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CMS2 > Facial Trauma > Flashcards

Facial Trauma Flashcards

1
Q

What changes/public measures have been implemented to reduce facial trauma?

A

Glassware to plastic
Seat belt laws

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2
Q

What is an example of a high energy injury?

A

Road traffic accidents

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3
Q

What is an example of a high energy penetrating injury?

A

Gunshot wounds

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4
Q

What is an example of a low energy injury?

A

Falls/assaults with a fist

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5
Q

What is an example of a low energy penetrating injury?

A

Knife injury

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6
Q

What are bites usually associated with?

A

Tearing and disruption of soft tissue

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7
Q

Why is so important to carry out ABC when treating a patient with facial trauma

A

May have associated brain/ chest injury which can be more life threatening to airway/ breathing or blood loss

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8
Q

Why are pelvic fractures so significant?

A

There are some big vessels in this area which can lead to lots of blood loss

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9
Q

What is the definition of a fracture?

A

a break in the continuity of bone

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10
Q

What is a displacement fracture?

A

extent to which 2 sides of the fracture have moved from their normal position

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11
Q

What is meant by angulation of fracture?

A

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

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12
Q

what is a compound fracture?

A

a fracture which is open to the external environment (through a tear/laceration in overlying skin/mucosa) - also known as an open fracture

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13
Q

what is a comminuted/complex fracture?

A

More than 2 bone fragments at the fracture site

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14
Q

What is a pathological fracture?

A

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

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15
Q

what is meant by an atrophic mandible?

A

over time, with age the alveolar ridges resorb - the mandible is very thin

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16
Q

why are edentulous atrophic mandibles often quite unstable when treating?

A

difficult to find a place to put a large plate

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17
Q

why do atrophic mandbile fractures often undergo alot of displacement/ called bucket handle fractures?

A

the muscles are pulling in different directions causing the fracture to be unstable/swing

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18
Q

Why can zygomatic arch fractures often cause trismus?

A

The temporalis runs below the zygomatic arch which can impinge on the temporalis and cause trismus

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19
Q

What muscles are affected when you get a fracture of the orbital floor? What signs will occurs?

A

Extraocular muscles
Pt may have difficulty looking up or double vision on upward gaze

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20
Q

what fracture can cause lower lip numbness?

A

mandible

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21
Q

what fracture can cause numbness of the cheek/upper lip/side of the nose?

A

fracture of the orbital floor

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22
Q

What fracture can lead to retrobulbar haemotoma?

A

orbital floor fractures (due to build up of pressure)

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23
Q

What is the most common mandible fracture?

A

Condyle

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24
Q

Are mandible fractures often bilateral or unilateral?

A

Bilateral

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25
Q

What is a guardsman fracture?

A

Fracture of the chin point and fracture of BOTH condyles

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26
Q

Who is common to experience a guardmans fracture?

A

An individual falling flat on their face

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27
Q

What 3 bones does the zygoma connect to?

A

Frontal bone, temporal bone and maxilla bone

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28
Q

How do zygoma and orbital fractures potentially impact vision?

A

change in volume of the orbit or by muscle/fat entrapment

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29
Q

what is a noticable feature of zygomatic fractures?

A

Flattening of the cheek prominence

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30
Q

What will happen if you get a blow hard directly onto the zygomatic arch?

A

You can get an isolated arch fracture

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31
Q

If you get a proper tripod fracture involving all 3 joints what can happen to the orbit?

A

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

32
Q

What bone does le fort III include that le fort I and le fort II do not?

A

zygoma

33
Q

what is a closed/simple fracture?

A

fracture that involves broken bone but the skin is still intact

34
Q

Do zygomatic arch fractures involve the occlusion>

A

No

35
Q

What are the steps in the examination of an injured face?

A

Clinical examination (EO and IO)
Radiography

36
Q

What is the first thing to do when approaching a pt who has had trauma?

A

A B C !!!!!

37
Q

what can lead to airway probelms in a pt with trauma?

A

facial swelling OR floor of mouth bleeding which can cause moth to swell up; moving the tongue up and back

38
Q

what can lead to breathing problems in a pt with trauma?

A

brain injury or chest injury

39
Q

why is it important to check circulation in pt with facial trauma?

A

face and neck have very good blood supply so possible to lose a lot of blood

40
Q

When doing an EO examination what two things should you always ensure to do?

A

Inspect AND palpate

41
Q

What is the technical term for bruising?

A

ecchymosis

42
Q

What is the term for blood over the sclera of eye ball?

A

SUbconjunctival haematoma

43
Q

How do you get subconjunctival haematoma?

A
  1. direct trauma (something poked in eye)
  2. fractures of the floor of orbit - blood from fracture might tract underneath conjunctiva (there will be no posterior limit)
44
Q

What should you make sure you inspect on EO examination?

A
  • Bruising
  • Bleeding
  • Swelling (also need to feel)
  • Flattening (zygoma responsible for prominence of cheek) - stand above/behind pt
  • Vision (eye movements) - double vision
45
Q

How might a pt develop surgical emphysema?

A

Fractured zygoma involving maxillary sinus (antrum) - if pt blows their nose –> increased pressure –> blow air into the tissues –> swelling

46
Q

What should you do when palpating EO?

A
  • check skin sensation
    –> ask if they can feel numbness
    –> light touch on both sides (compare LHS and RHS)
47
Q

What are you looking for in an intraoral exam?

A
  • gap in the occlusion
  • count the teeth!!!!!
  • step in the occlusion
  • malocclusion
48
Q

What malocclusion is often associated with condyle fractures?

A

anterior open bite

49
Q

Why must you always take 2 radiographs for facial trauma?

A

need to assess the fracture at different angles
- fractures could be missed
- to assess displacement and angulation

50
Q

what radiographs would you take of mandibular fracture?

A

OPT and PA (postero-anterior)

51
Q

What fractures are PA good for showing in the mandible?

A

Angle fractures and condyle fractures

52
Q

what radiograph would you use to look specifically at condyles?

A

CT or reverse townes

53
Q

what radiograph would you use for midface fracture?

A

facial views or occipital-mental views
CT or reverse Townes

54
Q

What are the stages in bone healing?

A
  1. inflammation phase (+ bleeding)
55
Q

What are the stages in bone healing?

A
  1. inflammation phase (+ bleeding)
  2. proliferation of fibroblasts + macrophages clear debris
  3. differentiation of osteoblasts/osteoclats = matrix + bone callus formation
  4. bone remodelling
56
Q

How long does the bone take to have sufficient strength in the head and neck?

A

6 weeks

57
Q

What are the requirement for bone healing?

A

Reduce the fracture
Restore the length of bone
Restore angulation

58
Q

what are the priorities in treating facial fractures? what are we trying to achieve?

A

occlusion (function restored)
eye sight restored
restore appearance

59
Q

What are the principles of fracture management? (SSSM)

A

Speed, safety, stability and mobility

60
Q

What are the principles of management for splinting?

A

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

61
Q

What are the principles of management for plating?

A

safety: involves operation (risk of scar/nerve damage)
speed: quicker
stability: very stable
mobility: not so much :(

62
Q

What are the ways of managing fractures? (4)

A
  1. conservative
  2. MUA
  3. Intermaxillary fixation
  4. Plating
63
Q

what type of fracture can you manage conservatively?

A

greenstick (bone is broken but doesn’t involve both cortices fo fracture is not displaced)

64
Q

What fracture can sometimes undergo MUA?

A

Condyle fractures

65
Q

What can an isolated zygomatic arch fracture be treated with? Where is the incision made onto?

A

MUA - incision onto the temporal fascia

66
Q

how can condyle fractures be managed?

A

intermaxillary fixation or plating

67
Q

what is the gold standard for condyle fractures?

A

PLATING

68
Q

what is the risk invovled with plating a condyle?

A

operation risk working very close to the facial nerve - warn pts they could develop facial weakness

69
Q

How can mandible fractures be managed?

A

Plates or gunning splint or external fixation

70
Q

When would external fixation be good for mandibles?

A

high energy injuries with contamination or missing bites of bone

71
Q

What things should you check post-operatively

A
  • EYE SIGHT (especially if zygoma or orbital fractures)
  • PAIN
  • VISUAL ACUITY
  • NUTRITION
  • PLAQUE TRAP (for intermaxillary fixation)
72
Q

What are some complications of fractures? - as a result of the fracture/tx?

A
  • Infection
  • Scarring
  • Nerve damage
  • Eyesight
  • Cosmetic
73
Q

WHat is meant by malunion healing?

A

bone heals but at the incorrect length or angulation - affects cosmetic/muscles/patient could develop osteoarthritis

74
Q

What is meant by delayed union?

A

bone has not healed after 6 weeks

75
Q

what is meant by non-union

A

no healing at all

76
Q

what can non-union result in

A

pseudoarthrosis (ends of the bone heal but they don not unite)

77
Q

how can you diagnose mid face fractures?

A

firmly grip the upper teeth and move backwards and forwards and then side to side - check for movement of nose or infraorbital margins

CMS2 (24 decks)

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