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Oral Surgery > Facial Trauma > Flashcards

Facial Trauma Flashcards

1
Q

most common etiology of facial trauma

A

43% vehicular accidents
34% assaults

7% work related
7% fall
4% sporting
5% miscellaneous

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2
Q

most common mandibular fracture location

A

condyle 29.5%
- shape implicaton

symphysis 22%

body 16%

alveolar 3.1%

ramus 1.7%

coronoid 1.3%

body 16%

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3
Q

classification of mandibular fractures

A

displaced (doesnt stay in position) or undisplaced fracture

  • location
  • direction of the line of fracture
  • direction of the muscular forces

horizontal favorable or unfavorable

vertical favorable vs unfavorable

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4
Q

neurological examination

A

cranial nerves examination

II- optic
III- occulomotor
IV- trochlear
V- trigeminal
VI- abducens
VII- facail
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5
Q

mandibular fracture by type

A

simple or closed

compound or open

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6
Q

simple or closed mandibular fracture

A

a fracture that does not produce a wound open to the external environment, whether it be through the skin, mucosa, or periodontal membrane

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7
Q

compound or open mandibular fracture

A

a fracture in which an external wound, involving skin, mucosa, or periodontal membrane, communicates with the break in the bone

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8
Q

comminuted mandibular fracture

A

a fracture in which the bone is splintered or crushed

  • like gun shot
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9
Q

greenstick

A

a fracture in which one cortex of the bone is broken, the other cortex being bent

  • INCOMPLETE
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10
Q

pathologic fracture

what to note

A

a fracture occuring from mild injury because of pre-existing bone disease

LOOK FOR EDENTULOUS ARCH – may be more likely to be pathologic if less bone present

  • different than injury - something going on before
  • like pre-exisitng patholgy - cyst tumor cancer, osteonecrosi, etc
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11
Q

radiographic examination of mandible series

A

LEAST PREDICTABLE

  • towne’s view
  • anterior - posterior view
  • lateral oblique right and left
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12
Q

panorex use

A

most common

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13
Q

most predictable radiographic examination uses

A

CT scan

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14
Q

general principles of fracture treatement

A

reduction

stabalization

fixation

rehabilitation

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15
Q

4 types of overarching fractures

A

mandible fractures

lefort fractures

zygomatic complex fractures

naso-orbital ethmoidal fractures

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16
Q

treatment of mandible fractures

A

objectives
re-establish
OCCLUSION

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17
Q

open bite suggestive of

A

fracture

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18
Q

primary objective of treatment of mandibular fracture

A

OCCLUSION then restore the form and function

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19
Q

common indications can do closed reduction tx

A

non displaced favorable

grossly communicated fractures

deficient or lack of overlying soft tissues

fractures in children with developing dentition

cornoid process fractures

majority of condylar fractures

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20
Q

physical examination should include

A
  1. general examination
    when, where, etc
  2. soft tissue
    - lips, cheeks, etc
  3. neurologic examination
    - facial injury in combination with brain injury - cranial nerve checking
  4. bony examination
  5. ocular examination
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21
Q

right side under the ear - what other structures should you think of?

A

facial nerve – 5 terminal branches

parotid gland – + the duct

facial artieries

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22
Q

bony fractures broken down into

A
  1. mandibular
  2. lefort fractures
  3. zygomatic complepx fractures
  4. naso-orbital ethmoidal fractures
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23
Q

muscle and fracture pattern

A

pull of muscle - may
displace fracture - take fracture away = displaced

sometimes muscle pull – brings fragments closure – favorable

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24
Q

if muscle pull
masseter on buccal and medial pterygoid on lingual?
fracture pulls up

A

pterygo-masseter SLING
if ledge of bone above – FAVORABLE -

horizontally favorable

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25
Q

no superior ledge of bone and fragment travels posterior and DOWN - leaving unsupported bone
sling is free

A

horizontally unfavorable

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26
Q

displaced or undisplaced fracture gets further catagorized into

A

location of the fracture

direction line of the fracture

direction of the muscular forces

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27
Q

if looking at a fracture in a PANO - what orientation

A

horizontal aspect

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28
Q

muscle pull together brings fracture fragment UP with no superior ledge of bone

A

horizontally unfavorable

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29
Q

no superior ledge of bone

A

fragment piece may go posteriorly DOWNWARD
- and then with no superior ledge of bone the masseteric and medial pterygoid together pull the fragment superiorly unopposed

horizontally UNFAVORABLE

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30
Q

looking at a fracture from below or from the top will catategorize it as

A

vertically favorable or unfavorable

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31
Q

medial pterygoid sling on the lingual - but no muscle pulling it buccally - but buccal bone present

A

vertically FAVORABLE - muscle alone cannot displace it

fragments wont get displaced

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32
Q

no buccal or lingual bone ledge looking from the top

A

vertically unfavorable

the medial pterygoid muscle can pull the fragment and displace it

33
Q

reduction to happen

A

need minimal displacement to happen

34
Q

simple =

A

closed

35
Q

compound =

A

open

36
Q

Which locations of mandibular fractures do you think would be involved with simple/ closed or compound/ open fractures?

A

coronoid or condyle in isolation may be simple

other areas — teeth involved
- pdl space – considered a point of entry - compound / open fracture then

37
Q

picture of radiograph with pano showing left mandibular fracture and asked to classify it

  • looks completely broken
  • no teeth
A

good example of PATHOLOGICAL FRACTURE

- mandible gets weak and then completely fractures

38
Q

x-ray shows displacement of the mandible superiorly

A

horizontally

39
Q

altered sensationo of lip?

A

inferior alveoolar canal affected

- can get pulled with displacement

40
Q

intra oral picture suggesting mandibular fracture - what to note

A

BREAK IN GINGIVA

OCCLUSAL STEP

open bite

sublingual hematoma or ecchymosis

41
Q

open bite?

A

suggestive of mandibular fracture

42
Q

pathonemonic for mandibular fracture

A

floor of the mouth ecchymosis

sublingual hematoma

43
Q

panorex with radio graph exam

A

mot common

44
Q

CT scan rx use?

A

most predictable

45
Q

mandible series?

A
  1. towne’s view
  2. anterior - posterior view
  3. lateral, oblique, right and left

LEAST PREDICTABLE

46
Q

general principles of fracture treatment

A
  1. reduction
  2. stabilization
  3. fixation
  4. rehabilitation
47
Q

primary objective in tx of mandibular fractures

A

RE-ESTABLISH OCCLUSION

then form and function *

48
Q

types of treatment for madnibualr fractures

A
  1. no treatment / liquid diet
  2. closed reductiono
  3. open reduction (most complicated - exposing the sites and re-aligning)
49
Q

two mandibulr areas that can likely be treated by closed reduction

A
  1. coronoid – not going to invasively go into the mandible and ‘hunt down’ this area

MAJORITY of condylar

50
Q

best indication to do closed reduction

A

have a non displaced favorable fracture

51
Q

tx of comminuted fractures

A

closed reduction

if try and get all pieces and put togethre- may strip off periosteum which is the life of the bone

52
Q

closed reduction tx modalities

A
  1. ivy loops
  2. arch bars
  3. splints
    - gunning splints
    - denture
    - lingual splints
    - cap splint
  4. external pin fixation
    - most unsightly form of
53
Q

arch bars basiclaly

A

bar on top and botoom
hold them together
intermaxillary fixation
- get teeth righ t– to then hold bone to the right place

Mand F

maxillary and mandibular arch fixation

54
Q

capping splint

A

closed reduction tx technique

pass wires over and under

  • NO TEETH
  • need another area for fixation
55
Q

dentures used in tx?

A

yes for mandibular fixation with denture – closed technique

modify the existing denture to hold onto the bars

56
Q

external fixation

A

bar around all of the mandible with screws fixated in

57
Q

tx modalities for open reduction - general

A

non rigid fixation

semi rigid

rigid fixation

58
Q

arch bar splints can use

A

patients denture

59
Q

example of non rigid fixation - include type of tx

A

for mandibular fracture - OPEN REDUCTION

- WIRES

60
Q

example of semi-rigid fixation - include type of tx for

A

for madnibular fracture - tx by OPEN REDUCITON

- MONOCORTICAL SCREWS/PLATES (CHAMPY)

61
Q

wires in open reduction example of

A

non rigid fixation tx

62
Q

monocortical screws/plates tx for

A

semi-rigid fixation uses open reduction

tx for mandibular fractures

63
Q

compression plates and reconstruction plates used in

A

open reduction rigid fixation treatment for mandibular fracture

64
Q

rigid fixation for open reduction tx options

A

compression plates and reconstruction plates

not really used as much but much thicker

65
Q

examples of mid face fractures

A
  1. lefort I,II, III
  2. zygomatic complex fracture
  3. zygomatic arch fracture
  4. naso-orbital ethmoidal fracture
66
Q

lefort I

A

horizontal fracture

over apices of maxillary teeth

67
Q

lefort II

A

pyramdal fracture
goes more superior

crosses zygomatic maxillary suture
on orbital floor
along the nasal frontal and maxilo-frontal suture

shape – triagular / pyramidal

68
Q

lefort III

A

goes even more superior than the lefort II

zygomatic arches and frontal zygomatic suture - more lateral

maxillary boe separted from cranium bone **

craniomaxillary dysjunction fracture

69
Q

zygomatic complex fracture

A

outside of orbit – look at slide picture

patient will present with zygomatic ecchymosis and edema

lateral eye and where zygomatic bone - frontal bone come together too

from view below can see the disjunction of zygomatic arch

70
Q

from view below can see the disjunction of zygomatic arch

A

ZMC complex fracture

71
Q

most common symptoms for midface fractures

A

KNOW this
1. pain, edema, and ecchymosis of cheeks and eyelids

  1. malar flattening
  2. step defect at INFRAORBITAL SUTURE
  3. step defect at FRONTOZYGOMATIC SUTURE
  4. TRISMUS
72
Q

Occlular eye exam important in

A

all really but with midface fractures may find

  • infra-orbital nerve parasthesia or anesthesia
  • enopthamlmos (posterior displacement of eyeball) or proptosis (protrusion of eyeball)
  • diplopia (double vision)
  • decreased mobility of extra ocular muscles (upward gaze)
73
Q

ZMC cranial nerve examination

A 
same as others 
CN II
CN III
CN IV
CN V
CN VI 
CN VII

(2-7)

74
Q

scan of choice for midface fractures

A

CT scan

75
Q

imaging facial series for midface fractures

A

plain film

submental-vertex view

townes, AP views

Waters View

76
Q

CT scan with ZMC fracture

A

sinus will look all grey because of the inflammation
- bones fractured to fluid and edema gets in

normally should be all black

77
Q

typically appearing like a v

A

TRISMUS

fracture of zygomatic arch

78
Q

trismus a sign for

A

zygomatic arch fracture

Oral Surgery (26 decks)

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