management of zygomatico orbital trauma Flashcards
How are maxillofacial fractures classed?
- Naso ethmoidal
- Lateral middle third (zygoma)
- Central middle third
- Mandibular
What are the different types of central middle third fractures?
- Nasal bone
- Unilateral maxillary fracture
- Le Fort I fracture
- Le Fort II fracture
- Le Fort III fracture
- Various combinations
What makes up the orbitonasal ethmoid complex?
4 walls, an anterior surface and an apex:
Anterior wall
Medial wall
Lateral wall
Floor
Apex
Roof
What is found in the anterior orbitonasal ethmoid complex?
Eyelids
Cornea sclera
What is found in the medial wall of the orbitonasal ethmoid complex?
Medical rectus muscle
Nose
Lacrimal duct and sac
Medial canthal ligament
Ethmoid sinus
Cribriform plate
What is found in the superior orbital fissure?
CNIII occulomotor nerve
CN IV trochlear nerve
CN VI abducens nerve
Branches of the ophthalmic nerve CNV
Ophthalmic veins
What is found in the inferior orbital fissure?
Infraorbital nerve
Infraorbital vein
Infraorbital artery
How should clinical examination of the maxillofacial region be carried out?
Should be organised, sequential and methodical
A - soft tissues
B - nerves
C - skeleton
D - dentition
Name 4 clinical signs of Malar (zygomatic) fractures
Any from:
- periorbital bruising
- subconjunctival ecchymoses
- sensory deficit - infraorbital nevre
- diplopia (double vision)
- subcutaneous emphysema
- epistaxis (nose bleed)
- step deformity
How should the skeleton be examined for maxillofacial injuries?
Palpation for irregularities of supraorbital ridge
Palpation for irregularities of infraorbital ridge and zygoma
Palpation for depression of zygomatic arch
Manoeuvre to ascertain motion in maxilla
How should dentists initially manage maxillofacial injuries?
Exclude an ocular injury
Give prophylactic antibiotics
Avoid blowing nose
How are orbitonasal ethmoid injuries definitely managed?
Review once swelling has subsided
Further radiographs and possiblt CT
Get informed consent
Closed reduction and possible fixation
Open reduction and internal fixation by either:
- intra-oral incisions
- local facial incisions
- coronal flap exposure
Describe a zygoma fracture that is causing limited mouth opening
It is impinging on the coronoid process
What is the Howard Gillies approach?
Cut at temporalis to reach the zygomatic bone at level of the coronoid process
Leaves no scars except one high up in the temporal region
What is the trans-conjunctival approach?
Retracts the lower eyelid so no scarring
What other approach can be used to access fractures, leaving no scarring?
Bi-coronal approach
What anatomy is found in the floor of the orbit?
Infraorbital nerve and vessels
Antrum
Nasolacrimal canal
Inferior rectus and oblique muscle
Give 4 signs of floor of orbit fracture
Any from:
- enophthalmos (posterior displacement of eyeball)
- diplopia (double vision)
- positive forced suction test
- infraorbital anaesthesia
- antro-orbital communication
- naso-lacrimal duct damage
What anatomy is found in the lateral wall of the orbit?
Lateral canthal ligament and muscle
CNVI
Lateral rectus muscle
Middle cranial fossa
Dura and temporal lobe of the brain
Give 4 signs of lateral wall fracture?
Exophthalmos - protrusion of eyeball
Inward displacement
Lateral canthal displacement
Lateral rectus palsy
What anatomy is found in the roof of the orbit?
Anterior cranial fossa
Dura and frontal lobe of brain
Superior rectus and oblique muscles
Frontal sinus
Supraorbital nerve
Give 4 signs of roof fracture
Any from:
- dural tear and brain damage
- CSF leak
- trochlear damage
- diplopia
- frontal anaesthesia
- exophthalmos (protrusion of eyeball)
What anatomy is found at the apex of the orbit?
Optic nerve
Ophthalmic artery and veins
What are the signs of apex fracture?
Blindness
Give 4 signs of medial wall fracture
Any from:
- nasal shortening
- bridge depression
- telecanthus
- diplopia
- naso-lacrimal apparatus damage
- cribriform plate damage
- CSF leak
- medial displacement of the eyeball
