Facial Trauma COPY

Question 1

Complications associated with Frontal Sinus fractures:

Answer 1

Epistaxis, CSF leakage, meningitis, intracranial hematomas.

weeks: sinusitis, mucoceles, meningitis
late: osteomyelitis, mucopyoceles, intracranial abscesses, orbital abscesses

Question 2

Indications for surgery for frontal sinus fractures

Answer 2

• displaced posterior table fractures greater than the thickness of one wall
• nasofrontal duct involvement

Question 3

Orbit is composed of how many bones?

Answer 3

7: zygoma, sphenoid, frontal, ethmoid, lacrimal, palatine, maxillary bones

Question 4

Bone which comprise of each orbital rim

Answer 4

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.

Question 5

Functions of the lateral rectus muscle:

Answer 5

abduction

Question 6

Function of medial rectus muscle

Answer 6

adduction

Question 7

Function of inferior rectus

Answer 7

Depression, adduction, and extorsion

Question 8

Superior rectus function

Answer 8

elevation, adduction, intorsion

Question 9

Superior oblique function

Answer 9

depression, abduction, intorsion

Question 10

Inferior oblique function

Answer 10

elevation, abduction, extorsion

Question 11

Blood supply to the frontal sinus

Answer 11

supraorbital branch of opthalmic artery +/- anterior ethmoid artery

Question 12

Venous drainage of frontal sinus

Answer 12

anterior facial, angular, and superior opthalmic veins which communicate with the cavernous sinus

Question 13

Route of spread of infection from frontal sinus

Answer 13

foramina of Breschet in the posterior table. Pass directly into the subarachnoid space

Question 14

Sensory innervation of the frontal sinus

Answer 14

supraorbital and supratrochlear nerves, branches of the ophthalmic division of the trigeminal nerve

Question 15

Nerves injured if entire forehead is numb

Answer 15

nerves injured at the brow within the supraorbital foramen or notch

Question 16

Hyperesthesia of the forehead and scalp indicates injury

Answer 16

supraorbital and supratrochlear neurovascular bundles

Question 17

life threatening facial injuries

Answer 17

1. hemorrhage (tx with anterior-posterior nasal packing, angio, ligation of external carotid, superficial temporal arteries), usually internal maxillary artery, nasal/sinus branches
2. Airway obstruction (tube or trach b/w 2nd/3rd tracheal rings)
3. Aspiration

Question 18

Presence of fat in a periorbital laceration should mandate what examination

Answer 18

check globe carefully for laceration. Record visual acuity, presence of diplopia, pupillary reaction

Question 19

Marcus Gunn pupil implies what cranial nerve injury?

Answer 19

injury to optic nerve.

- paradoxical pupillary dilation when light is swung between the intact and injured eyes.

Question 20

Numbness in the infraorbital division of the trigeminal nerve is consistent with what fracture

Answer 20

fx of the orbit or zygoma.

Question 21

Course of the infraorbital nerve

Answer 21

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

Question 22

Cervical spine fx accompany what maxillofacial injury?

Answer 22

maxillofacial soft tissue or bony injuries (frontal and mandibular fx).

Question 23

Panorex is likely to miss fractures in the mandibular region of ___

Answer 23

symphysis-parasymphysis region

Question 24

Split palate and alveolar fracture have what symptoms in contract with a LeFort fracture

Answer 24

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.

Question 25

Which nasoethmoidal fractures do not display telecanthus?

Answer 25

Type I -

Question 26

CSF detection methods

Answer 26

1. double halo test 2. beta transferrin 3. glucose in CSF 4. dye in spinal fluid via LP 5. dye in fistula

Question 27

Subcondylar fractures of the mandible generally present with what occlusal disturbance

Answer 27

contralateral anterior openbite, premature contact on the ipsilateral side

Question 28

Untreated Le Fort II & III fractures present with what symptoms and are characteristically found at what level

Answer 28

bilateral eyelid ecchymosis, bilateral infraorbital nerve numbness, bilateral nasal bleeding, facial swelling, malocclusion, anterior openbite; donkey facies

Question 29

What is donkey facies?

Answer 29

maxillary, zygomatic, nasal retrusion, increased length of middle third of the facial region. Face is overall flattened and elongated.

Question 30

incomplete or greenstick LeFort fractures present with what symptoms and are found at what level

Answer 30

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

Question 31

what is the difference between enophthalmos and ocular dystopia

Answer 31

enophthalmos = posterior displacement of the globe (1cc increase of orbital volume = 1mm displacement of globe) Ocular dystopia = inferior displacement of globe

Question 32

how are injuries of the parotid duct detected

Answer 32

lacerations in the vicinity of the duct, buccal branch facial nerve weakness

Question 33

Innervation of buccal branch of the facial nerve

Answer 33

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

Question 34

5 branches of the facial nerve

Answer 34

temporal, zygomatic, maxillary, buccal, marginal mandibular

Question 35

Pitanguy's line

Answer 35

0.5cm inferior to tragus to 1.5 cm lateral to brow

Question 36

innervation of temporal branch of facial nerve

Answer 36

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.

Question 37

Clinical signs of an anterior cranial fossa fracture

Answer 37

forehead bruise/lac spectacle hematoma disturbance of olfaction and CSF leak

Question 38

numbness of the lower lip accompanies what type of mandibular fx

Answer 38

injury to the inferior alveolar nerve - fx of the angle and body regio

Question 39

3D CTs are indicated for

Answer 39

fx of zygoma or mandible

Question 40

subluxation of the condylar head anterior to the glenoid fossa produces

Answer 40

locked jaw. Reduce by relaxing muscle, then providing pressure to posterior maxillary dentition