Maxillofacial trauma

Question 1

What can you use for imaging in oral trauma cases

Answer 1

-Skulls radiographs
-Intraoral radiographs
-Computed tomograpahy (CT)

Question 2

How might you manage oral trauma

Answer 2

1) Conservative management
2) MMF
3) Intra-oral splinting
4) Inter-fragmentary wiring
5) Rigid fixation

Question 3

T/F: the mouth can hang open with only one mandible broken

Answer 3

False- both mandibles need to be broken for it to be hanging ipen

Question 4

What are some maxillofacial considerations

Answer 4

1) Restoration of occlusion (return to normal)
2) Early return to function
3) Forces of mastication
4) Avoid iatrogenic injury to teeth
4) Avoid iatogenic injury to neurovascular structures
5) Fracture stabilization

Question 5

Pros and cons of skull radiographs

Answer 5

Pros:
-can perform awake
-can use with general evaluation for other bony injury

Cons:
-difficult to interpret with superimposition (no idea whats going on)
-you need to obtain multiple oblique views

Question 6

What are the positives of intra-oral radiographs

Answer 6

1) excellent detail
2) fast, performed intraoperative
3) aid in placement of fixation
4) assess health of periodontal structures
5) important if dental structures play role in fixation

Question 7

What are the cons of intra-oral radiographs

Answer 7

-need to be under anesthesia/sedation
-challenging for. caudal mandibular, maxillary or TMJ fracture

Question 8

intraoral radiographs may be challenging for what fractures

Answer 8

1) Caudal mandibular
2) Maxillary
3) TMJ fracture

*CT is better for these

Question 9

What are the pros of CT for maxillofacial trauma

Answer 9

1) Discern lesions hidden by superimposition, especially important in caudal mandibular, maxillary and TMJ fractures and luxation

2) Allows for more advanced treatment planning

3) Shown to be more sensitive and specific than film

Question 10

What are the negatives of CT for maxillofacial trauma

Answer 10

-Requires anesthesia
-Not readily available
-Expensive

Question 11

What can you do for managing oral trauma

Answer 11

1) Conservative management
2) Maxillomandibular fixation
3) Intra-dental wiring and splinting
4) Inter-fragmentary wiring
5) Rigid fixation

Question 12

What is the order of importance of oral fracture repair

Answer 12

1) Stabilize patient
2) Restore occlusion
3) Maintain blood supply (use least invasive technique)
4) Early return to function
5) Rigid(ish) skeletal fixation

Question 13

Why should you not use plates in the oral cavity

Answer 13

very invasive
need to maintain blood supply (use least invasive technique)

Question 14

Conservative management for maxillofacial trauma is appropriate for

Answer 14

1) Young patients - heal quickly
2) Non-displaced fractures

Question 15

What are examples of conservative management for maxillofacial trauma

Answer 15

tape muzzles
soft blue muzzles

Question 16

What are the pros and cons of conservative management for maxillofacial trauma

Answer 16

Pros:
-Low cost
-May be either adjunctive treatment or sole treatment
-Maintains occlusion

Negatives:
-Possible malunion
-Greatest risk of long term malocclusion
-High risk for aspiration

Question 17

utilize interdigitation of the maxillary and mandibular canine teeth or align/stabilize fracture fragments (must have all 4)

Answer 17

Maxillomandibular fixation (MMF) - interdental bonding or buttons

Question 18

What are the negatives of Maxillomandibular fixation (MMF) - interdental bonding or buttons

Answer 18

1) Some patients are very resentful
2) Challenges with anesthesia (re-intubation)
3) Place feeding tube prior to fixation
4) Patient at high risk of aspiration
5) Can have long term malocclusions

Question 19

T/F: Maxillomandibular fixation (MMF) - interdental bonding or buttons is technically challenging to perform

Answer 19

false - not technically challenging to perform

Question 20

feeding tube for Maxillomandibular fixation (MMF) - interdental bonding or buttons must be placed

Answer 20

Prior to fixation

Question 21

placement of wires between teeth with acrylic support, combination of both offers greater rigidity and strength

focus on maintaining occlusion

must have large teeth on either side of the fracture

Answer 21

Inter-dental wiring with acrylic splints

Question 22

when must you remove Inter-dental wiring with acrylic splints

Answer 22

4-6 weeks

Question 23

what must be required for Inter-dental wiring with acrylic splints

Answer 23

must have large teeth on either side of the fracture

must be healthy teeth ** (no periodontal disease)

Question 24

What are the pros and cons of Inter-dental wiring with acrylic splints

Answer 24

Pros:
-can return normal occlusion
-minimally invasive

Cons:
-very technique sensitive
-challenging with missing teeth or comminuted fractures

Question 25

Inter-dental wiring with acrylic splints focuses on

Answer 25

maintaining occlusion (can return normal occlusion)

Question 26

What is a good technique only for cats for symphyseal separation

Answer 26

symphyseal wiring

Question 27

wire placement between bone fragments goal is to place wire perpendicular to fracture line

Answer 27

Interfragmentary wiring

Question 28

What is the goal of Interfragmentary wiring

Answer 28

place wiring perpendicular to fracture line

Question 29

What are the pros of Interfragmentary wiring

Answer 29

can lead to very stable fracture repairs

Question 30

What are the cons of Interfragmentary wiring

Answer 30

very technique sensitive and invasive easy to traumatize tooth roots and mandibular canal

Question 31

When can you not use interfragmentary firing

Answer 31

1) comminuted fractures 2) Large defects 3) Fractures secondary to periodontal disease you need to have fracture pieces that fit together like a puzzle

Question 32

What are the pros and cons of interfragmentary wiring

Answer 32

Pros: can lead to very stable fracture repairs Negative: very technique sensitive and invasive easy to traumatize tooth roots

Question 33

for rigid stabilization, external fixation is usually inappropriate where

Answer 33

in the oral cavity

Question 34

for rigid stabilization internal fixation is typically

Answer 34

mini plates

Question 35

What are the pros and cons of rigid stabilization

Answer 35

Pros: -useful in edentulous patients -useful in very comminuted or caudal fractures Cons: -Difficult to avoid iatrogenic injury to teeth -Difficult to avoid trauma to neurovascular structures -Very expensive

Question 36

What are the cons of rigid stabilization

Answer 36

-Difficult to avoid iatrogenic injury to teeth -Difficult to avoid trauma to neurovascular structures -Very expensive

Question 37

What are the pros of rigid stabilization

Answer 37

-useful in edentulous patients -useful in very comminuted or caudal fractures

Question 38

What should you do for post-operative management of maxillofacial trauma cases

Answer 38

1) appropriate pain management- nocita, NSAIDS, buprenorphine, opioids 2) soft food/gruel diet +/- feeding tube 4) observation of apparatus +/- removal of apparatus Recheck radiographs rarely send home antibiotics unless lots of hardware

Question 39

What is the checklist that you should go through with mandibular fractures

Answer 39

1) Pediatric? 2) Fracture displaced? 3) Fracture comminuted? 4) Is soft tissue interrupted? 5) Are there teeth involved, can they stay? 6) Are there enough teeth for interdental wiring?