Maxillofacial Trauma 2 Flashcards
initial assessment of trauma patient
airway
breathing
circulation
evaluation of facial injuries
- inspect but don’t explore
- note for asymmetry, paralysis, weakness
- basic visual acuity test
waters view is for the assessment of
nasal and malar bone, tripod fractures, rim and maxillary sinus, maxillary bones and orbit
townes view is for
mandible
lateral view is for
frontal bone and sinus, mandible
submentovertex view is for
zygomatic arch, other arches
postero-anterior mandible and oblique view is for
mandible
caldwell view is for
frontal sinus and ethmoid sinus
when is ct scan not necessary
nasal bone, malar bone, mandible
ct scan indicated for fractures of
orbit, frontal sinus, midface, condyles, temporal bone, larynx
___ is easiest to fracture, ___ is hardest to fracture
nasal is easiest, frontal is hardest
key principles in treatment of facial injuries
reduction: returning bones to their correct place
fixation: holding bones/fragments together (wires, metal splinting, plating)
closed reduction with maxillomandibular fixation is indicated for
nasal bone fracture
what is open reduction with internal fixation
- fractures other than nasal bone
- uses surgical stainless wiring to affix malar bones
- uses titanium plates or screws for fixation
most common fracture of the face
nasal bone fracture
motion: inferolateral or posteroinferior displacement
visually: deviation of the nasal arch with distortion of one side
treatment for nasal bone fracture
closed reduction under anesthesia (uses boie’s elevator, asch forceps, walsham)
closed reduction, external splinting, septorhinoiplasty
indication for external splinting
nasal bone cannot be reduced by closed reduction
types of lefort fractures
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
management of maxillary fractures
- open reduction with internal fixation (plates)
- tools: rowe disimpaction forceps
how to inspect for fractures of the mandible
- malocclusion: ask patient to bite
- angle fractures are most common, then condylar process and symphisis
elevators of the mandible
temporalis, masseter, medial pterygoid, lateral pterygoid
depressor retractors in mandible
digastric, geniohyoid, genioglossus, mylohyoid
protrusors in mandible
lateral pterygoid
favorable fracture lines
- natural action of muscles will keep bony fragments in place
- fragments are pressed firmly together when muscles act on mandible
unfavorable fracture lines
- natural action of muscles will dislodge bony fragments
- fragments are pulled away from each other when muscles act on mandible
most important xray for mandible fractures
panoramic radiograph of the mandible
most common method used to manage mandible fractures
open reduction with internal fixation
- open reduction: reset bones
- internal fixation: attach and fix screws
method used in mandible fractures when microplates and miniplates were not yet available
external fixation
what is interdental wiring and intermaxillary fixaiton
- management for mandible fracture
- pulling arch bars and rubberbands to bind teeth for 6-8 weeks
how to inspect for frontal sinus fractures
note depressions of arch above nose
complications of untreated frontal sinus fractures
- mucocele formation-> eye proptosis -> brain erosion
- meningitis
treatment for frontal sinus fractures
- 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
contraindication for obliteration of sinuses in frontal sinus fracture
if posterior wall is absent or not intact (csf leak)
most common site for orbital fracture
orbital floor (blowout fracture)
- eye absorbs energy and gets displaced
- maxillary sinus roof collapses
- eye muscles can be entangled in bone
indications for surgery in orbital fractures
double vision due to muscle entrapment or posterior displacement of eyeball
2nd most common facial fracture and most common cause
zygomaticomaxillary complex fractures
commonly caused by interpersonal violence (unilateral)
classification of zygoma fractrues
read
symptoms of zygomaticomaxillary complex fractures
diplopia, anesthesia-hypesthesia, trismus, epistaxis, subconjunctival hemorrhage, periorbital ecchymosis
signs of zygomaticomaxillary complex fractures
facial contour flattening, slanted palpebral opening, extraocular muscle limitation of movement, ptosis, enopthalmos, step-offs, point tenderness, mucosal ecchymosis
how is the eye displaced
fracture -> orbit gets larger > eye sinks deeper / displaced inferiorly (whitnall’s tubercle pulls the eye downward by the ligament of lockwood via lateral canthus)
what is a step off
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
____ bleeds causing epistaxis in tripod fractures
maxillary sinus
fracture line can pass through ___ causing anesthesia-hypesthesia
infraorbital nerve
direct signs of tripod fracture in radio
- cortical break, defect, separation
- cortical overlap
- abnormal linear density or intensity
- abnormal cortical angulation
- absent bony fragment
- osseus displacement
indirect signs of tripod fracture
- soft tissue swelling / hematoma
- soft tissue emphysema
- soft tissue displacement
- paranasal sinus fluid or blood
indications for ct scan in tripod fracture
- suspected orbital floor fracture
- comminuted or severely displaced fracture
- injuries associated with other facial fractures
continuity of ___ indicates a lack of fracture
3 lines of dolan
treatment for tripod fracture
- open reduction internal fixation
- maxillary packing technique
- kazanjian method
- wire pin extension
treatment of zygomatic fracture
- gilies approach
- insert instrument to lift arch
