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
clinical signs and symptoms of maxillary fracture
elongated face
diplopia
pupil
range of motion
clinical findings of zygomatic fracture
facial asymmetry – facial width, cheek flattening
periorbital ecchymosis, crepitus
infraorbital nerve numbness
lateral canthal dystopia
trismus
signs of orbital and globe injury
what are you evaluating with ct of zygomatic fracture
degree of fracture displacement
comminution of buttresses
status of orbital floor
status of nasoorbitoethmoidal complex
what is the goal in management of fractures to reduce secondary deformities
precise anatomical reduction and stabilisation
clinical findings with orbital wall fracture
peri orbital bruising conjunctival hemorrhage enophthalmos visual acuity changes diplopia extraocular motility changes pain on eye motion infraorbital paresthesia
orbital floor fractures often occur where
medial to the infraorbital nerve
post traumatic deformity with substantial loss of tissue is caused by
high velocity injury eg gunshot wound
post traumatic deformity without substantial loss of tissue is due to
failure to diagnose, failure to disimpact or wholly replace displacements, failure to provide adequate fixation
mandibular deformities can be classified clinically as
non union
malunion
non surgical management of mandibular deformity (can present with malocclusion, tmj dysfunction, asymmetry)
imf with wire or elastic band bite block selective odontoplasty ortho rp/fp tmj splint
surgical management of mandibular deformity
arthrocentesis/arthroscopic lysis and lavage
orthognathic surgery
distraction osteogenesis
bone grafting
implant – dental, contour defect implant
time frame for fracture healing
4-6 weeks
in dealing with malocclusion, bite block can be used for up to
4-6 weeks
longer duration or significant severity –> ortho treatment or combined orthodontic orthognathic repositioning osteotomy
injury to ramus/condyle unit, wait for how long before yo can do bsso
6 months
