injury might isolated upper eyelid ecchymosis suggest?

A

An orbital roof injury.

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12
Q

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

A

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

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13
Q

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

A

With a beta-2-transferrin test.

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14
Q

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

A

Salty nasal drainage.

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15
Q

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

A

No

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16
Q

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

A

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

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17
Q

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

A

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

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18
Q

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

A

Pneumocephalus

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19
Q

What is a pericranial flap used for?

A

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

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20
Q

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

A

Open reduction and internal fixation

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21
Q

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

A

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.

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22
Q

What should be done for displaced posterior wall fractures?

A

may require exploration and repair due to possible dural injuries

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23
Q

What are common clinical symptoms of facial fractures? Mid Facial

A

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

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24
Q

What facial symptoms may occur with nasal or zygomatic fractures?

A

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

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25
Q

What dental-related symptom can occur with facial fractures?

A

Malocclusion (misalignment of the teeth).

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26
Q

What neurological symptom suggests an infraorbital nerve injury?

A

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

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27
Q

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

A

The nasal complex, orbit, zygoma, and maxilla.

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28
Q

How do nasal bone fractures typically present?

A

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

29
Q

What is the importance of intranasal examination in midfacial injuries?

A

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

30
Q

What are common complaints of patients with zygomatic injuries?

A

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

31
Q

What does trismus in a patient with zygomatic injury suggest?

A

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.

32
Q

What symptoms are commonly associated with maxillary fractures?

A

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

33
Q

How are injuries of the nasal region commonly classified?

A

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

34
Q

What should be evaluated radiographically in nasal bone fractures?

A

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

35
Q

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

A

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

36
Q

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

A

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

37
Q

What types of injuries are orbital injuries commonly associated with?

A

Nasal injuries, frontal bone injuries, and zygomaticomaxillary injuries

38
Q

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

A

The orbital floor and medial wall

39
Q

What complications may arise from isolated orbital fractures?

A

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

40
Q

Why is muscle entrapment in orbital fractures a surgical emergency?

A

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

41
Q

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

A

Forced duction testing to assess for restricted eye movements

42
Q

What bones does the zygoma articulate with?

A

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

43
Q

What characterizes a complete ZMC (zygomaticomaxillary complex) fracture?

A

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

44
Q

What distinguishes incomplete ZMC fractures from complete fractures?

A

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

45
Q

What are Le Fort I fractures?

A

Fractures that separate the maxilla from the remainder of the midface

46
Q

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

A

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

47
Q

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

A

Fractures that separate the midface from the skull base entirely

48
Q

What are common symptoms of maxillary fractures?

A

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

49
Q

What are common physical findings in patients with maxillary fractures?

A

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

50
Q

What is a characteristic feature of all Le Fort fractures?

A

Injury to the pterygoid plates

51
Q

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

A

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

52
Q

What are the aesthetic surgical indications for NOE fractures?

A

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

53
Q

When should cerebrospinal fluid leaks be repaired in NOE fractures?

A

If they have not resolved with conservative measures and time

54
Q

How should displaced and widened NOE bones be managed?

A

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

55
Q

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

A

Temporal Gillies incision or intraoral Keen incision

56
Q

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

A

The periosteum surrounding the arch

57
Q

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

A

To obtain appropriate centric occlusion.

58
Q

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

A

temporary maxillomandibular fixation (MMF)

59
Q

What structures are involved in lower facial skeletal injuries?

A

The mandible and its associated alveolar housing.

60
Q

What symptoms might a patient with mandibular trauma report?

A

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

61
Q

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

A

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

62
Q

What is a common finding in patients with subcondylar fractures?

A

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

63
Q

What is a characteristic presentation of bilateral subcondylar fractures?

A

An anterior open bite.

64
Q

What is the first step in mandibular fracture repair?

A

Establishing appropriate centric occlusion and centric relation

65
Q

How can mandibular fractures be managed?

A

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

66
Q

How are displaced mandibular fractures typically treated?

A

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

67
Q

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

A

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

68
Q

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

A

Large fasciocutaneous rotation flaps from the cervical and deltopectoral region

A1-G Surg Note Trauma (26 decks)

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