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Oral Surgery > Jaw Fractures > Flashcards

Jaw Fractures Flashcards

0
Q

What are the feature of a zygomatic fracture?

A 
Swelling and bruising over cheek
Flattened cheek profile
Step deformity at infra orbital rim, zygomatic arch
Periorbital ecchymyosis
Subconjunctival heamorraghe 
Parasthesia of infra orbital nerve 
Trismus
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1
Q

What are the features of a mandibular jaw fracture?

A 
Laceration,
Bleeding
Swelling
Palpable/visible step deformity
Damaged teeth
Para/anaesthesia 
Malocclusion or step deformity
Crepitus of mandible
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2
Q

What radiographic assessment would you do for a zygomatic fracture?

A

OM 15/30
CT skull
CT scan
Sunmentovertex

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3
Q

What radiographic features would

You see in a zygomatic fracture?

A

Fracture of arch or buttress
Fluid in Antrum
Step deformity at infra oribtal margin or zygomaticofacial suture

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4
Q

Which lines do you assess for on the OM cure for zygomatic fracture?

A

Campbell’s lines

Secondary curves

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5
Q

What are the 4 Campbell’s lines?

A

Supraorbital
Infraorbital
Supramaxilliary
Mandibular plane

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6
Q

What are the 4 secondary curves?

A

Outer curve nasal complex
Orbital rim
Superior margin zygomatic arch and lateral orbit margin
Lateral wall of Antrum

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7
Q

When would you carry out surgery for fractured zygoma?

A

Cosmetic
Impaired mandibular movement
Diploplia
Infra orbi nerve damage

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8
Q

What are the post op complications following zygoma surgery?

A

Retro bulbar haemorrhage

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9
Q

What are the 5 surgical approaches to repairing the zygoma?

A 
Gillies approach
Poswillo
Eyebrow incision 
Bicoronal flap
Intra oral (Keen)
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10
Q

How do you perform the eyebrow incision?

A

Lateral third of eye brow to access ZF suture?

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11
Q

How do you perform the Gillies approach?

A

Oblique incision in hair line in the Temporal fossa

usually used for zygoma fracture

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12
Q

How do you perform the poswillo approach?

A

Line between outer canthus and alar

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13
Q

How do you perform the bicoronal flap ?

A

This allows access for multiple facial injuries

Scalp incision when you want to expose zygomatic region then need to add a pre or post auricular incision

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14
Q

Where is the intro oral incision places?

A

Upper buccal sulcus

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15
Q

Which artery is generally responsible for retro bulbar haemorrhage?

A

Ciliary artery (branch of opthalmic artery which is a branch of internal carotid)

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16
Q

How can retrobulbar haemorrhage cause blindess?

A 
Ciliary artery bleeds
Increases pressure
Blocks blood vessels supplying optic nerve 
Leads to ischemic neuropathy
BLINDNESS if untreated
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17
Q

What should be performed post zygoma fracture surgery?

A

Post op eye obs

Pain pupil reaction proptosis visual acuity

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18
Q

How do you manage ischemic optic neuropathy?

A

Surgically
Surgical decompression

Medication
Mannitol and steroids

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19
Q

How common is retrobulbar haemorrhage?

A

0.3% post surgery

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20
Q

What are the guidelines regarding antibiotic cover for prophylaxis against IE?

A

NICE march 2008

No longer offered

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21
Q

What could you consider giving to someone with facial fractures?

A

Broad spectrum ab and analgesics since usually associated with trauma to mouth and sinus therefore bacteria easy to get into bone

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22
Q

Patients with mid facial fractures should avoid doing eat?

A

Blowing their nose to avoid surgical emphysema

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23
Q

What are the requirements for radiographic investigation of a patient with facial fracture?

A

At least two at 90 degrees to each other

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24
When would you undertake a conservative treatment approach for patients with facial trauma?
Those that have in displaced stable fracturs | Those that are not fit for surgery
25
What advice would you give to someone with facial trauma?
Soft diet good OH and analgesics
26
What are the three main stages for surgical treatment of fractures?
Reduction Immobilization Rehab
27
What are the options for reducing fractures?
Open or closed Open is under surgical access
29
What are the two categories of fixation?
indirect and direct | direct can be external or internal
30
What are the principles of indirect fixation?
IMF using eyelets, archbars, buttons and screws
31
What are the principles of direct external fixation?
Rare now Mainly used for comminuted fracture or infection eg osteomyelitis Uses pin system and can be done with open or closed reduction
32
What are the principles for direct internal fixation?
mini plates
33
Which views could you take for almost all fractures of the mandible?
All except for symphysis DPT and oblique lateral
34
Which views do you need to take for symphseal fracture of the jaw?
lower 45/90
35
When could you take a PA jaws?
condyle, angle, ramus,body
36
When could you take an OM view?
all except coronid and symphysis
37
What are the four types of fracture of the mandible?
Grrenstick simple comminuted Compound
38
What is a greenstick fracture?
incomplete fracture of flexible bone
39
What is a simple fracture?
fracture with minimal fragmentation
40
What is a communited fracture?
bone has become shattered into fragmemts eg bullet
41
What is a compound fracture?
Communicates with the external environment
42
What complications arise from the atrophic mandible and jaw fractures?
When stripped of the mucoperiosteum the bone becomes starved
43
What are the areas where mandible can fracture?
``` condyle coronid body ramus symphysis angle ```
44
What are the symptoms of body/angle fractur?
altered bite and numbness
45
What are the symtpms of condye fracture?
``` altered bite chin laceration pre auricuclar swelling bleeding in the EAM facial weakness ```
46
Where is the most common site of fracture in mandible?
Angle folllowed by symphysis
47
where is the least common site for fracture of mandible?
ramus
48
What do you need to be cautious of when there has been a chin fracture?
flail mandible as suprahyoid muscles pull on the loose portion of mandible
49
What are the advanages of miniplates?
maintains reduction minimises healing time restores early function prevents infection
50
What do you need to be cautious of with zygomatic or orbital injurires?
Orbital blow out
51
what is an orbital blow out?
when there is herniation of fat through the orbital floor
52
What is the managemnet for simple fractures?
ORIF
53
What is the managment for more complex fractures?
primary treatment: definitive airway debridemen,soft tissue management and mantainn boney dimensions using reconstrution plates or external fixes
54
What are the phases of secondary jaw reconstruction?
Flaps and grafs distraction osteogenesis and implants
55
What is the step by step operative management for pan facial trauma?
1. Restore the airway eg tracheostomy or submandibular intubation 2. Expose all fracture sites by planned incisons: coronal, lower eyelid, intrs oral and existing lacerations 3. Connect the incisons and lacerations by subperiosteal tunnelling which facilitates direct vision of all sites
56
Which structures do you reconstruct first in pan facial trauma?
Load bearing areas
57
Which structures do you reconstruct second in pan facial injuries?
Reconstruct facial projection 1. Start from stable posterior area and then process 2. Proceed along zygomatic arch to zygomatic complex
58
What do you re construct third in pan facial trauma?
Facial width | 1. Fixation of zygomatic to stable part of upper facial third
59
What do you reconstruct fourthly in pan facial injury?
1. Reposition and fix ramus fractures 2. Restore occlusion with IMF 3. Repostiin and stabilise mandibular fractures
60
How do you restore a lower maxillary fracture?
Gently reposition maxilla to the position indicated by the mandible via IMF

Oral Surgery (16 decks)

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