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5th yr- CMS2- Facial trauma > facial trauma > Flashcards

facial trauma Flashcards

1
Q

What does an examination of the injured face include

A
  1. Extra oral
  2. Intra oral
  3. Radiological
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2
Q

What must we check first when examining a patient with facial trauma

A

ABC
Airway
Breathing
Circualtion

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3
Q

What does the physical examination of the injured face include

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
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4
Q

Define fracture

A

A break in the continuity of a bone

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5
Q

Define displacement

A

The extent to which the two sides of the fracture have moved from their normal position

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6
Q

Define angulation

A

The angle by which one fragment has moved in comparison to its previous position

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7
Q

Define compound

A

A fracture which is open to external environment through a tear/ laceration in overlying skin/mucosa AKA open fracture

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8
Q

Define comminuted

A

A complex fracture pattern with more than two bone fragments at the fracture site

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9
Q

What is a pathological fracture

A

Fracture that occurs in an area of bone that has been critically weakened by disease eg cancer, osteoradionecrosis, MRONJ or very large cyst

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10
Q

What forces are the bones of the skull designed to withstand

A

Chewing forces

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11
Q

What happens to the alveolar ridge over time after losing teeth

A

Alveolar ridge is resorbed in both the upper and lower jaw where teeth have been lost

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12
Q

Why is resorption of the mandible a problem

A

Can lead to the mandible becoming really thin- atrophic mandible
This can increase risk of fracture

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13
Q

What problems can the muscle of mastication pose on an atrophic mandible

A

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

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14
Q

What unique problem is associated with a zygomatic arch fracture

A

As the temporals run below the zygomatic arch impingement of this muscle may cause trismus

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15
Q

What can patient with a fracture of the orbital floor suffer from

A

Diplopia on looking up
Numbness of the cheek, upper lip and nose is common
retrobulbar haematoma

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16
Q

What can a fracture of the mandible past the lingual cause

A

Lower lip numbness due to damage of the inferior alveolar nerve

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17
Q

What can happen if a retrobulbar haematoma is not treated

A

Can lead to death of the retina and the pt could permanently lose their vision

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18
Q

Name the different sites of the mandible that can fracture from most to least likely

A
  1. Condyle (30%)
  2. Angle of mandible (25%)
  3. Body of mandible (25%)
  4. Mental region (15%)
  5. Ramus (3%)
  6. Coronoid process (2%)
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19
Q

Where might compound fractures occur in the mandible

A
  1. Body of the mandible
  2. Mental region
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20
Q

What is the advantage to us if a patent has a compound fracture over a closed fracture

A

Compound fractures are easier to access

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21
Q

Where might a closed fracture occur in the mandible

A

Condyle
Coronoid porcess
Ramus

22
Q

What is the disadvantage to us if a patent has a compound fracture over a closed fracture

A

Compound fractures can become infected

23
Q

Mandible fractures are often…

A

bilateral

24
Q

What does the zygoma form

A

What is the zygoma attached to Your cheek prominence
Also makes up part of the orbital floor

25
Q

What is the zygoma attached to

A
  1. Maxillary wall
  2. Orbital floor
  3. temporal bone (zygoamtic arch)
26
Q

What problems can a zygoma fracture cause

A
  1. Disturbed vision
  2. Damage to the infraorbital nerve
  3. flattening of the prominence of the cheeks
27
Q

What classification can we use to classify fractures

A

Le forts classification

28
Q

What categories make up le forts classification

A

Le fort 1,2 OR 3

29
Q

What is a le fort 1 fracture

A

A fracture above the apices of the upper teeth

30
Q

What is a le fort 2 fracture

A

A fracture over the maxilla and nose

31
Q

What is a le fort 3 fracture

A

A fracture involving the maxilla, zygoma and orbital floor

32
Q

What does the physical examination of the injured face include

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
33
Q

What is the medical term for a bruising around the eye

A

circumorbital bruising

34
Q

What Is the medical term for a blood shot eye

A

subconjunctival haematoma

35
Q

What is the mechanism for getting a subconjunctival haematoma (blood shoot eye)

A

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)

36
Q

What do we look for when examining an injured face

A
  1. Swelling
  2. Bleeding
  3. Brusing
  4. Flattening
  5. Eye movements
  6. Check for double vision
37
Q

If we identify the pt has a swelling what should we do

A

Feel the swelling to determine if the patient has a surgical emphysema

38
Q

What is a surgical emphysema

A

When air gets trapped in the tissues

38
Q

What is another term for a fracture of the floor of the orbit

A

Blow out fracture

38
Q

How do we assess flattening

A

By looking at the patient from below to see if there is a lack of prominence in the chin or cheeks

38
Q

After carrying out a visual exam what should we do next to examine the injured face

A

Palpate the head and neck to assess sensation

39
Q

After carrying out a visual exam what should we do next to examine the injured face

A

Palpate the head and neck to assess sensationN

40
Q

Name the three divisions of the trigeminal nerves

A
  1. Ophthalmic
  2. Maxillary
  3. Mandibular
41
Q

Give examples of common findings we may find during an intra oral exam if a pt has a mandibular or zygomatic fracture

A
  1. Gap in the occlusion
  2. Gingival tear
  3. step in the occlusion
  4. Malocclusion
42
Q

What can a gap/ step in the occlusion look like

A

A missing tooth this is why its important to count the teeth

43
Q

What might you see in a patient with bilateral fractures at the condyles

A

An anterior open bite

44
Q

What radiographic assessments do we take to assess facial traumas

A

2 radiographs at different angles usually

45
Q

Why do we need to take 2 radiographs at different angles when assessing facial trauma

A
  1. Fractures may be missed
  2. Assess displacement
  3. Assess angulation
46
Q

which radiographs do we usually take when we suspect a mandibular fracture

A

OPT and postero anterior mandible
can also take a reverse Townes view

47
Q

What might we take to assess the condyles further

A

CT scan or reverse Townes view in a Hospital without a CT scan

48
Q

which radiographs do we usually take when we suspect a mid face fracture

A

Occipto mento view radiograph (facial view)
Submentovertex view
CT scan

49
Q

What can a Occipto mento view radiograph (facial view) show us

A
  1. Fluid levels
  2. Infraorbital Margin fracture
  3. Zygomatic buttress fracture
  4. Zygomatic arch fracture

5th yr- CMS2- Facial trauma (5 decks)

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