Facial Trauma COPY Flashcards
PSS - chp 41
Complications associated with Frontal Sinus fractures:
Epistaxis, CSF leakage, meningitis, intracranial hematomas.
weeks: sinusitis, mucoceles, meningitis
late: osteomyelitis, mucopyoceles, intracranial abscesses, orbital abscesses
Indications for surgery for frontal sinus fractures
- displaced posterior table fractures greater than the thickness of one wall
- nasofrontal duct involvement
Orbit is composed of how many bones?
7: zygoma, sphenoid, frontal, ethmoid, lacrimal, palatine, maxillary bones
Bone which comprise of each orbital rim
Supraorbital: frontal
Infraorbital: zygoma laterally, maxilla medially
Anteromedial: nasal spine of the frontal and frontal process of the maxilla
lateral: frontal zygoma and zygomatic process of frontal bone.
Functions of the lateral rectus muscle:
abduction
Function of medial rectus muscle
adduction
Function of inferior rectus
Depression, adduction, and extorsion
Superior rectus function
elevation, adduction, intorsion
Superior oblique function
depression, abduction, intorsion
Inferior oblique function
elevation, abduction, extorsion
Blood supply to the frontal sinus
supraorbital branch of opthalmic artery +/- anterior ethmoid artery
Venous drainage of frontal sinus
anterior facial, angular, and superior opthalmic veins which communicate with the cavernous sinus
Route of spread of infection from frontal sinus
foramina of Breschet in the posterior table. Pass directly into the subarachnoid space
Sensory innervation of the frontal sinus
supraorbital and supratrochlear nerves, branches of the ophthalmic division of the trigeminal nerve
Nerves injured if entire forehead is numb
nerves injured at the brow within the supraorbital foramen or notch
Hyperesthesia of the forehead and scalp indicates injury
supraorbital and supratrochlear neurovascular bundles
life threatening facial injuries
- hemorrhage (tx with anterior-posterior nasal packing, angio, ligation of external carotid, superficial temporal arteries), usually internal maxillary artery, nasal/sinus branches
- Airway obstruction (tube or trach b/w 2nd/3rd tracheal rings)
- Aspiration
Presence of fat in a periorbital laceration should mandate what examination
check globe carefully for laceration. Record visual acuity, presence of diplopia, pupillary reaction
Marcus Gunn pupil implies what cranial nerve injury?
injury to optic nerve.
- paradoxical pupillary dilation when light is swung between the intact and injured eyes.
Numbness in the infraorbital division of the trigeminal nerve is consistent with what fracture
fx of the orbit or zygoma.
Course of the infraorbital nerve
proximal two-thirds of orbit, the nerve is in a groove, dital third it in a canal which exits the maxillar 10mm below the infraorbital rim parallel to the lateral margin of the cornea in a straigt gaze.
Branches innervate anterior incisor, cuspid teeth, upper lip, ipsilateral nose, skin of medial cheek
Cervical spine fx accompany what maxillofacial injury?
maxillofacial soft tissue or bony injuries (frontal and mandibular fx).
Panorex is likely to miss fractures in the mandibular region of ___
symphysis-parasymphysis region
Split palate and alveolar fracture have what symptoms in contract with a LeFort fracture
P/A - have mucosal and palatal lacerations. lateral mobility of the maxillary dentition
Both - nasal bleeding, numbness in teeth
LeFort - mobile maxilla but segments of dental arch are not mobile - moves all in one piece.
Which nasoethmoidal fractures do not display telecanthus?
Type I -
CSF detection methods
- double halo test
- beta transferrin
- glucose in CSF
- dye in spinal fluid via LP
- dye in fistula
Subcondylar fractures of the mandible generally present with what occlusal disturbance
contralateral anterior openbite, premature contact on the ipsilateral side
Untreated Le Fort II & III fractures present with what symptoms and are characteristically found at what level
bilateral eyelid ecchymosis, bilateral infraorbital nerve numbness, bilateral nasal bleeding, facial swelling, malocclusion, anterior openbite; donkey facies
What is donkey facies?
maxillary, zygomatic, nasal retrusion, increased length of middle third of the facial region. Face is overall flattened and elongated.
incomplete or greenstick LeFort fractures present with what symptoms and are found at what level
minimal signs of facial injury - slight displacements and can be missed on imaging. can be treated with archbars and traction elastics for 3weeks. If fx is missed, LeFort I osteotomy is required electively
what is the difference between enophthalmos and ocular dystopia
enophthalmos = posterior displacement of the globe (1cc increase of orbital volume = 1mm displacement of globe)
Ocular dystopia = inferior displacement of globe
how are injuries of the parotid duct detected
lacerations in the vicinity of the duct, buccal branch facial nerve weakness
Innervation of buccal branch of the facial nerve
Muscle Action
Risorius Smirk
Buccinator Aids chewing by holding cheeks flat
Levator Labii Superioris Elevates upper lip
Levator labii superioris alaeque nasi muscle Snarl
Levator Anguli Oris Soft smile
Nasalis Flare Nostrils
Orbicularis oris muscle Purse Lips
5 branches of the facial nerve
temporal, zygomatic, maxillary, buccal, marginal mandibular
Pitanguy’s line
0.5cm inferior to tragus to 1.5 cm lateral to brow
innervation of temporal branch of facial nerve
crosses the zygomatic arch to the temporal region, supplying the auriculares anterior and superior, and joining with the zygomaticotemporal branch of the maxillary nerve, and with the auriculotemporal branch of the mandibular nerve.
The more anterior branches supply the frontalis, the orbicularis oculi, and corrugator supercilii, and join the supraorbital and lacrimal branches of the ophthalmic. The temporal branch acts as the efferent limb of the corneal reflex.
Clinical signs of an anterior cranial fossa fracture
forehead bruise/lac
spectacle hematoma
disturbance of olfaction and CSF leak
numbness of the lower lip accompanies what type of mandibular fx
injury to the inferior alveolar nerve - fx of the angle and body regio
3D CTs are indicated for
fx of zygoma or mandible
subluxation of the condylar head anterior to the glenoid fossa produces
locked jaw. Reduce by relaxing muscle, then providing pressure to posterior maxillary dentition
