Facial Trauma 4 : Treatment Flashcards
What are the bone healing stages and describe the 4 stages?
1) Inflammatory → Haemorrhage in area due to tissue damage
2) Proliferative → Once the inflammatory phase has slowed down fibroblasts proliferate and macrophages move in devouring debris and dead cells. Fibrous tissue is laid down to stabilise the fracture to stop mobility.
3) Bone callus → Then differentiation of osteoblasts and osteoclasts. Osteoclasts start to secrete bone matrix and fibrous healing tissue gets reinforced with bone callus.
4) Remodelling → Bone callus is reduced in size
What are the requirements for bone healing?
1) Reduce the fracture
2) Restore length of bone
3) Restore angulation
What are the 4 key principles for restoring fractures?
SPEED, SAFETY, STABILITY, MOBILITY
What are the principles for FACIAL fracture management?
1) Restore anatomy and eliminate deformity (restore appearance).
2) Restore OCCLUSION and masticatory abilities.
3) Restore function including nasal airflow and ocular function especially in zygoma fractures.
4) Minimise morbidity.
5) Early return to function.
What are the 4 types of fracture management?
1) Conservative management → do nothing e.g greenstick fractures where the bone is broken but does not involve both cortices so fracture in undisplaced
2) MUA (manipulation under anaesthesia) → moving the bone back into correct position e.g condyle fractures
3) Intermaxillary fixation → wire teeth back together using elastic bands to achieve correct occlusion
4) Plating (open reduction internal fixation) → bigger plates for mandible smaller plates for zygoma
How would you treat isolated zygomatic arch fracture?
MUA, incision in hairline dissect down to temporal fascia. Bone is pushed back into position.
How would you treat a comminuted fracture of zygoma and orbit?
Plate
What is the main issue with condyle fractures?
often produce malocclusion
How would you treat a condyle fracture?
Use intermaxillary fixation by manipulating the bone and holding the patient in occlusion and applying wire islets and elastic bands. This means correct angulation and length. Usually has to be placed for 6 weeks. Can also plate condyle fractures.
What is the issue of using plates for condyle fractures?
high risk due to facial nerve proximity , warn patients of facial weakness.
What is the main way of treating mandible fractures?
use osteosynthesis plates which encourage bone to grow in right place.
What are the tx options of atrophic mandibles?
1) Gunning splint (for pts who also have dentures) –> Need to remove all the anterior teeth and then wire the posterior teeth dentures in place and hold in occlusion
2) Place a plate but needs to be placed on a STURDY bone.
3) External fixation for mandible fractures for high-energy injuries with lots of contamination or missing bits of bone
What is KEY for POST OP care for a zygoma fracture?
Retrobulbar haematoma → checking visual acuity, pain 24-48 hours after the treatment of zygomatic fracture
What is the problem with intermaxillary fixation?
Nutrition. Intermaxillary fixation leads to plaque trap → poor OH , caries, gum disease
What are some complications of fractures?
- Cosmetic
- Eyesight
- Nerve damage
- Scarring
- Infection
