Facial trauma Flashcards
What is a compound fracture?
A fracture open to external environment through a tear/laceration in overlying skin/mucosa. (most mandible fractures)
What is a comminuted (complex) fracture?
A complex fracture pattern with more than two bone fragments at the fracture site. (usually a high impact/energy fracture)
What is a pathological fracture?
Fracture in an area of bone that has been critically weakened by disease (cancer, osteoradionecrosis, MRONJ, cysts)
Why are elderly people more at risk of breaking their mandible/maxilla?
Mandibular ride resorption with lost teeth and age
What is a bucket handle fracture?
Bilateral edentulous mandible fracture
What can a fracture of the orbital floor cause?
Herniated trapped medial rectus muscle causing diplopia (double vision)
What intraoral nerves can be affected by facial fractures?
Inferior alveolar
Superior alveolar
What does a floor of orbit fracture usually present with?
Numbness of cheek, side of nose and upper lip
What is a retrobulbar haematoma?
Pressure stops venous drainage behind the eyeball, causes congestion in retina that causes pain and can cause permanent blindness.
What is a guardsman fracture?
Results in mid line and bilateral condyle fracture which is common in people that fall flat on their face.
What are the 3 fracture patterns of the face?
Le fort 1 - above apices
Le fort 2 - maxilla and nose
Le fort 3 - maxilla, zygomas and orbital floor
What don’t zygomatic arch fractures involve?
The occlusion
What can you physically inspect in a patient who has had a facial injury?
- inspection
- palpation
- percussion
- auscultation
If there is a facial swelling why should you palpate it?
If the swelling feels like bubble wrap it may suggest surgical emphysema (air in tissues)
Why do you sometimes examine a patient from a bird’s eye view?
Can see flattening of the body of zygoma easier
What should you examine in a patient who has had facial trauma?
ABC!
Loss of consciousness?
Check for bruising, subconjunctival haematoma,
Bleeding - nose mouth lacerations
Swelling
Flattening
Eye movements - check for upwards motion, and double vision
Palpation - check skin sensation of trigeminal
IO: gingival step/tear
Count the teeth
Malocclusion?
What malocclusion do you normally get with bilateral condyle fractures?
Anterior open bite
What radiographic examination should be taken to assess displacement and angulation of fractures?
OPT and PA of mandible - good for angle and condyle fractures
What other radiographic techniques can be used for facial fractures IF you don’t have a CT?
- Reverse Townes
- Mid face
What radiographic view can you do to look at the zygomatic arch?
Submentovertex view - from underneath the chin to the top of the skull
What is the best scan to do for a facial fracture?
CT - gives information and detail about angulation and displacement of fracture
What are the 4 stages of fracture healing?
1) Inflammatory - haemorrhage in the area
2) Proliferative - fibroblasts proliferate, macrophages devour debris and fibrous tissue layed down to stabilise fracture (soft callus)
3) Bony callus - differentiation of osteoblasts and osteoclasts to produce bone matrix
4) Remodelling - bony callus is reduced in size and bone ends are remodelled to become whole bone
What are the requirements for bone healing?
- reduce fracture
- restore length of bone
- restore angulation
What does a fracture need to heal?
Holding in position (around 6 weeks) with a little bit of movement and stress to help the healing.
Joints have to be the right distance apart and angulation, if the fracture doesn’t heal in the right angulation or length the joint will not work properly.
What are the priorities when treating facial fractures?
- restore function
- zygoma fractures - eyesight
- restore appearance
What are the principles of fracture management?
- Speed, safety, mobility and stability
What are the options for management of fractures?
- Conservative management
- MUA (manipulation under anaesthesia)
- IMF (intermaxillary fixation)
- ORIF (open reduction internal fixation) - plating
Why are atrophic mandibles at risk of ORIF?
Muscles pull in an awkward positions, reconstructive plates are used to counteract forces of muscles
What is another option for splinting for fractured edentulous mandibles?
Gunning splint
What do you have to monitor post operatively after management of fractures?
Eye observations for zygoma/orbital fractures - risk of retrobulbar haematoma
Nutrition
What are complications of fracture management?
- Nerve damage
- Eyesight (muscle entrapment, retrobulbar haematoma)
- Malunion
- Malocclusions
- Delayed union (risk of plate fracture)
- Non -union (can develop pseudojoint)
