Facial fractures

Question 1

What are the most common sites for mandibular fractures?

Answer 1

Angle of mandible
Condyle
Parasymphyseal

• usually 2 fractures present

Question 2

What is the main symptom for a unilateral condylar fracture?

Answer 2

Deviation on opening

Question 3

What xrays should be used in suspected Mandibular fracture cases?

Answer 3

OPG

PA mandible

Question 4

What are the main signs and symptoms of mandibular fractures?

Answer 4

Limited opening 
Deviation on opening 
Numbness/paraesthesia 
Gingival tearing/bleeding 
Haematoma esp. sublingual 
Step deformity/open bite 
Mobility of teeth 
Loss of occlusal strength

Question 5

What is the most common management of mandibular fractures?

Answer 5

Open reduction internal fixation ORIF

Question 6

When should IMF be used?

Answer 6

To re-establish occlusion (fracture reduction) prior to bone plating

Question 7

How should condylar fractures be managed?

Answer 7

• conservative management
• closed reduction (IMF)
• ORIF if grossly displaced, bilateral or comminuted fractures

Question 8

What extra treatment is required for compound fractures (fractures that involve dental region)?

Answer 8

Antibiotics are required

Question 9

What are the signs of a tripod fracture?

Answer 9

Disruption of Z-F suture
Depression of zygomatic arch
Fracture of infraorbital rim

Question 10

What are the signs and symptoms of zygomatic arch related fractures?

Answer 10

Loss of cheek prominence 
Z-F tenderness (upper corner of orbit) 
Step in infraorbital rim 
Subconjunctival haemorrhage 
Infraorbital paraesthesia 
Unilateral epistaxis 
Diplopia 
Trismus

Question 11

What radiographs are used for suspected zygomatic fractures?

Answer 11

Occipitomental (OM)
OM10+30degrees

Complex fractures
- CT scan

Question 12

What lines are used for assessing facial fractures?

Answer 12

Campbell’s lines
Upper line: pass across upper edge of orbits

Middle line: follows zygomatic arch and inferior orbital margins

Lower line: passes through condyle and coronoid process of mandible through maxillary antra

Question 13

How are zygomatic arch fractures managed?

Answer 13

Arch fractures:
- gillies lift

Z-F complex fractures:
- ORIF using mini plates

Question 14

What are the signs of orbital floor fractures?

Answer 14

Diplopia 
Enphthalmos 
Hypoglobus 
Subconjunctival haemorrhage 
Infraorbital paraesthesia

Question 15

What is the tell tale sign of orbital floor fracture on X-ray?

Answer 15

Tear drop sign

Question 16

What xrays are used in suspected orbital floor fractures?

Answer 16

OM may be helpful but usually require reformatted CT

Question 17

How are maxillary fractures classified?

Answer 17

Le fort classification

Le fort 1:
Horizontal maxillary fractures separating teeth from upper face (floating palate)

Le fort 2:
Pyramidal fracture involving nasofrontal suture (floating maxilla)

Le fort 3:
Transverse Craniofacial dysjunction where maxilla is detached from base of skull (floating face)

Question 18

What are the signs of maxilla fractures?

Answer 18

Hose face/fish face 
Posterior gagging/AOB
Bilateral black eyes/subconjunctival haemorrhage 
Palatal haematoma  
Mobility of palatal segment 
Possible CSF leakage

Question 19

What xrays are used for suspected maxillary fractures?

Answer 19

OM and lateral ceph

CT reformatted often required