Maxillofacial Surgery - Facial Fractures Flashcards
What is the name for not being able to open your mouth?
Trismus
Give some examples of maxillofacial surgery
Dentoalveolar (wisdom teeth) Cleft lip and palate Facial deformity Craniofacial surgery head and neck oncology
What is the aim of treatment in maxillofacial surgery?
Restore facial aesthetics and function
What is an osteotomy?
Cutting of bone during surgery
What is the aetiology of facial fractures?
Assault = 70-80% RTA Sports Industrial Falls
What are some of the signs and symptoms of a facial fracture?
Pain Swelling Loss of function Steps (in bone) Crepitus
Why is anatomy important in symptoms of facial fracture?
Nerve damage Associated structures Eyes Nose Mouth
How are facial fractures classified?
Simple (closed)/ Compound (open)
Displaced/undisplaced
ANATOMICAL
How are facial fractures classified anatomically?
Lower third:
-Mandible
Middle Third:
- Contral (maxilla/naso-orbito-ethmoidal complex)
- Lateral (zygomatic-orbital complex)
Upper Third:
-Frontal sinus
Panfacial
-Everything is fucked
How do you asses facial fractures?
ATLS (Advanced treatment life support) principles are paramount
Airway? (?C Spine injury)
Breathing?
Circulation?
Briefly discuss c-spine injuries in relation to facial fractures
Always bear in mind the possibility
Mechanism of injury important
As high as 3% of cases
Briefly discuss head injury in relation to facial face
Always bear in mind the possibility
?Loss of conciousness
?Amnesia - reterograde/anteroretrograde
?Irrational/aggressive
?Alcohol ?Drugs
GCS?
What are the common bones of the face to fracture?
Mandible
Zygoma
Nasal
Maxilla
Describe mandible fractures
Alcohol in 80%
Assaults more common
RTA more common in S England
Dentition/Occlusion is the key
What are the signs and symptoms of a mandible fracture?
Paraesthesia
-Mental nerve distribution
Occlusion problems
The bite is not right
Bilateral fracture in obtunded patient
AIRWAY RISK
What do we mean by an obtunded patient?
State similar to lethargy
Less interest in environment
Slow responses to stimulation
What are the treatment options for mandibular fractures?
Conservative (Non-Surgical)
Conservative (Surgical)
Surgical
Plates placed at tension zones
Describe central middle third facial fractures
High velocity/force
Variable
Complex
Describe middle third fractures
Central or lateral
Usually blunt force
Middle - high velocity
Variable
may be complex
Maybe cranial and ocular involvement
How do middle third facial fractures present?
Classical facial appearance
CSF leak?
AIRWAY
BLEEDING
Nerve anaesthesia?
Midline split
Anterior open bite (AOB)
What is the treatment for middle third fractures?
Conservative treatment possible but usually surgery required.
External fixation rarely used (still useful in some cases)
Nasal reconstruction often required
Primary bone grafting
Describe lateral middle third fractures
Zygomatic
May involve orbit/eye
Assault/Sport/Falls/RTA
May go unnoticed
What are the treatments for lateral middle third facial fractures?
Conservative (non-surgical)
Conservative (surgical)
Surgical (ORIF)
Describe upper third fractures
Often as part of panfacial injury
These are usually compound skull fractures
Associated CNS injury?
Base of skull?
CSF leak?
What might be affected in upper third facial fractures?
Frontal sinus injuries
Sense of smell
Orbital roof injuries
