Facial Reconstriction And Trauma Flashcards
What factors determine the degree of damage in craniofacial injuries?
Low velocity vs. high velocity injuries
The velocity of the injury affects the extent of damage to facial structures.
What are common symptoms associated with fractures?
Bruising, swelling, tenderness, loss of function
Fractures can lead to visible signs and functional impairments.
How long can management of most facial injuries wait before requiring ORIF?
Approximately 5 days for swelling to decrease
ORIF stands for Open Reduction and Internal Fixation.
What protocol should be followed for the approach to facial injuries?
ATLS protocol
Advanced Trauma Life Support (ATLS) protocol is essential for assessing injuries.
What clinical assessments are necessary for facial injuries?
Inspect, palpate, clinical assessment for injury to underlying structures
This includes assessing for facial nerve damage, bony injuries, ocular involvement and septal hematoma
What is a key consideration for patients with major facial injuries?
Tetanus prophylaxis
Patients at risk for infection may require preventive measures.
What is the gold standard for radiological evaluation of facial injuries?
CT scan
A CT scan is the preferred imaging method for assessing facial fractures.
What specific CT scan parameters are indicated for facial injuries?
Fine cuts of 1.5 mm through the orbit
This provides detailed imaging for accurate diagnosis.
What should be done for wound management in facial injuries?
Wound irrigation with NS/RL and remove foreign materials
Normal Saline (NS) or Ringer’s Lactate (RL) solutions are used for irrigation.
What type of tissue management is recommended for detached or nonviable tissue?
Conservative debridement
This approach minimizes further tissue damage while cleaning the wound.
When should lacerations be repaired in facial injuries?
At the time of presentation when the patient’s general condition allows
Timely repair can prevent complications and improve outcomes.
What type of trauma should be considered in facial injuries?
Intracranial trauma
It’s important to rule out (head fractures).
What are the signs of a basal skull fracture?
Battle’s sign, Hemotympanum, Raccoon eyes, CF otorrhea/rhinorrhea
These signs indicate serious trauma and require immediate attention.
What are the treatment goals for facial injuries?
Re-establish normal occlusion, normal eye function, re-establish facial height and width
These goals aim to restore function and appearance.
What types of consultations may be indicated for facial injuries?
Dentistry, ophthalmology, neurosurgery
Multidisciplinary teams may be required for comprehensive care.
Fill in the blank: The management of craniofacial injuries generally involves a wait period of ______ before surgical intervention.
5 days
Allowing time for swelling to decrease can improve surgical outcomes.
What is a common feature of mandibular fractures due to its structure?
Mandibular fractures often occur at two points of injury because it is a ring structure.
Where are mandibular fractures commonly located?
At sites of weakness such as the condylar neck and angle of the mandible.
What type of force typically causes bilateral fractures of the mandible?
Anterior force.
What type of force typically causes ipsilateral subcondylar and contralateral angle or body fractures?
Lateral force.
How is a fracture classified as open?
If it extends into the tooth-bearing area (alveolus).
What are common clinical features of mandibular fractures?
- Pain
- Swelling
- Difficulty opening mouth (trismus)
- Malocclusion
- Asymmetry of dental arch
- Damaged, loose, or lost teeth
- Palpable ‘step’ along mandible
- Numbness in CN V3 distribution
- Intra-oral lacerations or hematoma (sublingual)
- Chin deviating toward side of a fractured condyle
What is the anatomical boundary of the Symphysis in the mandible?
Midline of the mandible; between the central incisors from the alveolar process through the inferior border of the mandible.
What defines the Body of the mandible?
From the symphysis to the distal alveolar border of the third molar.
What characterizes the Angle region of the mandible?
Triangular region between the anterior border of the masseter and the posterosuperior insertion of the masseter distal to the third molar.
What is the Ramus in the context of the mandible?
Part of the mandible that extends posterosuperiorly into the condylar and coronoid processes.
What area does the Condylar region of the mandible refer to?
Area of the condylar process of the mandible.
Define the Subcondylar area of the mandible.
Area below the condylar neck (i.e. sigmoid notch) of the mandible.
What is the Coronoid Process in the mandible?
Area of the coronoid process of the mandible.
What is the most common type of mandibular fracture?
The condylar fracture.
What is one method of treatment for mandibular fractures?
Maxillary and mandibular arch bars wired together (intermaxillary fixation) or ORIF.
When should treatment for mandibular fractures ideally be managed?
Within 48 hours.
What is the recommended antibiotic protocol for mandibular fractures?
Antibiotics from initial presentation until at least 3 doses postoperatively; consider extended course for late presentation.
Why is timing crucial in facial reconstruction after trauma?
To prevent secondary traumatic brain injury (TBI)
A second TBI can occur if there’s additional trauma or instability affecting the brain after the initial injury.
What must happen before facial reconstruction can proceed?
The patient must be cleared by the trauma team
This ensures that life-threatening injuries or urgent medical issues have been addressed.
What is the advised approach regarding immediate surgery after trauma?
Wait, don’t rush to surgery
Immediate surgery may not be beneficial if the patient has other injuries or isn’t stable.
What complication can arise from administering anesthesia too soon?
Hypotension (a drop in blood pressure)
Hypotension can worsen brain injuries and lead to poor oxygenation in tissues.
What are the properties of titanium plates used in facial reconstruction?
Strength, durability, and compatibility with human tissues
Titanium plates are lightweight and cause minimal interference with imaging.
Titanium plates are commonly used in facial reconstruction.
minimal interference with imaging (e.g., MRI), making it a preferred material for permanent fixation.
These plates provide strong support for facial bones and are used to hold fractured segments in place, promoting healing and maintaining facial structure.
What is the advantage of using bioabsorbable materials in facial reconstruction?
They eliminate the need for a second surgery to remove them
They degrade safely within the body, providing temporary stabilization.
They are particularly useful in pediatric patients or in cases where permanent fixation may not be necessary.
What role do screws play in operative fixation for facial reconstruction?
They provide additional stability and maintain correct alignment of bone segments
Both titanium and bioabsorbable screws are available based on patient needs.
Fill in the blank: The emphasis on a multidisciplinary approach in trauma includes _______.
the trauma team evaluating and clearing the patient
True or False: Titanium plates interfere significantly with imaging techniques like MRI.
False
Titanium plates cause minimal interference with imaging.
List the materials commonly used in operative fixation for facial reconstruction.
- Metallic Plates (Titanium)
- Bioabsorbable Materials
- Screws
What is a potential risk of performing surgery too quickly after a traumatic injury?
Worsening of the patient’s condition due to secondary injuries
Secondary injuries are a major risk factor for worsening outcomes.
What are Le Fort I fractures?
Horizontal fractures of the maxilla that separate the teeth from the upper facial bones
Le Fort I fractures are classified as low-level fractures and are often associated with trauma to the midface.
What characterizes Le Fort III fractures?
Fractures that involve the craniofacial dysjunction, separating the maxilla from the skull
Le Fort III fractures are also known as craniofacial fractures and are typically more severe than Le Fort I fractures.
What is the primary mechanism of injury for Le Fort fractures?
High-energy trauma, such as vehicular accidents or assaults
These fractures often result from significant force applied to the face.
Fill in the blank: Le Fort fractures are classified into three types: Le Fort I, Le Fort II, and _______.
Le Fort III
True or False: Le Fort II fractures involve a pyramidal shape and include the nasal bones.
True
Le Fort II fractures are often described as a pyramidal fracture pattern and typically involve the nasal bones.
What is the clinical significance of Le Fort fractures?
They require careful assessment and management to prevent complications like airway obstruction and facial deformities
Prompt diagnosis and treatment are crucial for optimal recovery.
List the types of Le Fort fractures.
- Le Fort I
- Le Fort II
- Le Fort III
What type of fracture is characterized by a horizontal cut through the maxilla?
Le Fort I fracture
Le Fort II fractures are also known as _______.
Pyramidal fractures
What type of imaging is commonly used to diagnose Le Fort fractures?
CT scans or X-rays
These imaging techniques help visualize the extent and pattern of fractures.
Whats the primary goal treatment of treating maxillary fractures?
Restoring normal premorbid occlusion
Because any disruption in the occlusion can affect chewing, speech and appearance.
Whats the treatment of maxillary fracture?
MMF: maxillomandibular fixation: it involves wiring or elastic bands
ORIF
(If occlusion is unaffected => managed non-operative)
What is the most common facial fracture?
Nasal fracture
Nasal fractures are the most frequently occurring facial fractures.
What type of force is more common in nasal fractures?
Lateral force
Lateral forces are more commonly associated with nasal fractures compared to anterior forces.
What can anterior forces in nasal fractures produce?
More serious injuries
Anterior forces can lead to more severe injuries than lateral forces.
List three clinical features of nasal fractures.
- Epistaxis/hemorrhage
- Deviation/flattening of nose
- Swelling
Additional clinical features include periorbital ecchymosis, tenderness over nasal dorsum, crepitus, septal hematoma, respiratory obstruction, and subconjunctival hemorrhage.
What is a potential complication of a septal hematoma?
Septal necrosis and perforation
Septal hematomas can lead to severe complications if not inspected and drained.
What is the initial treatment focus for nasal fractures?
Airway or cosmetic issues
Treatment is primarily focused on ensuring airway patency and addressing cosmetic concerns.
How is a septal hematoma treated?
Small incision in the septal mucosa followed by packing
This procedure helps to prevent complications associated with septal hematomas.
What is the best timing for closed reduction of nasal fractures?
Immediately (<6 h) or when swelling subsides (5-7 d)
Timely intervention is crucial for optimal outcomes.
What is used for packing nostrils after closed reduction?
Petroleum or non-adhesive gauze packing
This helps to maintain the position of the nasal structures post-reduction.
What percentage of nasal fractures may require rhinoplasty later for residual deformity?
30%
Rhinoplasty may be necessary for those patients with persistent deformities after the initial treatment.
What are the three classifications of zygomatic fractures?
- Fracture restricted to zygomatic arch
- Depressed fracture of zygomatic complex
- Unstable fracture of zygomatic complex (tetrapod fracture)
What are the three most common clinical features of zygomatic fractures?
- Subconjunctival hemorrhage
- Periorbital ecchymosis
- CN V2 numbness (infraorbital and superior dental nerves)
Fill in the blank: A fracture restricted to the zygomatic arch is classified as a _______.
[Fracture restricted to zygomatic arch]
What is a pathognomonic feature indicating a zygomatic fracture when viewing from above?
Flattening of malar prominence
What clinical feature may be present with zygomatic arch fractures?
- Ipsilateral epistaxis
- Trismus
What should be done if a zygomatic fracture is non-displaced, stable, and asymptomatic?
Soft diet; no treatment necessary
What surgical approaches can be used for non-displaced zygomatic arch fractures?
- Gillies approach
- Keane approach
What is required if the zygomatic arch is comminuted?
Coronal incision and ORIF
What is the treatment for displaced or unstable fractures of the zygomatic complex?
ORIF (Open Reduction Internal Fixation)
True or False: Periorbital ecchymosis is often associated with fractures of the orbital floor.
True
What is the significance of a palpable step deformity in zygomatic fractures?
Indicates a fracture in the bony orbital rim, especially inferiorly
What is a common pain symptom associated with zygomatic fractures?
Pain over fractures on palpation
What is the definition of an orbital floor fracture?
Fracture of the floor of the orbit that may be a ‘pure blow-out fracture’ with an intact orbital rim, or associated with other fractures such as orbital rim fracture and/or zygoma.
What is a common cause of orbital floor fractures?
Blunt force to the eyeball, such as from a baseball or fist, leading to a sudden increase in intraorbital pressure.
What are some clinical features of orbital floor fractures?
- Restricted EOM if muscle is trapped
- Periorbital edema and bruising
- Subconjunctival hemorrhage
- Ptosis
- Exophthalmos
- Exorbitism
- Enophthalmos
- Hypoglobus
- Diplopia
- Orbital rim step-offs with possible infraorbital nerve anesthesia
- Orbital entrapment
What does diplopia with straight gaze indicate in the context of orbital floor fractures?
Inability to look up past neutral due to entrapment of the inferior rectus muscle.
What imaging technique is diagnostic for orbital floor fractures?
CT scan with axial, coronal, and sagittal views with fine cuts through the orbit.
What is a diagnostic maneuver for assessing orbital entrapment?
Forced duction test, which involves pulling on the inferior rectus muscle with forceps to ensure full range of motion under general anesthesia.
When is surgical repair indicated for orbital floor fractures?
- Entrapment
- Any size defect with enophthalmos (if the patient is bothered by it)
- Persistent diplopia lasting more than 10 days
What materials can be used for reconstruction of the orbital floor?
- Bone graft
- Alloplastic material (e.g. titanium meshes, MEDPOR®, MEDPOR TITAN®)
What are some complications that can arise after treatment for orbital floor fractures?
- Persistent diplopia
- Enophthalmos
What is Superior Orbital Fissure Syndrome?
Fracture of the superior orbital fissure causing ptosis, proptosis, anesthesia in CN V1 distribution, and painful ophthalmoplegia.
What is an uncommon complication seen in Le Fort II and III fractures?
Superior Orbital Fissure Syndrome with an incidence of 1 in 130.
What is the reported recovery time following operative reduction of fractures associated with Superior Orbital Fissure Syndrome?
4.8 to 23 weeks.
What is Orbital Apex Syndrome?
Fracture through the optic canal with involvement of CN II at the apex of the orbit, presenting symptoms similar to SOF syndrome plus vision loss.
What are the treatment options for Orbital Apex Syndrome?
- Steroids
- Urgent decompression of the fracture in the optic canal (posterior craniotomy for decompression)
What is an abrasion?
Superficial injury to skin
Abrasions are often caused by friction or scraping against a rough surface.
Define laceration.
Sharp cut in skin
Lacerations can vary in depth and severity, affecting different layers of skin.
What does avulsion refer to?
Ripped a part of something
Avulsions can involve skin, tissue, or even limbs and often require surgical intervention.
What type of injury is a crush injury?
Injury caused by a compressive force
Crush injuries can lead to significant tissue damage and complications.
What is a gunshot wound (GSW)?
Combo of penetrating and other injuries
GSWs can result in complex injuries due to the high velocity of the projectile.
What is critical for minimizing deformity in soft tissue trauma?
Anatomic realignment
Proper alignment helps preserve function and appearance of the affected area.
How significant can bleeding be in soft tissue trauma?
Can be significant
It is important to manage bleeding effectively to prevent shock and other complications.
What should be avoided when managing bleeding?
Blind clamping
Blind clamping can lead to further injury or complications if major vessels are affected.
What is the initial treatment for soft tissue trauma?
Copious irrigation, removal of foreign bodies, layered closure
These steps help in preventing infection and promoting healing.
When is debridement rarely performed?
On the face
The face has critical structures and a rich blood supply, making conservative treatment preferable.
Why is the face resistant to injury?
It is very vascular
The blood supply in facial tissues supports healing and reduces the risk of necrosis.
What are the steps for treating facial injuries?
Cut, wash out, and close
This approach minimizes trauma and preserves the function and aesthetics of the face.
What is the term for the layer of tissue that covers the scalp?
Galea
The galea is a fibrous layer that plays a significant role in scalp anatomy.
What is a major complication associated with scalp injuries?
Significant bleeding
Scalp injuries often lead to substantial blood loss due to the rich vascular supply.
What should be avoided during the closure of scalp injuries to prevent hair loss?
Alopecia
Proper closure techniques in layers help maintain the integrity of hair follicles.
What is the temporal danger zone in forehead injuries?
Careful of temporal danger zone
The temporal danger zone is an area where there is a risk of injury to the facial nerve.
Within how many hours should facial nerve injuries be repaired?
72 hours
Timely intervention is crucial for optimal recovery of facial nerve function.
What is the unique structure of the eyebrow referred to?
LedVend
This term likely refers to the specific anatomical features or vascular supply of the eyebrow.
What should be done to align and preserve the structure of the ear during surgery?
Align correctly and preserve
Proper alignment is essential for maintaining the aesthetic and functional aspects of the ear.
What gland is significant in relation to scalp and forehead injuries?
Parotid gland
The parotid gland is located near the ear and can be affected in facial injuries.
What is the recommended approach for closing scalp injuries?
Close in layers
Layered closure helps in proper healing and minimizes complications.
What should be checked at the cervical tip during examination?
Tip to check for
This likely refers to assessing for any related injuries or complications in the cervical region.
What should be monitored for in eyelid injuries?
Levator injury leading to ptosis
Ptosis refers to the drooping or falling of the upper eyelid.
What is the procedure to avoid notching in eyelid injuries?
Evert edges
Everting the edges of the eyelid helps to align the wound properly.
What is a significant risk associated with medial lid injuries?
Injury to the lacrimal apparatus
This can lead to complications with tear drainage.
What should be done to identify injuries to the lacrimal apparatus?
Cannulate puncta with a probe
This helps in assessing the integrity of the lacrimal drainage system.
What is the recommended approach for ear injuries?
Direct repair over lacrimal stent or DCR
DCR stands for Dacryocystorhinostomy, a surgical procedure to create a new tear drainage pathway.
What should be done for cartilaginous injuries in the ear?
Try to repair and close skin over EAM injuries
EAM stands for External Auditory Meatus.
What is the management for hematomas in ear injuries?
Drain immediately and bolster to avoid cauliflower ear
Cauliflower ear is a deformity caused by trauma and subsequent hematoma formation in the ear.
Fill in the blank: To avoid stenosis in ear injuries, a _______ should be used.
stent
Stenting helps maintain the patency of the ear canal after injury.
What is the purpose of stenting in lip injuries?
To check for extravasation
Stenting is a technique used to stabilize the area and monitor for fluid leakage.
What is a common consequence of untreated hematomas?
Cauliflower ear
Cauliflower ear occurs due to the accumulation of blood between the cartilage and skin of the ear.
What are the three layers involved in the closure of a lip injury?
- Wet vermilion
- Dry vermilion
- Vermilion skin junction
Proper alignment of these layers is crucial for aesthetic and functional recovery.
What is the significance of the vermillion border in lip reconstruction?
Discrepancy greater than 1mm is obvious at conversational distance
Precise alignment of the vermillion border is essential for aesthetic results.
What anatomical structures are involved in the repair of the nose?
- Skin
- Cartilage
- Mucosa
The repair process involves understanding and reconstructing these three layers.
What is the function of the parotid duct?
Drains saliva opposite the 2nd maxillary molar
This duct is critical for saliva drainage and oral health.
What is the mentolabial sulcus?
The groove between the lip and the chin
This anatomical feature is important for facial aesthetics.
What is the philtrum?
The vertical groove between the upper lip and the nose
The philtrum plays a role in facial symmetry and aesthetics.
What is the oral commissure?
The corners of the mouth
They are important for oral function and expression.
What should be done if a septal hematoma is suspected?
Need drainage (intra nasal exam)
Septal hematomas require prompt treatment to prevent complications.
Fill in the blank: The area where the lip meets the skin is called the _______.
Vermillion border
The vermillion border is crucial for lip aesthetics.
True or False: The repair of the nose involves only the skin layer.
False
Repair involves skin, cartilage, and mucosa.
What is the Cupid’s bow?
The double curve of the upper lip
This feature is significant for lip aesthetics.
