MAXILLOFACIAL TRAUMA (TB) Flashcards
What does craniomaxillofacial trauma entail?
Trauma to the facial skeleton.
What types of trauma can affect the face?
Blunt, sharp, and other types of trauma.
Who manages injuries located in the front of the neck?
ENT specialists.
What is the ultimate goal of treatment in facial trauma?
Repair and restore appearance and function to an acceptable level for both patient and physician.
What functions of the face must be preserved in trauma management?
Breathing and mastication.
What is the only absolute indication for surgical management in facial fractures?
Compromised breathing due to fractures like nasal or maxillary fractures.
When is surgical management required for mandibular fractures?
When it affects chewing and function, considering the patient’s budget.
When does cosmesis become an indication for surgery?
When the patient is concerned about facial appearance.
What is the most common cause of facial injuries?
Motor vehicular accidents (MVAs).
Why are work and sports injuries common causes of nasal bone fractures?
Because the nose is protruded and prone to impact.
What types of bites can cause facial trauma?
Human and animal bites such as horse bites.
What is the male to female ratio for maxillofacial trauma?
2:1 (M > F).
At what age is maxillofacial trauma most common?
First three decades of life, but also common in working adults in their 40s.
What is the first priority when a trauma patient is brought to the ER?
Check airway, breathing, circulation, and disability.
What should you ask once the trauma patient is stabilized?
Date, time, place, and mode of injury.
Why is it important to know the patient’s premorbid appearance?
To guide restoration of facial structure.
What must be checked before repairing facial lacerations?
Presence of foreign bodies like stones, glass, or dust.
What should be checked during palpation of facial trauma?
Step-off deformities and mobility.
What might Battle’s sign indicate?
Temporal bone fracture.
What is the significance of visual loss in facial trauma?
It may be unreliable due to swelling and blood.
What does anterior rhinoscopy assess?
Epistaxis, obstructions, and foreign bodies.
What is the anterior drawer sign used for?
Detecting maxillary fracture.
How many facial buttresses are there?
Eight: four vertical and four horizontal.
What are the vertical facial buttresses?
Ascending ramus of the mandible, zygomaticomaxillary, nasomaxillary, and pterygomaxillary buttress.
What are the horizontal facial buttresses?
Frontal bar, orbital rim, upper and lower transverse maxilla and mandible.
Which bone is the strongest in the face?
Frontal bone.
How much G-force is needed to fracture the nasal bone?
30 G-force.
What bones are included in upper third facial fractures?
Anterior/posterior tables of frontal sinus, frontal outflow tracts, supraorbital rims, glabella.
What is the most common type of frontal sinus fracture?
Combination of anterior and posterior tables with/without frontal recess involvement.
What does hemosinus indicate?
Presence of blood inside the fractured sinuses.
What facial bones are part of the middle third?
Zygomas, inferior orbital rim, maxilla, nose.
Which bones contribute to the orbit?
Frontal, zygomatic, maxillary, lacrimal, lamina papyracea, greater/lesser wing of sphenoid.
What is the significance of the orbital apex?
Injury can cause Superior Orbital Fissure Syndrome (CN III, IV, V, VI affected).
What are blowout fractures?
Orbital wall fractures with intact orbital rims due to blunt force.
What is a Zygomaticomaxillary Complex (ZMC) fracture?
Fractures involving the orbit, zygoma, and maxilla.
What are complications of ZMC fractures?
Temporalis muscle impingement, trismus, infraorbital hypoesthesia.
What is another term for ZMC fracture?
Tripod fracture.
What defines a Markowitz Type I NOE fracture?
Large central fragment with MCL attachment; treated with rigid fixation.
What defines a Markowitz Type II NOE fracture?
Significant comminution, repairable MCL; requires transnasal fixation.
What defines a Markowitz Type III NOE fracture?
Detached or unstable MCL fragment; treated with transnasal fixation.
What structure does the medial orbital wall protect?
Optic nerve, globe
What does the orbital floor protect?
Globe
What does the maxillary sinus protect?
Globe, middle cranial fossa
What structures are protected by the ethmoid sinus?
Globe, optic nerve, anterior cranial fossa, middle cranial fossa
What structure is protected by the frontal sinus?
Anterior cranial fossa
What structures are protected by the sphenoid sinus?
Carotid arteries, Cavernous sinus
What does the face as a whole protect?
Cranial cavity
What does the condylar neck of the mandible protect?
Middle cranial fossa
What nerve can be affected in mandibular fractures?
Inferior alveolar nerve
What are clinical signs of a mandibular fracture?
Changes in occlusion, trismus, malocclusion, limited mouth opening
Which structures are involved in Le Fort I fracture?
Above maxillary dentition, nasal septum, posterior maxillary walls, pterygoid plates
Which bones are fractured in Le Fort II?
Zygomaticomaxillary buttress, inferior orbital rim and floor, medial orbit, nasal root/bones
What defines a Le Fort III fracture?
Complete craniofacial disjunction at the skull base, separation of zygomas from temporal and frontal bones, lateral and medial orbit involvement
What is the principle order of fracture repair in panfacial trauma?
Known to unknown, stable to unstable, lateral to medial, up to down or down to up depending on the case
What is Angle’s Class I occlusion?
Normal occlusion: mesiobuccal cusp of maxillary first molar in the mesiobuccal groove of mandibular first molar
What is Angle’s Class II occlusion?
Maxillary molar is more anterior to mandibular molar
What is Angle’s Class III occlusion?
Maxillary molar is more posterior to mandibular molar
What is the diagnostic modality of choice for facial fractures?
Plain facial CT scan with 3D reconstruction
Which X-ray is used when CT is not available for maxillary fractures?
Water’s View X-ray
What imaging is best for dentoalveolar or mandibular fractures?
Panoramic X-ray
What are the first three steps in managing maxillofacial trauma?
Anesthesia, wound debridement, infection control
What are the functional goals in maxillofacial trauma management?
Breathing, vision, mastication
What are the cosmetic goals in maxillofacial trauma management?
Restore appearance
When is surgery required for frontal sinus fracture?
Posterior table fracture, comminution, CSF leak
What is cranialization in frontal sinus fracture management?
Repair of anterior table and removing sinus space if CSF leak or posterior table fracture exists
When do we just observe in upper third facial fractures?
Minimal displacement, no CSF leak, asymptomatic
When do we just observe in middle third facial fractures?
Minimal displacement, asymptomatic, no breathing or nerve issues
When do we just observe in lower third facial fractures?
Minimal displacement, asymptomatic, no malocclusion or TMJ dysfunction
What is the coronal approach used for?
Upper third facial fractures, especially frontal sinus
What approach allows access without facial scars for middle/lower third fractures?
Gingivobuccal-vestibular approach
What are the steps in repairing panfacial fractures?
Establish occlusion, reestablish facial height, maxilla repositioning, nose and NOE repair, orbital wall repair
What are complications of maxillofacial fracture repair?
Malocclusion, malunion, nonunion, globe malposition, infections, pseudoarthrosis, nerve injury, scars, brain/ocular injury
What happens if titanium plates are placed without reducing fracture lines?
Pointless fixation; proper reduction must come first
