Max/Facs Flashcards
Orbit of Eye
Frontal
Maxillary
Zygoma
Lacrimal
Ethmoid
Palatine
Sphenoid
Le Fort Fractures
I - horizontal fractures of the maxilla that run above the teeth bearing alveolar process and the nasal f loor and hard palate
Separate teeth from upper face
II-pyramidal shaped extendingfrom the upper nasal bridge at the apex, downwards through the medial wall of the orbits then on through the region of the zygomatico-maxillary suture lines.
Extend into orbital rim
III -extends through the upper nasal bridge, extend bilaterally across the orbits, to extend through the fronto-zygomatic sutures, then down through the zygomatic arches
Through orbital wall involving entire face
Orbital Tripod fracture
Zygoma + Maxialla + lateral wall of orbit
Enopthalmos => poor cosmesis
Surgical Mx
Ophthalmology for any eye involvement
ABx Indications in facial trauma
Bite
Contaminated
Evidence of devascularisation
Full thickness - biccal mucosa
Cartilage - ear or nose
Peri-orbital burns
Usually paediatric - chew through wire
5-21 day eschar falls off and labial artery => significant haemorrhage
Poor cosmesis and microstomia
Plastic/ENT follow up
Eyelid lacs - specialist referral
Deep
Eye apparatus i.e. lacrimal
Lid margin
Avulsion or tissue loss
Dental fracture Ellis Classification
I - enamel only
OP FU
II - enamal + dentine
OP FU + cover dentine
III - enamel + dentine + pulp
Early referral to dentist
Avulsed tooth
Saline/milk
Remplant - 30mins 90%success, 1hr 66% success, 3hrs 20% success
Hold by crown
Secure with splint
Early dental referral
Complication of reimplantation
Ankylosis - tooth fuses to surrounding bone
Loss of viability
Luxed tooth
Concussion - tender, no displacement or mobility
Subluxation - loose
Intrusion - displaced deeper into socket
Extrusion - displacement out of socket
Lateral - displacement eccentrically, often assoc with alveolar socket fracture
Mx
Reposition
Splint
Refer for dentist for FU
TMJ dislocation
Jaw dislocation normally anteriorly
Unilateral or bilateral
Reduction
Sedation/analgesia
Intra-oral - down and backwards
Extra-oral
Syringe technique
Ludwig’s angina
Infection extends into the submaxillary, sublingual, and submental spaces + displacement of tongue
Usually dental in orgin
Risk - DM, immunocompromised, chemo, oral malignancy, sialadenitis related infection
Treatment is similar to other skin and soft tissue infections of the head and neck:
* Early airway protection - approach as DIFFICULT AIRWAY
- Avoid neuromuscular induced paralysis
- Trismus, may need surgical airway as not always responsive to
paralysis (internal pterygoid or masseter muscle spasm)
- Broad antibiotics to cover hemolytic strep, mixed strep-staph and bacteroides species
- as 2.4g penicillin daily Q 4hrs IV plus metronidazole 1 g IV load, with 500 mg IV q6h
- Clindamycin 900 mg q6h also is effective
- If very ill consider going broader - Mero + Vanco + Clinda
CT - may not be able to lie flat
OR
Complication of upper canine infection
Intra-cranial extension
Peri-orbital cellulitis
Cavernous sinus thromobis
ANUG
Acute necrotising Ulcerative Gingivitis
ANUG - cellulitis of gingiva (non-nectrotic tissue)
Classic triad of pain + ulcerated (punched out) interdental papillae) + gingival bleeding
ANUG + fauces/tonsils = VINCENT’S ANGINA
ANUG + Lips/buccal mucosa = CANCRUM ORIS
Mx
Analgesia
ABx - Pen /tetracycline
Dental hygiene - chlorheidine wash
Dentist -
Dental Pain DDx
Referred MI pain
Temporal arteritis
Trigeminal Neuralgia
Maxiallry Sinusitis
Migraines, cluster headaches
Aphthous ulcers
Infections => ulcers (HFM, Herpangina, HIV, syphilis, TB)
Systemic = > Wegener’s, Lupus, Behcet’s, Scleroderma
Dental Infection Microbes
General
Strep viridans
Anaerobes: Fusobacteriem, Prevotella
Necrotising
Serratia, Klebsiella, Enterococcus
Candida
