Maxillofacial Surgery - Facial Fractures

Question 1

What is the name for not being able to open your mouth?

Answer 1

Trismus

Question 2

Give some examples of maxillofacial surgery

Answer 2

Dentoalveolar (wisdom teeth)
Cleft lip and palate
Facial deformity
Craniofacial surgery
head and neck oncology

Question 3

What is the aim of treatment in maxillofacial surgery?

Answer 3

Restore facial aesthetics and function

Question 4

What is an osteotomy?

Answer 4

Cutting of bone during surgery

Question 5

What is the aetiology of facial fractures?

Answer 5

Assault = 70-80%
RTA
Sports
Industrial
Falls

Question 6

What are some of the signs and symptoms of a facial fracture?

Answer 6

Pain
Swelling
Loss of function
Steps (in bone)
Crepitus

Question 7

Why is anatomy important in symptoms of facial fracture?

Answer 7

Nerve damage
Associated structures
Eyes
Nose
Mouth

Question 8

How are facial fractures classified?

Answer 8

Simple (closed)/ Compound (open)

Displaced/undisplaced

ANATOMICAL

Question 9

How are facial fractures classified anatomically?

Answer 9

Lower third:
-Mandible

Middle Third:

• Contral (maxilla/naso-orbito-ethmoidal complex)
• Lateral (zygomatic-orbital complex)

Upper Third:
-Frontal sinus

Panfacial
-Everything is fucked

Question 10

How do you asses facial fractures?

Answer 10

ATLS (Advanced treatment life support) principles are paramount

Airway? (?C Spine injury)
Breathing?
Circulation?

Question 11

Briefly discuss c-spine injuries in relation to facial fractures

Answer 11

Always bear in mind the possibility

Mechanism of injury important

As high as 3% of cases

Question 12

Briefly discuss head injury in relation to facial face

Answer 12

Always bear in mind the possibility

?Loss of conciousness
?Amnesia - reterograde/anteroretrograde
?Irrational/aggressive
?Alcohol ?Drugs

GCS?

Question 13

What are the common bones of the face to fracture?

Answer 13

Mandible
Zygoma
Nasal
Maxilla

Question 14

Describe mandible fractures

Answer 14

Alcohol in 80%

Assaults more common

RTA more common in S England

Dentition/Occlusion is the key

Question 15

What are the signs and symptoms of a mandible fracture?

Answer 15

Paraesthesia
-Mental nerve distribution

Occlusion problems
The bite is not right

Bilateral fracture in obtunded patient
AIRWAY RISK

Question 16

What do we mean by an obtunded patient?

Answer 16

State similar to lethargy

Less interest in environment
Slow responses to stimulation

Question 17

What are the treatment options for mandibular fractures?

Answer 17

Conservative (Non-Surgical)
Conservative (Surgical)
Surgical

Plates placed at tension zones

Question 18

Describe central middle third facial fractures

Answer 18

High velocity/force
Variable
Complex

Question 19

Describe middle third fractures

Answer 19

Central or lateral

Usually blunt force
Middle - high velocity
Variable
may be complex

Maybe cranial and ocular involvement

Question 20

How do middle third facial fractures present?

Answer 20

Classical facial appearance

CSF leak?
AIRWAY
BLEEDING

Nerve anaesthesia?
Midline split
Anterior open bite (AOB)

Question 21

What is the treatment for middle third fractures?

Answer 21

Conservative treatment possible but usually surgery required.

External fixation rarely used (still useful in some cases)

Nasal reconstruction often required

Primary bone grafting

Question 22

Describe lateral middle third fractures

Answer 22

Zygomatic
May involve orbit/eye
Assault/Sport/Falls/RTA
May go unnoticed

Question 23

What are the treatments for lateral middle third facial fractures?

Answer 23

Conservative (non-surgical)
Conservative (surgical)
Surgical (ORIF)

Question 24

Describe upper third fractures

Answer 24

Often as part of panfacial injury

These are usually compound skull fractures

Associated CNS injury?
Base of skull?
CSF leak?

Question 25

What might be affected in upper third facial fractures?

Answer 25

Frontal sinus injuries
Sense of smell
Orbital roof injuries