MaxFax / Dental Trauma

Question 1

Signs of BOS #

Answer 1

Periorbital bruising
Battle sign (postauricular bruising)
Haemotympanum
Otorrhoea

Question 2

Mandibular fracture

Answer 2

Body most common, then angle
–> Malocclusion, trismus, mental paraesthesia

Consider ‘open’ if any communication with oral cavity (ie. tooth root, gum lac)

Any displaced –> OT.

Antibiotics only if ‘open’

Question 3

Nasal bone #

Answer 3

Clinical Dx- only require imaging if other injuries suspected

Concerns:
- Epistaxis
- Septal haematoma
–> Abscess, necrosis, saddle-deformity
–> I&D under local

Delayed reduction at 1/52

Question 4

Answer 4

Tripod fracture

Separation of **zygoma*

at:
- Frontal bone
- Zygomatic arch
- Infraorbital rim and floor

Similar to blow-out. Entrapment of:
–> Extraocular muscles
–> Infraorbital nerve

Don’t blow nose, +/- OT

Question 5

Classifications of Le Forte #:

Answer 5

Separation of maxilla
Not always symmetrical- May be different LeForte on L and R

Le Forte I
- Maxilla, pterygoid plates
- Stable

Le Forte II- Most common
- Nasal, infraorbital rim, orbital floor, maxilla and sinuses
- Stable or unstable

Le Forte III
- Seperated from frontal bone at junctions with: nasal, maxilla/ orbital wall, zygomatic arch
- Always unstable (‘floating face’)

Question 6

Management of haemorrhaging Le Forte #:

Answer 6

• Sit up, lean forward (if Cspine cleared)
• Reduce midface by grasping maxilla and pulling forward
• Packing
  –> Anterior
  –> Posterior if BOS intact
  –> Nasopharynx if intubated
• Antibiotics if:
  –> Sinus
  –> CSF leak

Question 7

Answer 7

Orbital floor #
Isolated blowout, vs, part of Tripod

• Eye sunken, and lower
• Diplopia
• Impaired movement
  –> Trapped fat, inferior rectus/ oblique
• Infraorbital numbness (infraorbital nerve)
• ‘Trapdoor’ on CT

Mx:
Oral antis (sinus)
Nasal decongestant spray
Don’t blow nose
+/- delayed OT (2 weeks)

Question 8

What associated structures can be injured in temporal bone #?

Answer 8

MANY associated structures running through its foramina

Cochlear
Vestibule
Facial nerve
Carotid artery
Jugular vein
CSF leak

Question 9

Classification and Mx of dental fractures:

Answer 9

I- Enamel only
- File
- Dentist for cosmesis

II- Enamel, dentin
- Risk of infection through to pulp
- Cover with calcium hydroxide or dermabond
- Antibiotics
- Dentist 24-48hrs

III- Enamel, dentin, pulp
- MaxFax emergency
- Bite onto adrenaline gauze if bleeding
- Cover with calcium hydroxide
- Antibiotics
- Dentist within 24hrs

Question 10

Management of the avulsed tooth:

Answer 10

• Clean tooth with saline
• Store in:
  –> first line: Milk
  –> second line: Saline, Saliva
  (risk of swallow if patient holds in socket)
• Wash socket with saline
• Replace tooth
• Splint:
  –> Al foil held with dermabond or calcium hydroxylate
  OR
  —> Calcium hydroxylate rolled into a worm

Avoid hot/cold
Urgent dentist or MaxFax

Question 11

Mx of tooth subluxation and intrusion:

Answer 11

Subluxation:
- Loose, or partially displaced
- Replace
- Splint (paste or Alfoil)

Intrusion:
- Need MaxFax

Question 12

Intra and extraoral techniques for reducing TMJ:

Answer 12

Most commonly:
- Anterior
- Atraumatic
- Bilateral

_______________

1- Syringe
- Roll between molars
- 97% success!

2- Gag reflex

3- Tongue Depressors
- Progressive stacking

4- Intraoral
Classic
- Down and back
Wrist pivot
- Upwards tilt

5- Extraoral
- Pull jaw up on one side, while pushing coronoid down on other

Question 13

How to anaesthetise upper teeth:

Answer 13

Individually

At gum/lip (mucobuccal) fold

2ml

Tooth only

OR:
- Infraorbital block

Question 14

How to anaesthetise lower teeth

Answer 14

Inferior alveolar nerve block

Between coronoid notch/ pterygomandibular raphe

2ml

Hemi-teeth
+Tooth, lip, gum, anterior 2/3 tongue