Fractures of the Maxilla

Question 1

What bone lines the floor of the orbit?

Answer 1

Maxillary bone

Question 2

What is the name of the injury to lateral and mid face and orbit?

Answer 2

zygomaticomaxillary complex

Question 3

What are the common signs of injury to the zygomaticomaxillary complex?

Answer 3

• Swelling
• Bruising
• Subconjunctival haemorrhage
• Infraorbital paraesthesia
• Unilateral epistaxis
• Trismus (fracture of zygomatic arch can impinge on coronoid process of the mandible)
• Step deformity

Question 4

What are common signs of injury to the orbit?

Answer 4

• Swelling
• Bruising
• Subconjunctival haemorrhage
• Infra-orbital paraesthesia
• Unilateral epistaxis
• Diplopia (esp on upwards gaze)
• Enophthalmos (posterior positioning of the eye)
• Hypoglobus (inferior positioning of the eye)

Question 5

What is a retrobulbar hemorrhage and how do we manage this?

Answer 5

Bleeding in the orbit - raised intra-orbital pressure.
4Ps indicate this = pain, paralysis (Restricted ocular movement), poor visual acuity, proptosis (outwards bulging of eye)
TREATMENT: lateral/inferior cantholysis, timolol eye drops to reduce eye pressure, corticosteroids, acetazolamide, definitive surgical management to evacuate the hematoma

Question 6

If there is a clear clinical fracture, what image do we need to get?

Answer 6

CT - to asses in the coronal, axial and sagittal view

Question 7

What are the indications for immediate repair of orbital fractures?

Answer 7

• White eyed blowout fracture (trapped inferior rectus)
• Non resolving oculocardiac reflex (Traction of extra-ocular muscles of the eye causes stimulation of parasympathetic system causing slowed heart rare, hypotension and vomiting)
• Significant early enophthalmos or hypoglobus

Question 8

What are the two main approaches to dealing with isolated fractures of the zygomatic arch?

Answer 8

1) Intraoral through incision in the vestibule to life the fracture upwards and out to allow for normal bone healing

2) Gillies temporal approach incision in the hairline and down the temporalis fascia

Question 9

Explain what the three Fort fracture planes are in a Le Fort fracture

Answer 9

Fort 1 - palate and alveolus separated from the maxillary complex by a transverse fracture

Fort 2 - pyramidal fractures passing through the anterior and lateral walls of the maxillary sinus

Fort 3 - maxillary complex is separated from the cranium by a fracture going across the lateral walls of both orbits, the orbital floors and crosses the cribriform plate of the ethmoid bone

Question 10

What do we need to be aware of monitoring / managing once the definitive surgery for a facial fracture has been undertaken?

Answer 10

Occlusion
Dentition
Scarring
Sensory-motor dysfunction
TMJ dysfunction
secondary deformity
Psychological (mental health, PTS)