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13 ENT > Maxillofacial Trauma 2 > Flashcards

Maxillofacial Trauma 2 Flashcards

1
Q

initial assessment of trauma patient

A

airway
breathing
circulation

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2
Q

evaluation of facial injuries

A
  • inspect but don’t explore
  • note for asymmetry, paralysis, weakness
  • basic visual acuity test
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3
Q

waters view is for the assessment of

A

nasal and malar bone, tripod fractures, rim and maxillary sinus, maxillary bones and orbit

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4
Q

townes view is for

A

mandible

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5
Q

lateral view is for

A

frontal bone and sinus, mandible

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6
Q

submentovertex view is for

A

zygomatic arch, other arches

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7
Q

postero-anterior mandible and oblique view is for

A

mandible

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8
Q

caldwell view is for

A

frontal sinus and ethmoid sinus

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9
Q

when is ct scan not necessary

A

nasal bone, malar bone, mandible

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10
Q

ct scan indicated for fractures of

A

orbit, frontal sinus, midface, condyles, temporal bone, larynx

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11
Q

___ is easiest to fracture, ___ is hardest to fracture

A

nasal is easiest, frontal is hardest

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12
Q

key principles in treatment of facial injuries

A

reduction: returning bones to their correct place
fixation: holding bones/fragments together (wires, metal splinting, plating)

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13
Q

closed reduction with maxillomandibular fixation is indicated for

A

nasal bone fracture

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14
Q

what is open reduction with internal fixation

A
  • fractures other than nasal bone
  • uses surgical stainless wiring to affix malar bones
  • uses titanium plates or screws for fixation
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15
Q

most common fracture of the face

A

nasal bone fracture

motion: inferolateral or posteroinferior displacement
visually: deviation of the nasal arch with distortion of one side

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16
Q

treatment for nasal bone fracture

A

closed reduction under anesthesia (uses boie’s elevator, asch forceps, walsham)

closed reduction, external splinting, septorhinoiplasty

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17
Q

indication for external splinting

A

nasal bone cannot be reduced by closed reduction

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18
Q

types of lefort fractures

A

type 1 (guerin): maxilla separates anteriorly (drawer sign)

type 2 (pyramidal): fracture separates the middle part of the nose and maxilla from the rest of the skull

type 3 (craniofacial disjunction): type 2 + fracture of zygomatic arch

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19
Q

management of maxillary fractures

A
  • open reduction with internal fixation (plates)

- tools: rowe disimpaction forceps

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20
Q

how to inspect for fractures of the mandible

A
  • malocclusion: ask patient to bite

- angle fractures are most common, then condylar process and symphisis

21
Q

elevators of the mandible

A

temporalis, masseter, medial pterygoid, lateral pterygoid

22
Q

depressor retractors in mandible

A

digastric, geniohyoid, genioglossus, mylohyoid

23
Q

protrusors in mandible

A

lateral pterygoid

24
Q

favorable fracture lines

A
  • natural action of muscles will keep bony fragments in place
  • fragments are pressed firmly together when muscles act on mandible
25
Q

unfavorable fracture lines

A
  • natural action of muscles will dislodge bony fragments

- fragments are pulled away from each other when muscles act on mandible

26
Q

most important xray for mandible fractures

A

panoramic radiograph of the mandible

27
Q

most common method used to manage mandible fractures

A

open reduction with internal fixation

  • open reduction: reset bones
  • internal fixation: attach and fix screws
28
Q

method used in mandible fractures when microplates and miniplates were not yet available

A

external fixation

29
Q

what is interdental wiring and intermaxillary fixaiton

A
  • management for mandible fracture

- pulling arch bars and rubberbands to bind teeth for 6-8 weeks

30
Q

how to inspect for frontal sinus fractures

A

note depressions of arch above nose

31
Q

complications of untreated frontal sinus fractures

A
  • mucocele formation-> eye proptosis -> brain erosion

- meningitis

32
Q

treatment for frontal sinus fractures

A
  • prevent complications!!
  • obliteration: remove all sinus mucosa and obliterate sinus cavity, use autologous tissue to fill obliterated sinus
  • cranialization: indicated if there is csf leak, bone is removed and allow the brain to collapse forward
33
Q

contraindication for obliteration of sinuses in frontal sinus fracture

A

if posterior wall is absent or not intact (csf leak)

34
Q

most common site for orbital fracture

A

orbital floor (blowout fracture)

  • eye absorbs energy and gets displaced
  • maxillary sinus roof collapses
  • eye muscles can be entangled in bone
35
Q

indications for surgery in orbital fractures

A

double vision due to muscle entrapment or posterior displacement of eyeball

36
Q

2nd most common facial fracture and most common cause

A

zygomaticomaxillary complex fractures

commonly caused by interpersonal violence (unilateral)

37
Q

classification of zygoma fractrues

A

read

38
Q

symptoms of zygomaticomaxillary complex fractures

A

diplopia, anesthesia-hypesthesia, trismus, epistaxis, subconjunctival hemorrhage, periorbital ecchymosis

39
Q

signs of zygomaticomaxillary complex fractures

A

facial contour flattening, slanted palpebral opening, extraocular muscle limitation of movement, ptosis, enopthalmos, step-offs, point tenderness, mucosal ecchymosis

40
Q

how is the eye displaced

A

fracture -> orbit gets larger > eye sinks deeper / displaced inferiorly (whitnall’s tubercle pulls the eye downward by the ligament of lockwood via lateral canthus)

41
Q

what is a step off

A

can be palpated when there is a fracture at the lower rim (where zygomatic and maxillary meet) = disconnection of bones, zygomatic is disconnected, maxillary intact

42
Q

____ bleeds causing epistaxis in tripod fractures

A

maxillary sinus

43
Q

fracture line can pass through ___ causing anesthesia-hypesthesia

A

infraorbital nerve

44
Q

direct signs of tripod fracture in radio

A
  • cortical break, defect, separation
  • cortical overlap
  • abnormal linear density or intensity
  • abnormal cortical angulation
  • absent bony fragment
  • osseus displacement
45
Q

indirect signs of tripod fracture

A
  • soft tissue swelling / hematoma
  • soft tissue emphysema
  • soft tissue displacement
  • paranasal sinus fluid or blood
46
Q

indications for ct scan in tripod fracture

A
  • suspected orbital floor fracture
  • comminuted or severely displaced fracture
  • injuries associated with other facial fractures
47
Q

continuity of ___ indicates a lack of fracture

A

3 lines of dolan

48
Q

treatment for tripod fracture

A
  • open reduction internal fixation
  • maxillary packing technique
  • kazanjian method
  • wire pin extension
49
Q

treatment of zygomatic fracture

A
  • gilies approach

- insert instrument to lift arch

13 ENT (18 decks)

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