Maxillofacial Trauma II Flashcards
classification of fractures
- greenstick
- simple fracture
- comminuted fracture
- compound fracture (open)
greenstick fracture
incomplete fracture
simple fracture
single fracture line
comminuted fracture
results in multiple fractured segments
compound fracture (open)
communication with the external environment
how does a compound fracture (open) communicate with the external environment?
through…
- PDL
- sinus
- mucosa
- skin
symphysis of mandible
area between mental foramina
parasymphysis of mandible
posterior to canine and anterior to mental foramina
body of mandible
between mental foramina and distal of second molar
angle of mandible
distal of second molar and inferior aspect of ramus
ramus of mandible
between sigmoid notch and angle
condyle of mandible
between sigmoid notch and top of condylar head
T/F: with open fracture, forces are all tooth bearing
true
midface fractures
- lefort 1
- lefort 2
- lefort 3
- zygomaticomaxillary complex (ZMC)
- NOE
lefort 1 (horizontal)
may result from a force of injury directed low on the maxillary alveolar rim in a downward direction
lefort 2 (pyramidal)
result from blow to lower or mid maxillary area
lefort 3 (transverse)
may follow impact to the nasal bridge or upper maxilla
also referred to as craniofacial dysjunction
zygomaticomaxillary complex (ZMC)
cheekbone is fractured
what structures are involved in a NOE fracture?
- frontal sinus
- naso-orbital-ethmoid (NOE)
- orbital floor
dentoalveolar fractures
fracture to teeth and alveolar bone that may extend to adjacent bone
panfacial fractures
fracture of all the facial bones
goals of tx’ing facial fractures
- fracture healing
- return of normal fxn
- restore facial/dental esthetics
- restore occlusion
principles of managing facial fractures
- reduction
- stabilization
- immobilization
- prevent infection
- restoration of occlusion
tx options for facial fractures
- no tx
- closed reduction
- open reduction with internal fixation (ORIF)
- combo
non-surgical tx for facial fractures
- soft, no-chew diet
- close follow-up
- low tolerance for switching to surgical tx
T/F: there are many non-surgical tx options for facial fractures
false, very limited application
when is non-surgical tx of facial fractures indicated?
fractures WITHOUT MALOCCLUSION and a compliant patient
what type of facial fractures are indicated for non-surgical tx?
- subcondylar
2. greenstick
closed reduction
dentition of hte opposite arch used as the handle to reduce the fracture
what must the pt have in order to have closed reduction performed?
- good teeth
- favorable fracture
- min-moderate displacement
what happens after occlusion of patient with facial fracture is established
teeth then need to be wired together (maxillo-mandibular fixation)
what can be used to wire together teeth of patients with facial fracture for closed reduction?
- arch bars and MMF (maxillo-mandibular fixation)
2. ivy loops and MMF
how long should maxillo-mandibular fixation (MMF) be for?
4-8 weeks
the length of maxillo-mandibular fixation (MMF) depends on what?
- fracture(s)
- age of pt
- medical hx
open reducation with internal fixation (ORIF)
expose fractures and use direct visualization and dentition to manipulate segments into place then fixate with plates and screws
indications for open reducation with internal fixation (ORIF)
- grossly displaced
- cannot tolerate MMF
- need a short/absent period of MMF
which pts can’t tolerate MMF?
pts with seizures, lung disease
which type of patients need a short/absent period of MMF?
pts with condylar fractures
advantages of intraoral surgical approach
- no external scar
2. no FACIAL NERVE damage
disadvantages of intraoral surgical approach
- oral contamination
2. fracture reduction can be more difficult to reduce
advantages of of extraoral surgical approach
excellent access for reduction and fixaton
disadvantages of of extraoral surgical approach
- external scar
2. potential for facial nerve damage
what is involved in panfacial trauma?
- frontal bone
- ZMC
- NOE region
- maxilla and mandible
