Midface

Question 1

Another name for lefort 1 fractures

Answer 1

Guerin

Question 2

Describe lefort 1 fx

Answer 2

Above alveolar process with hard palate and pterygoid process, horizontally crossing through inferior/base of maxillary sinus and lower border of piriform aperture

With nasal septal involvement and pterygoid process

Question 3

What else should be considered in Lefort 1 fxs

Answer 3

Coexisting mandibular fx, especially subcondylar type

Question 4

Standard approach for lefort 1

Answer 4

Transoral vestibular incision

*midfacial degloving for higher fracture lines

Question 5

Typical incision site for lefort 1

Answer 5

Mobile mucosa 5-10mm above attached gingiva

Question 6

Qualities of an upper vestibular incision

Answer 6

Longer and higher laterally.

Question 7

This can be done in lefort 1 surgery to avoid lateral position of alar bases

Answer 7

Alar cinch technique

Question 8

Goal of treatment for lefort 1 fx

Answer 8

Correct repositioning of bones to restore relation to mandible, cranial base and rest of midface

Question 9

Most common configuration of occlusion if inappropriately established during surgery

Answer 9

Anterior open bite

Question 10

What can be used to reestablish occlusion in an edentulous patient?

Answer 10

Dentures or gunning splint

Question 11

Along which buttresses are plates and screws placed for lefort fx? Why?

Answer 11

Along medial and lateral vertical buttresses, due to higher bone density, thus adequate bone stock for stable screw anchorage

Question 12

Possible complications of screws in low density bone (3)

Answer 12

Screw loosening. Plate fractures. Midface collapse

Question 13

What kinds of plates are used for lefort 1? How many screws on each side?

Answer 13

L or Y shaped plates, mini 1.5/2.0, at least 2 screws

Question 14

Importance of plate adaptation (2)

Answer 14

Prevents secondary dislocation and excess mechanical stress on screw sites (which can kead to microfractures)

Question 15

Importance of plate adaptation (2)

Answer 15

Prevents secondary dislocation and excess mechanical stress on screw sites (which can kead to microfractures)

Question 16

Why is it important to fixate palatal fractures

Answer 16

To restore the width and projection of the maxillary arch

Question 17

Can you place a plate transmucosally for palatal fractures?

Answer 17

Yes if it is a locking miniplate

Question 18

Large anterior sinus wall defects should be treated with (2) to avoid (2)

Answer 18

Bone grafts or titanium mesh, to avoid contractions or problems with the infraorbital nerve

Question 19

What is a possible source of bone graft

Answer 19

Split calvarial bone graft

Question 20

How long is soft diet recommended for lefort 1 fx

Answer 20

4 weeks

Question 21

Is mmf required for post op lefort 1?

Answer 21

Consider for comminuted palatal fractures, up to 3 weeks

Question 22

Complications of lefort 1 inadequate reduction (6)

Answer 22

Inashortening of midface, anterior open bite, pseudoprognathism, asymmetry, malocclusion, superior rotation of nasal tip

Question 23

Usual cause of infection in lefort 1? How to solve it

Answer 23

Instability from loose screw or graft

Solve by removing depending on fx healing

Question 24

Articulations of Tripod/ZMC Fx

Answer 24

Frontal
Zygimaticomaxillary
Infraorbital
Zygomatic Arch
Lateral Orbital Wall

Question 25

Reliable positioning guide in the reduction of isolated ZMC fractures

Answer 25

Zygomaticosphenoid suture line

Question 26

Ideal CT view for NOE fx

Answer 26

Coronal

Question 27

Absolute indication for primary dorsal nasal bone grafting in NOE

Answer 27

Fractures that destroy the perpendicular plate of the ethmoid, the septum, and the nasomaxillary buttresses.

Question 28

Single most important step in restoring preinjury NOE

Answer 28

Restoration of premorbid medial canthal position

Question 29

Location of medial tendon insertion

Answer 29

5mm posterior to medial orbital rim, midway between roof and floor, just superior to upper edge if the lacrimal fossa

Question 30

Number of days bolsters for NOE are kept

Answer 30

10 days

Question 31

Number of days bolsters for NOE are kept

Answer 31

10 days

Question 32

Indications for open septal surgery for seotal fractures (3)

Answer 32

Septal hematima, septal deviation with nasal obstruction, protrusion of bone or cartilage thru septal mucosa (will preclude healing and give rise to recurrent epistaxis)

Question 33

Management for septal hematoma (3)

Answer 33

Incision, drainage, transseptal sutures

Question 34

Optimal timing of repair for septal fractures

Answer 34

5 days (delay may result in scarring and fibrosis)

Question 35

Golden period for closed nasal bone reduction

Answer 35

After 4-6 weeks, it is rarely successful

Question 36

Most reliable method for managing bony nasal deflections

Answer 36

Rhinoplasty, resecting dorsal humo and lateral osteotomies