Middle Third fractures Flashcards
Guerin Fracture is another name for
Lefort 1 also called as
horizontal or telescopic fracture
or Floating Maxilla fracture
Criteria for Glasgow Comma scale
Motor response
Verbal performance
eye opening
HALO ON PILLOW or Tramline effect is seen in
CSF rhinorrhea - Nasoethmoidal , lefort 2 and 3 fractures
CSF biochemical analysis in case of rhinorrhea is
Beta 2 transferrin (also present in perilymph and aqueous humour)
Beta 1 transferrin is seen in
Nasal secretions
Tears
Saliva
Management of CSF rhinorrhea
Bed rest, head elevation, fluid restriction, avoid nasal blowing, VALSAVA
Mannitol 100 ml IV
Acetazolamide
Antibiotics - Cephalosporins
Spontaneous closure within 1 week
lumbar drainage - next week
surgical - 3rd week
Epiphora seen in
Lefort 3
Athens displaced Zygomatic complex can be reduced by
Gillies Temporal Approach (GTA)
intraoral approach is Keen’s technique
Lefort 3 involves
Maxilla
Lacrimal
Nasal
Ethmoidal bones
Lefort 2 involves
Maxilla
Nasal
Lacrimal bones
Rowe’s Disimpaction forceps are used for
Reducing the tooth bearing portion of the upper jaw
Bristowe’s Elevator used for
elevating Fractured zygomatic bone
Asche’s / Walsham forceps is used for
Reduction of nasal complex fractures
For hypovolemic shock post trauma what solution is infused IV?
Ringer Lactate due To it’s high osmotic value maintains fluid in vascular compartment.
Hess Chart measures….?
The degree of diplopia I. maxillofacial trauma accurately
seen in - Zygomatic complex, lefort 2 And 3 # - passing Whitnells tubercle
Lefort 3 is also called …. when fracture line runs from fronto nasal suture transversely backward parallel with the base involving Ethmoidal bone and cribriform plate
Craniofacial Dysjunction
Moon face appearance seen in
Lefort 2 and 3
Patient with maxillofacial trauma requires …. mmol of sodium
100
Patient with maxillofacial trauma requires …. mmol of potassium
60 mmol
Gillies approach uses ….. Elevator
Bristowe’s Elevator
Zygomatic nerve supplies
Temple
Cheek
one side of upper lip
and side of 👃
Diplopia occura due to injury of
Inferior rectus
secondly inferior oblique
Ye most accurate diagnostic criteria for blowout fracture of orbital floor consists of
2 mm thick section of sagittal CT scans
and
lateral Hyppcycloidal tomograms
Treatment of Blowout Fracture of orbital floor should be made within
not before 10 days - edema to subside
2-3 weeks of injury
ENOPTHALMOSOUS greater than 3 mm
Grafts for orbital floor reconstruction
Alloplastic- Teflon , polyvinyl sponge
Allogenic- allogenic bone
Autologous - illiac crest
In traumatic telecanthus the intercanthal distance is increased to
35-40 mm
Fir diagnosis of Nasal Fractures
True Lateral and
15 - 30 degrees occipitomental projection
Redness in conjunctiva remains bright red due to
oxygenation of HB can take place through thin conjunctiva
Dautry procedure is used in
Chronic Subluxation of TMJ - Zygomatic arch is pushed down infront of Condyle - prevents dislocation to occur
Lefort 1 Osteotomy comprises of …. bones
5
two maxilla
vomer
pterygoid plates
Surgical approach for Frontonasal area is best by
Coronal method
Bicoronal approach gives best exposure to…. complex
Nasoethmoidal complex
Tetrapod of zygomatic fracture includes
Infraorbital rim - Infraorbital foramen
Lateral Orbital Wall
Zygomaticomaxillary buttress
Zygomatic arch (thin posterior)
Latency Phase of fracture healing lasts
5-7 days
but patients younger than 4-5 yrs have 0-2 days
Three Variables of distraction include
Rate
Rhythm
Time
Rate of distraction in young children is
2mm/day
in adults it’s 1 mm/d
geriatric patients 0.5 mm/d
Vascularity of Lefort 1 Osteotomy segment is by
Ascending Palatine
ascending pharyngeal of facial artery
Elevation of zygomatic arch is confirmed by
Audible crunch OR crack sound
Exophthalmos is seen in
Blow in #
Thyrotoxicosis
Grave’s Disease
Medullary Carcinoma
Combitube method of intubation is contraindicated in
Patients with innate gag reflex and in rare circumstance of caustic ingestion.
Not used in patients with notable upper airway or neck trauma, since placement is blind and may cause iatrogenic injury
Fiber-optic intubating bronchoscope can be used in
suspected cervical spine injury
Illizarov principal or distraction osteogenesis works on the principle of
law of Tension- stress meaning by gradual traction on living tissues created stresses that stimulate regeneration and active growth of certain structures
…… nervw injury is most common with transverse fracture of temporal bone
Facial nerve
In CSF levels of these enzymes indicate injury
LDH - Lactate Dehydrogenase
CK- creatinine kinase
Most common of facial fractures is
Nasal bone fracture
Antimongoloid slant is due to
downward displacement of zygoma a slant to the lateral canthus, ENOPTHALMOS and accentuation of supra tarsal fold of upper eyelid.
seen in LEFORT 3
Craniofacial dysostosis - Crouzon syndrome
mandibulofacial dysostosis - Teacher Collins Franacetti syndrome
