facial trauma Flashcards
What does an examination of the injured face include
- Extra oral
- Intra oral
- Radiological
What must we check first when examining a patient with facial trauma
ABC
Airway
Breathing
Circualtion
What does the physical examination of the injured face include
- Inspection
- Palpation
- Percussion
- Auscultation
Define fracture
A break in the continuity of a bone
Define displacement
The extent to which the two sides of the fracture have moved from their normal position
Define angulation
The angle by which one fragment has moved in comparison to its previous position
Define compound
A fracture which is open to external environment through a tear/ laceration in overlying skin/mucosa AKA open fracture
Define comminuted
A complex fracture pattern with more than two bone fragments at the fracture site
What is a pathological fracture
Fracture that occurs in an area of bone that has been critically weakened by disease eg cancer, osteoradionecrosis, MRONJ or very large cyst
What forces are the bones of the skull designed to withstand
Chewing forces
What happens to the alveolar ridge over time after losing teeth
Alveolar ridge is resorbed in both the upper and lower jaw where teeth have been lost
Why is resorption of the mandible a problem
Can lead to the mandible becoming really thin- atrophic mandible
This can increase risk of fracture
What problems can the muscle of mastication pose on an atrophic mandible
Can act to cause further displacement of fractures as the master muscle pulls the mandible upwards, the digastric muscle pulls the mandible down
this can lead to the fracture becoming unstable
What unique problem is associated with a zygomatic arch fracture
As the temporals run below the zygomatic arch impingement of this muscle may cause trismus
What can patient with a fracture of the orbital floor suffer from
Diplopia on looking up
Numbness of the cheek, upper lip and nose is common
retrobulbar haematoma
What can a fracture of the mandible past the lingual cause
Lower lip numbness due to damage of the inferior alveolar nerve
What can happen if a retrobulbar haematoma is not treated
Can lead to death of the retina and the pt could permanently lose their vision
Name the different sites of the mandible that can fracture from most to least likely
- Condyle (30%)
- Angle of mandible (25%)
- Body of mandible (25%)
- Mental region (15%)
- Ramus (3%)
- Coronoid process (2%)
Where might compound fractures occur in the mandible
- Body of the mandible
- Mental region
What is the advantage to us if a patent has a compound fracture over a closed fracture
Compound fractures are easier to access
Where might a closed fracture occur in the mandible
Condyle
Coronoid porcess
Ramus
What is the disadvantage to us if a patent has a compound fracture over a closed fracture
Compound fractures can become infected
Mandible fractures are often…
bilateral
What does the zygoma form
What is the zygoma attached to Your cheek prominence
Also makes up part of the orbital floor
What is the zygoma attached to
- Maxillary wall
- Orbital floor
- temporal bone (zygoamtic arch)
What problems can a zygoma fracture cause
- Disturbed vision
- Damage to the infraorbital nerve
- flattening of the prominence of the cheeks
What classification can we use to classify fractures
Le forts classification
What categories make up le forts classification
Le fort 1,2 OR 3
What is a le fort 1 fracture
A fracture above the apices of the upper teeth
What is a le fort 2 fracture
A fracture over the maxilla and nose
What is a le fort 3 fracture
A fracture involving the maxilla, zygoma and orbital floor
What does the physical examination of the injured face include
- Inspection
- Palpation
- Percussion
- Auscultation
What is the medical term for a bruising around the eye
circumorbital bruising
What Is the medical term for a blood shot eye
subconjunctival haematoma
What is the mechanism for getting a subconjunctival haematoma (blood shoot eye)
Pt must sustain direct trauma to the eye ball (subconjunctival haematoma with a posterior limit)
OR
Pt may have a fracture around the floor of the orbit which may lead to bleeding which can tract forward into the conjunctiva leading to a blood shot eye (subconjunctival haematoma without a posterior limit)
What do we look for when examining an injured face
- Swelling
- Bleeding
- Brusing
- Flattening
- Eye movements
- Check for double vision
If we identify the pt has a swelling what should we do
Feel the swelling to determine if the patient has a surgical emphysema
What is a surgical emphysema
When air gets trapped in the tissues
What is another term for a fracture of the floor of the orbit
Blow out fracture
How do we assess flattening
By looking at the patient from below to see if there is a lack of prominence in the chin or cheeks
After carrying out a visual exam what should we do next to examine the injured face
Palpate the head and neck to assess sensation
After carrying out a visual exam what should we do next to examine the injured face
Palpate the head and neck to assess sensationN
Name the three divisions of the trigeminal nerves
- Ophthalmic
- Maxillary
- Mandibular
Give examples of common findings we may find during an intra oral exam if a pt has a mandibular or zygomatic fracture
- Gap in the occlusion
- Gingival tear
- step in the occlusion
- Malocclusion
What can a gap/ step in the occlusion look like
A missing tooth this is why its important to count the teeth
What might you see in a patient with bilateral fractures at the condyles
An anterior open bite
What radiographic assessments do we take to assess facial traumas
2 radiographs at different angles usually
Why do we need to take 2 radiographs at different angles when assessing facial trauma
- Fractures may be missed
- Assess displacement
- Assess angulation
which radiographs do we usually take when we suspect a mandibular fracture
OPT and postero anterior mandible
can also take a reverse Townes view
What might we take to assess the condyles further
CT scan or reverse Townes view in a Hospital without a CT scan
which radiographs do we usually take when we suspect a mid face fracture
Occipto mento view radiograph (facial view)
Submentovertex view
CT scan
What can a Occipto mento view radiograph (facial view) show us
- Fluid levels
- Infraorbital Margin fracture
- Zygomatic buttress fracture
- Zygomatic arch fracture
