Facial Trauma Flashcards
What changes/public measures have been implemented to reduce facial trauma?
Glassware to plastic
Seat belt laws
What is an example of a high energy injury?
Road traffic accidents
What is an example of a high energy penetrating injury?
Gunshot wounds
What is an example of a low energy injury?
Falls/assaults with a fist
What is an example of a low energy penetrating injury?
Knife injury
What are bites usually associated with?
Tearing and disruption of soft tissue
Why is so important to carry out ABC when treating a patient with facial trauma
May have associated brain/ chest injury which can be more life threatening to airway/ breathing or blood loss
Why are pelvic fractures so significant?
There are some big vessels in this area which can lead to lots of blood loss
What is the definition of a fracture?
a break in the continuity of bone
What is a displacement fracture?
extent to which 2 sides of the fracture have moved from their normal position
What is meant by angulation of fracture?
the angle by which one fragment has moved in comparison to its previous position
what is a compound fracture?
a fracture which is open to the external environment (through a tear/laceration in overlying skin/mucosa) - also known as an open fracture
what is a comminuted/complex fracture?
More than 2 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 (cancer, osteoradionecrosis, MRONJ or very large cyst)
what is meant by an atrophic mandible?
over time, with age the alveolar ridges resorb - the mandible is very thin
why are edentulous atrophic mandibles often quite unstable when treating?
difficult to find a place to put a large plate
why do atrophic mandbile fractures often undergo alot of displacement/ called bucket handle fractures?
the muscles are pulling in different directions causing the fracture to be unstable/swing
Why can zygomatic arch fractures often cause trismus?
The temporalis runs below the zygomatic arch which can impinge on the temporalis and cause trismus
What muscles are affected when you get a fracture of the orbital floor? What signs will occurs?
Extraocular muscles
Pt may have difficulty looking up or double vision on upward gaze
what fracture can cause lower lip numbness?
mandible
what fracture can cause numbness of the cheek/upper lip/side of the nose?
fracture of the orbital floor
What fracture can lead to retrobulbar haemotoma?
orbital floor fractures (due to build up of pressure)
What is the most common mandible fracture?
Condyle
Are mandible fractures often bilateral or unilateral?
Bilateral
What is a guardsman fracture?
Fracture of the chin point and fracture of BOTH condyles
Who is common to experience a guardmans fracture?
An individual falling flat on their face
What 3 bones does the zygoma connect to?
Frontal bone, temporal bone and maxilla bone
How do zygoma and orbital fractures potentially impact vision?
change in volume of the orbit or by muscle/fat entrapment
what is a noticable feature of zygomatic fractures?
Flattening of the cheek prominence
What will happen if you get a blow hard directly onto the zygomatic arch?
You can get an isolated arch fracture
If you get a proper tripod fracture involving all 3 joints what can happen to the orbit?
The zygomatic bone can be pushed in or out and you can get changes in volume of the orbit through moving the zygoma in one direction or another
What bone does le fort III include that le fort I and le fort II do not?
zygoma
what is a closed/simple fracture?
fracture that involves broken bone but the skin is still intact
Do zygomatic arch fractures involve the occlusion>
No
What are the steps in the examination of an injured face?
Clinical examination (EO and IO)
Radiography
What is the first thing to do when approaching a pt who has had trauma?
A B C !!!!!
what can lead to airway probelms in a pt with trauma?
facial swelling OR floor of mouth bleeding which can cause moth to swell up; moving the tongue up and back
what can lead to breathing problems in a pt with trauma?
brain injury or chest injury
why is it important to check circulation in pt with facial trauma?
face and neck have very good blood supply so possible to lose a lot of blood
When doing an EO examination what two things should you always ensure to do?
Inspect AND palpate
What is the technical term for bruising?
ecchymosis
What is the term for blood over the sclera of eye ball?
SUbconjunctival haematoma
How do you get subconjunctival haematoma?
- direct trauma (something poked in eye)
- fractures of the floor of orbit - blood from fracture might tract underneath conjunctiva (there will be no posterior limit)
What should you make sure you inspect on EO examination?
- Bruising
- Bleeding
- Swelling (also need to feel)
- Flattening (zygoma responsible for prominence of cheek) - stand above/behind pt
- Vision (eye movements) - double vision
How might a pt develop surgical emphysema?
Fractured zygoma involving maxillary sinus (antrum) - if pt blows their nose –> increased pressure –> blow air into the tissues –> swelling
What should you do when palpating EO?
- check skin sensation
–> ask if they can feel numbness
–> light touch on both sides (compare LHS and RHS)
What are you looking for in an intraoral exam?
- gap in the occlusion
- count the teeth!!!!!
- step in the occlusion
- malocclusion
What malocclusion is often associated with condyle fractures?
anterior open bite
Why must you always take 2 radiographs for facial trauma?
need to assess the fracture at different angles
- fractures could be missed
- to assess displacement and angulation
what radiographs would you take of mandibular fracture?
OPT and PA (postero-anterior)
What fractures are PA good for showing in the mandible?
Angle fractures and condyle fractures
what radiograph would you use to look specifically at condyles?
CT or reverse townes
what radiograph would you use for midface fracture?
facial views or occipital-mental views
CT or reverse Townes
What are the stages in bone healing?
- inflammation phase (+ bleeding)
What are the stages in bone healing?
- inflammation phase (+ bleeding)
- proliferation of fibroblasts + macrophages clear debris
- differentiation of osteoblasts/osteoclats = matrix + bone callus formation
- bone remodelling
How long does the bone take to have sufficient strength in the head and neck?
6 weeks
What are the requirement for bone healing?
Reduce the fracture
Restore the length of bone
Restore angulation
what are the priorities in treating facial fractures? what are we trying to achieve?
occlusion (function restored)
eye sight restored
restore appearance
What are the principles of fracture management? (SSSM)
Speed, safety, stability and mobility
What are the principles of management for splinting?
safety: v. safe
speed: not so quick (6 weeks)
stability: not as stable as plate
mobility: good amt - pt will be able to apply physiological stress
What are the principles of management for plating?
safety: involves operation (risk of scar/nerve damage)
speed: quicker
stability: very stable
mobility: not so much :(
What are the ways of managing fractures? (4)
- conservative
- MUA
- Intermaxillary fixation
- Plating
what type of fracture can you manage conservatively?
greenstick (bone is broken but doesn’t involve both cortices fo fracture is not displaced)
What fracture can sometimes undergo MUA?
Condyle fractures
What can an isolated zygomatic arch fracture be treated with? Where is the incision made onto?
MUA - incision onto the temporal fascia
how can condyle fractures be managed?
intermaxillary fixation or plating
what is the gold standard for condyle fractures?
PLATING
what is the risk invovled with plating a condyle?
operation risk working very close to the facial nerve - warn pts they could develop facial weakness
How can mandible fractures be managed?
Plates or gunning splint or external fixation
When would external fixation be good for mandibles?
high energy injuries with contamination or missing bites of bone
What things should you check post-operatively
- EYE SIGHT (especially if zygoma or orbital fractures)
- PAIN
- VISUAL ACUITY
- NUTRITION
- PLAQUE TRAP (for intermaxillary fixation)
What are some complications of fractures? - as a result of the fracture/tx?
- Infection
- Scarring
- Nerve damage
- Eyesight
- Cosmetic
WHat is meant by malunion healing?
bone heals but at the incorrect length or angulation - affects cosmetic/muscles/patient could develop osteoarthritis
What is meant by delayed union?
bone has not healed after 6 weeks
what is meant by non-union
no healing at all
what can non-union result in
pseudoarthrosis (ends of the bone heal but they don not unite)
how can you diagnose mid face fractures?
firmly grip the upper teeth and move backwards and forwards and then side to side - check for movement of nose or infraorbital margins
