Facial Trauma Flashcards
What can cause maxillary fractures?
high-energy blunt force object to the facial skeleton - potentially life threatening as well as disfiguring
What is the maxilla?
bridge between the cranial base and the dental occlusion plane
What are the types of maxillary fractures?
le fort I, II and III - modern trauma higher impact - maxillary fractures a combination of all types
What is a le fort I fracture?
horizontal fracture
passes horizontally above teeth apices
What is a le fort II fracture?
pyramidal
nasal bridge - through frontal process of maxilla, through lacrimal bone and inferior orbital floor - under zygoma - across pterygomaxillary fissure - through pterygoid plates
What is a le fort III fracture?
transverse
craniofacial dysjunctions
What is important in the history of someone with a maxillary fracture?
mechanism of injury loss of consciousness confusion breathing vision
What is important in the examination of someone with a maxillary fracture?
upper airway compromise vision cranial nerves dental occlusion soft tissue swelling bruising haematoma posterior retrusion of the mid face palpate - bony irregularities, step-offs, crepitus, sensory disturbances
What is the management of maxillary fractures?
surgery to reduce fracture and fix
What causes orbital floor fractures?
impact injury to the globe - large enough to not penetrate the globe, small enough to not fracture the orbital rim - sudden increase in infraorbital pressure - infraorbital groove is a weak point
What are the symptoms of an orbital floor fracture?
pain decreased visual acuity diplopia hypoesthesia in the infraorbital region restriction of ocular movement
What is diplopia?
double vision
What is hypoesthesia?
reduced sense of touch or sensation
What are the signs of an orbital floor fracture?
periorbital ecchymosis oedema enophthalmos restriction of ocular movement bony step of orbital rim
What is ecchymosis?
discolouration of skin resulting from bleeding underneath
What is enophthalmos?
posterior displacement of the eyeball within the orbit due to changes in the volume of the orbit relative to its contents or loss of function of the orbitalis muscle
What are the investigations for a suspected orbital floor fracture?
CT sinuses - tear drop sign - blow out fracture - medial wall and floor
What is the management of an orbital floor fracture?
conservative - surgical repair of bony walls if entrapment, large defect or significant enophthalmos
