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Oms > maxillo facial injuries > Flashcards

maxillo facial injuries Flashcards

1
Q

etiology of maxillo facial injuries

A 
rta
industrial accidents
interpersonal violence
medical conditions eg syncope
sports
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2
Q

what are the 5 aspects of advanced trauma life support survey

A 
airway with cervical spine
breathing and ventilation 
circulation 
disability and neurological status 
exposure/environment control
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3
Q

what can affect the airway in trauma

A

fracture of supporting bones
disruption of facial and oral soft tissues
hemorrhage and swelling

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4
Q

what to look out for when evaluating circulation for atls

A 
hypotension 
tachycardia
loss of peripheral ulspulse
cold clammy skin 
falling urinary output
confusion and disorientation
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5
Q

treatment options for hemorrhage

A 
direct pressure
(nasal) packing 
embolisation 
fracture immobilisation 
surgical control
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6
Q

how to manage inadequate circulation in trauma case

A

fluid replacement
iv
blood transfusion

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7
Q

what are the general principles in dealing with maxillofacial fracture

A 
reduction 
immobilisation 
fixation 
rehabilitation 
restore pre injury form and function 
soft tissue redrape
precise hard tissue repair
restore volume and aesthetics
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8
Q

in load sharing, what bears the functional load

A

plate and bone

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9
Q

in what situations do you use load bearing osteosynthesis

A

comminuted fractures
atrophic edentulous fracture
defect fracture
complicated mandibular fracture

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10
Q

downsides of closed reduction

A

accuracy of reduction is doubtful
may have inadequate reduction
may have poor alignment

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11
Q

does closed reduction have to be done under GA

A

no

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12
Q

risks of open reduction

A

damage vital structures

aesthetics

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13
Q

how are mandibular fractures classified

A

relation to overlying soft tissues (closed, open, complicated)

condition of fracture fragments (greenstick, simple, multiple, comminuted)

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14
Q

what are the common anatomical sites of mandibular fracture

A

angle
parasymphysis
symphysis

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15
Q

clinical signs and symptoms of mandibular fracture

A 
pain and swelling 
deranged occlusion 
reduced mouth opening 
numbness
sublingual hematoma
new gap between teeth 
unable to open against resistance
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16
Q

what are you feeling for when you palpate mandibular fracture

A 
tenderness
step deformity
crepitation 
depression 
nerve injury
17
Q

steps for open reduction of mandibular fracture

A 
imf, put teeth into occlusion 
incise to expose fracture
reduction 
plates
release imf
check occlusion 
closure
imf if need guidance
18
Q

clinical findings for unilateral condylar fracture dislocation

A

midline shift towards injury

telescoping with ipsilateral premature contact, ramus shortens

19
Q

clinical findings for bilateral condylar dislocation without fracture

A

pseudo prognathism

total inability to occlude teeth

20
Q

aims of treatment for condylar fracture

A 
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
21
Q

management of condylar joint effusion/edema

A

nsaids, no other management needed

22
Q

absolute indications for ORIF of condylar fracture

A

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

23
Q

condylar fractures in children most often treated by closed or open reduction

A

closed

24
Q

surgical complications of orif of condylar fracture

A 
facial nerve palsy 
disfiguring scar
parotid fistulae
facial asymmetry 
frey's syndrome
condylar resorption 
avascular necrosis 
occlusal disturbance
reduced bite force
25
Q

clinical signs and symptoms of maxillary fracture

A

elongated face
diplopia
pupil
range of motion

26
Q

clinical findings of zygomatic fracture

A

facial asymmetry – facial width, cheek flattening

periorbital ecchymosis, crepitus

infraorbital nerve numbness

lateral canthal dystopia

trismus

signs of orbital and globe injury

27
Q

what are you evaluating with ct of zygomatic fracture

A

degree of fracture displacement
comminution of buttresses
status of orbital floor
status of nasoorbitoethmoidal complex

28
Q

what is the goal in management of fractures to reduce secondary deformities

A

precise anatomical reduction and stabilisation

29
Q

clinical findings with orbital wall fracture

A 
peri orbital bruising 
conjunctival hemorrhage 
enophthalmos 
visual acuity changes
diplopia
extraocular motility changes 
pain on eye motion 
infraorbital paresthesia
30
Q

orbital floor fractures often occur where

A

medial to the infraorbital nerve

31
Q

post traumatic deformity with substantial loss of tissue is caused by

A

high velocity injury eg gunshot wound

32
Q

post traumatic deformity without substantial loss of tissue is due to

A

failure to diagnose, failure to disimpact or wholly replace displacements, failure to provide adequate fixation

33
Q

mandibular deformities can be classified clinically as

A

non union

malunion

34
Q

non surgical management of mandibular deformity (can present with malocclusion, tmj dysfunction, asymmetry)

A 
imf with wire or elastic band
bite block 
selective odontoplasty
ortho 
rp/fp
tmj splint
35
Q

surgical management of mandibular deformity

A

arthrocentesis/arthroscopic lysis and lavage
orthognathic surgery
distraction osteogenesis
bone grafting
implant – dental, contour defect implant

36
Q

time frame for fracture healing

A

4-6 weeks

37
Q

in dealing with malocclusion, bite block can be used for up to

A

4-6 weeks

longer duration or significant severity –> ortho treatment or combined orthodontic orthognathic repositioning osteotomy

38
Q

injury to ramus/condyle unit, wait for how long before yo can do bsso

A

6 months

Oms (24 decks)

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