Maxillofacial trauma Flashcards
What is the most common isolated facial bone fracture?
Nasal bone fracture
What causes facial fractures most often?
Interpersonal violence and motor vehicle accidents
Other causes include falls, sports, and industrial injuries
How does alcohol affect maxillofacial trauma?
Alcohol is an aggravating factor
Who commonly gets maxillofacial injuries?
80% are males aged 20 - 35
How is energy helpful in understanding the severity of trauma?
Kinetic energy is directly direct related to injury severity and is predicted by 1/2 inertia and v^2.
What are the symptoms of a base of skull fracture?
Base of skull fracture (Bone in base of skull. Symptoms include bruising behind the ears, bruising around the eyes and bleeding behind the eardrum.
CSF leak occurs in 20% of cases.
This results in fluid leaking from the nose or the ear.
What are the types of head injury associated with contact?
Scalp laceration
Skull fracture
Coup
Epidural haematoma
Subdural haematoma
What head injuries are associated with acceleration?
Concussion
Contrecoup
Subdural haematomas
Diffuse axonal injury.
How do sinuses protect from brain injuries during facial trama?
The sinuses act like crumple zones to distribute and absorb energy to protect the brain.
Which anatomical structures of the face are most commonly injured?
Nose
Lower third of the facial skeleton is more prominent and so it is more commonly fractured. It is also the most common cause for surgical intervention.
What causes lower third of the face fractures most often?
Assaults. Lateral forces.
The mandible is made of U shaped bone. What should you look for if it is fractured?
Look for contralateral fractures on the other side.
How does the the TMJ protect the face from injury?
Mandible articulates with temporal bone at the TMJ which acts as a crumple zone
How should cervical spine injuries be managed if they occur with facial fractures?
Stabilize the cervical spine with a rigid collar until the spine injury is ruled out.
ATLS-ABC
What are the common features of a frontal bone fracture?
High energy impact
Usually involves the anterior table. Can involve the posterior table as well but that is less common but more significant because it may affect the cranial cavity.
Produces a cosmetic defect
How should frontal bone fractures be managed?
Requires joint management by maxillofacial and neurosurgical teams
What are the anterior and posterior tables of the frontal bone?
The anterior surface of the frontal bone on the side facing forehead skin and is a part of the sinus.
Posterior table is the other side of the sinus facing the cranial cavity.
How should soft tissues and oral cavity be assessed following trauma?
Assess for disfigurement and damage to underlying anatomical structures such as parotid ducts, vessels, and nerves.
Foreign bodies and debris should be removed with lavage
Oral cavity should be checked for tongue laceration, deranged occlusion, IAN damage and parasthesia
What midface structures should be assessed following trauma injuries?
Nasal bone, maxilla, zygomatic arch, zygomatic complex, orbit.
What causes nasal bone fractures most often?
Main cause is interpersonal violence
How do you treat nasal bone fractures prior to surgery?
Assess for asymmetry and mobility clinically
Manage epistaxis
Allow 5-7 days for the oedema to resolve, facilitating precise operative intervention
What are the features of zygomatic bone fractures?
Periorbital swelling and ecchymoses
Subconjunctival haemorrhage
Palpable step at the infraorbital margin or lateral brow area
Infraorbital nerve involvement
Depression of the malar eminence
Diplopia is common due to orbital involvement
What are the features of orbital fractures?
Medial and inferior walls of the orbital skeleton are exquisitely thin
Commonly involved in zygomatic complex fractures
Also occur as an isolated injury due to a direct blow to the orbit or orbital rim
Assessment of the eye is paramount when these injuries occur
Subconjunctival and periorbital haematoma are common
Diplopia occurs when the orbital muscles and soft tissues are trapped
What are the features of midface fractures?
Facial swelling with bilateral periorbital haemorrhages (raccoon signs)
Flattening and elongation of the midface
Dish face deformity
Test mobility of the maxilla
Patients often complain of malocclusion
What are le fort fractures?
Often includes any array of fronto-orbital, zygomatic, and nasoethmoidal fractures in combination with maxillary injury.
What is the difference between le fort 1, 2 and 3 injuries?
Le fort 1 = Maxilla involved up to the maxillary sinus
Le fort 2 = sinuses involved
Le fort 3 = the zygomatic bone involved as well as the sinuses.
What are the types of fractures?
Greenstick (Occurs in children)
Simple or closed
Comminuted
Compound
Pathological
What are the most common sites of fracture in the mandible?
Condyle
Body
Angle
What are the symptoms of a fractured mandible?
Pain
Swelling
Limited mouth opening
Mental parasthesia
Deviation of the mandible
Step deformity
Mobility at site
Haematoma
What are the management methods of a mandibular facture?
Closed reduction: IMF screws, eyelet wires, bonded brackets
What are the benefits and limitations of using closed reduction over surgery?
Less expensive
Does not traumatize vascular envelope
Period of immobilization (difficulty eating/weight loss)
Requires intact dentition
Requires patient compliance
Risk damage to roots
Gingivae inflammation/ poor oral hygiene
What are the benefits and limitations of using open reduction and internal fixation?
More expensive
Intra or extraoral approach
Periosteal stripping disturbs vascular envelope
Direct visualisation and reduction of fracture
Earlier return to normal function
Better nutrition
Better oral hygiene
What are the things to look out for with paediatric mandibular fractures?
Bony growth centres and developing tooth buds
Restoration of mandibular continuity important for function and also future craniofacial development
Conservative management if minimally displaced
TMJ - growth centre in children so beware of late sequlae (ankylosis)
How does edentulism affect the mandible?
Causes atrophy
Individuals develop comorbidities
Poor healing
Poor bone stock
How should people with mandibular fractures that have undergone surgery be treated post surgery?
Soft diet important in patients who have undergone open reduction internal fixation
Patients placed in intermaxillary fixation need to be advised about nutritional issues and oral hygiene instructions
Postoperative radiographs and clinical assessment to check for:
- fracture healing
- fracture segment alignment and status of occlusion
How does mechanism of injury affect the treatment?
Mechanism of injury important in history taking
Patterns of injury from type of mechanism deployed
Injury prevention as part of continuum of care – mouthguard, helmets.
