Maxillofacial Trauma

Question 1

Enumerate your treatment priorities in maxillofacial trauma patients. In the right order

Answer 1

1. CNS injuries (GCS)
2. thoracoABD (ABD rigidity etc.)
3. Soft tissue injuries (larynx etc.) (facial extremity trauma)
4. Fractures (last)

Question 2

Differentiate open reduction from closed reduction

Answer 2

Open – incisions to directly expose the bone to be repaired

Closed – fracture will not require any incision to position the bone

Question 3

With limited resources, what is the best radiographic imaging you can request for?

Answer 3

Upright waters view to also see the air-fluid level

Question 4

Fracture that is the most common bone injury involving the face.

Answer 4

Nasal fractures

Question 5

Enumerate the usual signs of nasal fractures

Answer 5

• The usual signs of nasal fracture are:

(1) depression or displacement of the nasal bones
(2) edema of the nose
(3) epistaxis
(4) fracture of the septal cartilage with displacement or mobility

Question 6

What is the management for nasal fracture complication->septal hematoma?

Answer 6

Incision and drainage, septoplasty

Question 7

2nd most common fracture of the facial skeleton

Answer 7

mandibular fracture

Question 8

Enumerate at least 5 anatomic weaknesses of the mandible

Answer 8

• Incisive fossa/ mental foramen
• Impacted/unerupted teeth
• Cysts/abscesses
• Edentulousness
• Angle & condyle- poorly resistant to lateral forces
• Thin alveolar process

Question 9

Enumerate the anatomic strengths of the mandible

Answer 9

• thickened lower margin

- crests

Question 10

List the incident of commonly fractured regions of the mandible

Answer 10

Boies-ABC (Angle, Body, Condyle)

Doc- CBA

Question 11

When is a fracture of the mandible’s body favorable? When is it unfavorable?
A- diagonally from the first molar to the chin (postero-anterior)
B- diagonally anteroposterior

Answer 11

favorable -A

unfavorable-B see page 4 of trans

Question 12

Diagnostic of mandibular fractures (as per Dr. Alcira)

Answer 12

• Malocclusion/ open bite deformity

- palpable step-ladder deformity

Question 13

Which of the following cannot be observed in mandibular fractures?
A. abnormal taste
B. ecchymosis
trismus 
C. ear bleed
D. open bite deformity

Answer 13

A. abnormal taste

ear bleeding can happen

Question 14

What does it mean if there is ear bleeding in a patient with mandibular fracture? explain why.

Answer 14

Condyle was fractured and the force was strong enough to rupture the external canal. Condyle is near to the canal making this possible

Question 15

Imaging to be requested for in mandibular fractures

Answer 15

AP view or waters, lateral oblique. never lateral because of superimpositions

Question 16

Initial management for mandibular fractures

Answer 16

asses ABC

1. fracture immobilization
2. fracture alignment

Question 17

Type of bandaging for mandibular fractures

Answer 17

figure-of-8 or Barton’s bandage technique

Question 18

Definitive for fractures of the body of the mandible accdg to favorable and unfavorable fractures

Answer 18

DEFINITIVE MGT: fracture reduction

• FAVORABLE BODY & CONDYLAR: CLOSED reduction
• UNFAVORABLE: OPEN reduction

Question 19

Principle for the definitive management for mandibular fractures. Enumerate how it’s done.

Answer 19

Determine and restore the pre-injury occlusion by interdental wiring and intermaxillary fixation

Question 20

What is the conventional xray ordered for zygoma and orbital floor fractures? What will you look for?

Answer 20

Upright water’ view, look for Tear Drop sign

Question 21

Type of test done in zygoma and orbital floor fractures to check for extraocular muscle entrapment

Answer 21

Forced Duction test

Question 22

Describe Le fort I

Answer 22

• low transverse fracture of maxilla involving the palate only
• mobility or displacement of maxillary dental arch and palate;
• dental malocclusion is usually present

Question 23

Describe Le fort II

Answer 23

• pyramidal fracture involves fracture en bloc of the palate and middle third of the face, including the nose
• mobility of palate
• nose en bloc
• significant epistaxis

Question 24

Describe Le Fort III

Answer 24

• involves complete disruption of attachments of facial skeleton to the cranium
• entire zygomaticomaxillary complex may be mobile and displaced

Question 25

Most serious condition among facial fractures

Answer 25

Midface fractures

Question 26

AKA Zygomaticomaxillary complex fracture

Answer 26

tripod/trimalar fracture

Question 27

Diagnose the type of fracture- telecanthus, (+) bow string test, epistaxis, periorbital swelling

Answer 27

Naso-Orbitoethmoidal (NOE) fractures

Question 28

Differentiate NOE I and NOE II

Answer 28

NOE I-Medial canthan tendon is intact and connected to a single large fracture fragment NOE II: comminuted of NOE complex, but with intact medial canthal attachments

Question 29

Enumerate at least 3 sequelae of maxillofacial fractures

Answer 29

``` infection malunion non-union impairment of loss of function (TMJ ankylosis) cosmetic deformity ```

Question 30

Type of le Fort that results in floating palate

Answer 30

Le Fort I Low palate or Guerin Fracture 20-30%

Question 31

Type of Le Fort resulting to floating maxilla

Answer 31

Le Fort II Pyramidal fracture 35-55%

Question 32

type of Le Fort resulting to dishpan deformity

Answer 32

Le Fort III Craniofacial dysjunction 5-15%

Question 33

What is the P.E. finding in midface fractures that if absent could indicate that fractures are locked on each other?

Answer 33

Drawer Sign

Question 34

When a fracture involved the frontal recess, what is necessary management to prevent mucocele formation?

Answer 34

Fractures involving the frontal recess- should include cannulation of the frontal recess (not keeping it patent can lead to the complication-> mucocele

Question 35

What is the least common type of maxillofacial fracture?

Answer 35

Frontal sinus fracture because tremendous force is needed to fracture this

Question 36

3 areas involved in frontal sinus fracture?

Answer 36

anterior table, posterior table, frontal recess that opens to the middle meatus

Question 37

Complication of an untreated or improper treatment of frontal sinus fracture

Answer 37

mucocele

Question 38

gold standard for diagnosis CSF rhinorrhea

Answer 38

CT scan contrast

Question 39

When is CSF rhinorrhea (+) in Filter paper test

Answer 39

(+) halo sign

Question 40

Other maneuvers to detect CSF rhinorrhea

Answer 40

- unilateral - affected by head position (Head Bow) - increasing the jugular vein compression

Question 41

Type of fracture that results from blunt eye trauma with prolapsing of the intraocular contents into the maxillary sinus

Answer 41

"Blow-out fractures"- isolated fractures involving the orbital floor with sparing of the orbital rims

Question 42

benefits of using arch bars in managing mandibular fractures

Answer 42

Like arch bars, parang braces. When you wire the jaw shut you 1. Reestablish alignment 2. Restore occlusion 3. Immobilize the mandible 4. Reduce the fracture * *Without interdental and intermaxillary you may be reducing the fracture without correcting the occlusion.

Question 43

Enumerate the type of mandibular fractures from the most common to the least common

Answer 43

1st Condyle, 2nd Body, 3rd Angle | remember CBA

Question 44

Common fractures you see in children

Answer 44

greenstick/incomplete fractures

Question 45

What are the 2 conditions wherein you do immediate reduction of the fracture?

Answer 45

We only do immediate reduction of the fracture if 1. If it will control the bleeding 2. If it is interrupting the airway

Question 46

if the coronoid is the only fracture, what is your management?

Answer 46

None. Leave it alone.

Question 47

What is your management for coronoid fracture with trismus?

Answer 47

coronoidectomy

Question 48

Oral hygiene in mandibular fracture patients is best done with what?

Answer 48

pulsed water jet device (water pik)

Question 49

What is the sequelae for untreated zygoma and orbital floor fractures?

Answer 49

flattened cheek, ocular complications

Question 50

Fractures of the orbital floor may only be manifested by this finding. Explain the mechanism behind it.

Answer 50

restricted upward gaze d/t entrapment of the inferior rectus muscle

Question 51

What is the nerve damaged if there is hyperthesia of the cheek in zygoma and orbital floor fractures? be specific

Answer 51

maxillary division of the trigeminal nerve.

Question 52

Imaging helpful for orbital fractures

Answer 52

planigraphic or CT

Question 53

When the neck is palpated and free air and crepitation was noted what injury do you suspect?

Answer 53

rupture of tracheobronchial tree, and laryngeal fracture

Question 54

For how long can reduction and fixation of facial fractures be postponed?

Answer 54

4th to 6th day

Question 55

Facial fractures should be reduced within what time period to avoid malunion or nonunion?

Answer 55

within 1st 2 weeks

Question 56

Best radiograph to request for nasal fracture?

Answer 56

lateral radiograph

Question 57

What is the best radiograph requested for fractures of the middle 3rd of the face and paranasal sinuses?

Answer 57

Waters projection (Boies)

Question 58

best radiograph for mandibular fractures

Answer 58

panoramic radiograph

Question 59

Principle for treating facial injuries

Answer 59

" if in doubt, preserve tissue"

Question 60

Most common type of nasal fracture

Answer 60

depression of one nasal bone with contralateral displacement of nasal pyramid