Maxillofacial Trauma Flashcards
Enumerate your treatment priorities in maxillofacial trauma patients. In the right order
- CNS injuries (GCS)
- thoracoABD (ABD rigidity etc.)
- Soft tissue injuries (larynx etc.) (facial extremity trauma)
- Fractures (last)
Differentiate open reduction from closed reduction
Open – incisions to directly expose the bone to be repaired
Closed – fracture will not require any incision to position the bone
With limited resources, what is the best radiographic imaging you can request for?
Upright waters view to also see the air-fluid level
Fracture that is the most common bone injury involving the face.
Nasal fractures
Enumerate the usual signs of nasal fractures
• 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
What is the management for nasal fracture complication->septal hematoma?
Incision and drainage, septoplasty
2nd most common fracture of the facial skeleton
mandibular fracture
Enumerate at least 5 anatomic weaknesses of the mandible
- Incisive fossa/ mental foramen
- Impacted/unerupted teeth
- Cysts/abscesses
- Edentulousness
- Angle & condyle- poorly resistant to lateral forces
- Thin alveolar process
Enumerate the anatomic strengths of the mandible
- thickened lower margin
- crests
List the incident of commonly fractured regions of the mandible
Boies-ABC (Angle, Body, Condyle)
Doc- CBA
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
favorable -A
unfavorable-B see page 4 of trans
Diagnostic of mandibular fractures (as per Dr. Alcira)
- Malocclusion/ open bite deformity
- palpable step-ladder deformity
Which of the following cannot be observed in mandibular fractures? A. abnormal taste B. ecchymosis trismus C. ear bleed D. open bite deformity
A. abnormal taste
ear bleeding can happen
What does it mean if there is ear bleeding in a patient with mandibular fracture? explain why.
Condyle was fractured and the force was strong enough to rupture the external canal. Condyle is near to the canal making this possible
Imaging to be requested for in mandibular fractures
AP view or waters, lateral oblique. never lateral because of superimpositions
Initial management for mandibular fractures
asses ABC
- fracture immobilization
- fracture alignment
Type of bandaging for mandibular fractures
figure-of-8 or Barton’s bandage technique
Definitive for fractures of the body of the mandible accdg to favorable and unfavorable fractures
DEFINITIVE MGT: fracture reduction
- FAVORABLE BODY & CONDYLAR: CLOSED reduction
- UNFAVORABLE: OPEN reduction
Principle for the definitive management for mandibular fractures. Enumerate how it’s done.
Determine and restore the pre-injury occlusion by interdental wiring and intermaxillary fixation
What is the conventional xray ordered for zygoma and orbital floor fractures? What will you look for?
Upright water’ view, look for Tear Drop sign
Type of test done in zygoma and orbital floor fractures to check for extraocular muscle entrapment
Forced Duction test
Describe Le fort I
- low transverse fracture of maxilla involving the palate only
- mobility or displacement of maxillary dental arch and palate;
- dental malocclusion is usually present
Describe Le fort II
- 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
Describe Le Fort III
- involves complete disruption of attachments of facial skeleton to the cranium
- entire zygomaticomaxillary complex may be mobile and displaced
Most serious condition among facial fractures
Midface fractures
AKA Zygomaticomaxillary complex fracture
tripod/trimalar fracture
Diagnose the type of fracture- telecanthus, (+) bow string test, epistaxis, periorbital swelling
Naso-Orbitoethmoidal (NOE) fractures
Differentiate NOE I and NOE II
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
Enumerate at least 3 sequelae of maxillofacial fractures
infection malunion non-union impairment of loss of function (TMJ ankylosis) cosmetic deformity
Type of le Fort that results in floating palate
Le Fort I Low palate or Guerin Fracture 20-30%
Type of Le Fort resulting to floating maxilla
Le Fort II Pyramidal fracture 35-55%
type of Le Fort resulting to dishpan deformity
Le Fort III Craniofacial dysjunction 5-15%
What is the P.E. finding in midface fractures that if absent could indicate that fractures are locked on each other?
Drawer Sign
When a fracture involved the frontal recess, what is necessary management to prevent mucocele formation?
Fractures involving the frontal recess- should include cannulation of the frontal recess (not keeping it patent can lead to the complication-> mucocele
What is the least common type of maxillofacial fracture?
Frontal sinus fracture because tremendous force is needed to fracture this
3 areas involved in frontal sinus fracture?
anterior table, posterior table, frontal recess that opens to the middle meatus
Complication of an untreated or improper treatment of frontal sinus fracture
mucocele
gold standard for diagnosis CSF rhinorrhea
CT scan contrast
When is CSF rhinorrhea (+) in Filter paper test
(+) halo sign
Other maneuvers to detect CSF rhinorrhea
- unilateral
- affected by head position (Head Bow)
- increasing the jugular vein compression
Type of fracture that results from blunt eye trauma with prolapsing of the intraocular contents into the maxillary sinus
“Blow-out fractures”- isolated fractures involving the orbital floor with sparing of the orbital rims
benefits of using arch bars in managing mandibular fractures
Like arch bars, parang braces. When you wire the jaw shut you
- Reestablish alignment
- Restore occlusion
- Immobilize the mandible
- Reduce the fracture
* *Without interdental and intermaxillary you may be reducing the fracture without correcting the occlusion.
Enumerate the type of mandibular fractures from the most common to the least common
1st Condyle, 2nd Body, 3rd Angle
remember CBA
Common fractures you see in children
greenstick/incomplete fractures
What are the 2 conditions wherein you do immediate reduction of the fracture?
We only do immediate reduction of the fracture if
- If it will control the bleeding
- If it is interrupting the airway
if the coronoid is the only fracture, what is your management?
None. Leave it alone.
What is your management for coronoid fracture with trismus?
coronoidectomy
Oral hygiene in mandibular fracture patients is best done with what?
pulsed water jet device (water pik)
What is the sequelae for untreated zygoma and orbital floor fractures?
flattened cheek, ocular complications
Fractures of the orbital floor may only be manifested by this finding. Explain the mechanism behind it.
restricted upward gaze d/t entrapment of the inferior rectus muscle
What is the nerve damaged if there is hyperthesia of the cheek in zygoma and orbital floor fractures? be specific
maxillary division of the trigeminal nerve.
Imaging helpful for orbital fractures
planigraphic or CT
When the neck is palpated and free air and crepitation was noted what injury do you suspect?
rupture of tracheobronchial tree, and laryngeal fracture
For how long can reduction and fixation of facial fractures be postponed?
4th to 6th day
Facial fractures should be reduced within what time period to avoid malunion or nonunion?
within 1st 2 weeks
Best radiograph to request for nasal fracture?
lateral radiograph
What is the best radiograph requested for fractures of the middle 3rd of the face and paranasal sinuses?
Waters projection (Boies)
best radiograph for mandibular fractures
panoramic radiograph
Principle for treating facial injuries
” if in doubt, preserve tissue”
Most common type of nasal fracture
depression of one nasal bone with contralateral displacement of nasal pyramid
