maxillo facial injuries Flashcards
etiology of maxillo facial injuries
rta industrial accidents interpersonal violence medical conditions eg syncope sports
what are the 5 aspects of advanced trauma life support survey
airway with cervical spine breathing and ventilation circulation disability and neurological status exposure/environment control
what can affect the airway in trauma
fracture of supporting bones
disruption of facial and oral soft tissues
hemorrhage and swelling
what to look out for when evaluating circulation for atls
hypotension tachycardia loss of peripheral ulspulse cold clammy skin falling urinary output confusion and disorientation
treatment options for hemorrhage
direct pressure (nasal) packing embolisation fracture immobilisation surgical control
how to manage inadequate circulation in trauma case
fluid replacement
iv
blood transfusion
what are the general principles in dealing with maxillofacial fracture
reduction immobilisation fixation rehabilitation restore pre injury form and function soft tissue redrape precise hard tissue repair restore volume and aesthetics
in load sharing, what bears the functional load
plate and bone
in what situations do you use load bearing osteosynthesis
comminuted fractures
atrophic edentulous fracture
defect fracture
complicated mandibular fracture
downsides of closed reduction
accuracy of reduction is doubtful
may have inadequate reduction
may have poor alignment
does closed reduction have to be done under GA
no
risks of open reduction
damage vital structures
aesthetics
how are mandibular fractures classified
relation to overlying soft tissues (closed, open, complicated)
condition of fracture fragments (greenstick, simple, multiple, comminuted)
what are the common anatomical sites of mandibular fracture
angle
parasymphysis
symphysis
clinical signs and symptoms of mandibular fracture
pain and swelling deranged occlusion reduced mouth opening numbness sublingual hematoma new gap between teeth unable to open against resistance
what are you feeling for when you palpate mandibular fracture
tenderness step deformity crepitation depression nerve injury
steps for open reduction of mandibular fracture
imf, put teeth into occlusion incise to expose fracture reduction plates release imf check occlusion closure imf if need guidance
clinical findings for unilateral condylar fracture dislocation
midline shift towards injury
telescoping with ipsilateral premature contact, ramus shortens
clinical findings for bilateral condylar dislocation without fracture
pseudo prognathism
total inability to occlude teeth
aims of treatment for condylar fracture
pain free opening, interincisal opening distance opening at 40mm facial and jaw symmetry stable tmj good movement of jaw in all excursions restore pre injury occlusion restore facial width
management of condylar joint effusion/edema
nsaids, no other management needed
absolute indications for ORIF of condylar fracture
condylar displacement into middle cranial fossa
lateral extracapsular displacement of condyle
inability to obtain adequate occlusion by closed reduction techniques
invasion by foreign body
displacement of more than 5mm
angulation of 37º and above
condylar fractures in children most often treated by closed or open reduction
closed
surgical complications of orif of condylar fracture
facial nerve palsy disfiguring scar parotid fistulae facial asymmetry frey's syndrome condylar resorption avascular necrosis occlusal disturbance reduced bite force
