Midfacial fractures Flashcards
What is the most likely facial structure that sustains trauma?
Nasal complex
What are the limits to the midface?
Zygomatic Frontal suture
Maxillary dental occlusal surface
What zygomatic complex is most likely to be fractured?
Left side
The paired _____ articulate with the frontal bone
and the maxilla.
nasal bones
The central location of the nose and its prominence on
the facial skeleton make ______ fractures the most
common facial fracture.
nasal bone
The ______ forms the midline support
structure of the nose.
nasal septum
The bony portion of the nasal septum consists of
the perpendicular plate of the _____ bone
posterosuperiorly and the _____ bone posteroinferiorly.
ethmoid; vomer
The ____ and _____ bones form the bony
floor of the nasal cavity.
maxilla and the palatine
The ___ and ______ forceps, are designed to reduce the displaced septum and impacted nasal bones.
The Asch and the Walsham
The maxilla is less dense and houses the
paranasal sinuses.
The ______ is classically described as a quadrilateral bone that articulates with the temporal, sphenoidal, frontal, and maxillary bones, thus creating 4 different sutures
zygoma
The _______ of the orbit is made of: Maxillary bone and part of
zygoma bounded laterally by the inferior orbital fissure
and small part of the ethmoid bone
Floor of orbit
Optic nerve (CN-II), enters the orbit ________
to the true apex!
superio-medially
Bones forming the _______:
Frontal, Zygomatic, Ethmoid, Lacrimal,
Maxilla, Palatal, Sphenoid
Orbit
The shape of the ____ is like a Four-sided
pyramid or cone
orbit
The_____ is composed of a
confluence of four paired bones:
* Lateral nasal bones (2) ,
* Frontal processes of the maxilla (3) ,
* lacrimal bones (4) ,
* Lamina papyraceae of the ethmoid bones (5)
NOE complex
The ______ is the portion of the ethmoid bone that most frequently sustains injury in trauma
Lamina papyracea of ethmoid bone
Functionally, though composed of thin bone, the
bony part of the midface has focal areas of
strength referred to as ________.
Buttresses
The medial butresses are the nasomaxillary, the lateral zygomaticomaxillary, & posterior pterygomaxillary butresses.
These butresses serve to withstand occlusal or masticatory forces.
The buttress radiate forces cephalically from the maxilla to the base of skull.
Cosmetically, they serve to establish vertical height of the face.
Vertical maxillary buttresses
*Supraorbital rims
*Infraorbital rims
*Alveolar process of the maxilla
These buttresses help reinforce the vertical buttresses.
The frontal bar is the thick area of the frontal bone which supports the nasomaxillary & zygomaticmaxillary vertical
buttresses.
Below the eyes, you have the area of the infraorbital rim which supports the same vertical buttresses as the frontal bar.
The maxillary alveolar ridge is the inferior-most part of this buttrress of the midface
Horizontal maxillary buttresses
Repair of the _______ buttresses restores vertical height and increases resistance to occlusal forces.
vertical facial
What is battle sign suggestive of?
Skull base fracture (mastoid)
Horizontal fracture through the maxilla above the level of the nasal floor and alveolar process
Piriform rims
Anterior maxilla
Zygomatic buttresses
Pterygoid plates
Le Forte 1 fracture
S&S of ______:
* Slight swelling of upper lip
- Ecchymosis in upper lip sulcus
- Hematoma intra-orally over zygoma and in palate
- Disturbed occlusion
- Mobility of teeth of the involved segment of maxilla
- Combination of soft tissue laceration
- Impacted type of fracture is often not mobile and teeth cusps may be damaged
Le Forte 1 fracture
- Separation of NF suture, medial orbital walls (lacrimal bone), inferior orbital floor and rim (adjacent to Infraorbital canal and
foramen), anterior maxilla below zygomatic buttress and pterygoid plates. - Separation of the block from the base of skull is completed via the nasal septum and may involve the floor of the anterior cranial fossa
Le Fort 2 fracture
Separation of NF suture, medial orbital walls (involve the depth of the ethmoid bone and cribriform plate, pass below optic foramen and cross the inferior orbital fissure), inferior orbital floor, lateral orbital wall, ZF suture, zygomatic arch, root of pterygoid plate
Le Fort 3 fracture
S&S of ___
* Gross edema of soft tissues
* Bilateral peri-orbital ecchymosis
* Bilateral subconjunctival hemorrhage
* Nasal deformity
* Nasal bleeding and obstruction
* CSF leak rhinorrhea
* Dish-face deformity
* Ophthalmoplegia
* Possible diplopia and enophthalmos
* Retropositioning of the maxilla with anterior open bite
* Lengthening of the face
* Difficulty in mouth opening
* Mobility of the upper jaw
* Hematoma of the palate
* Step deformity at infra-orbital margin (II)
* Anesthesia of midface
* Nasal bone moves with mid-face as a whole
Le Fort 2 and 3 fractures: very difficult to distinguish between the 2
The “dish-face” deformity is associated with which Le Fort fracture?
Le Fort 3
What bone is dislodged from maxilla in all 3 Le fort fractures?
Pterygoid plates
S&S of ______
* Flattening of the malar prominence
* Flattening over the zygomatic arch
* Deformity at the orbital margin
* Deformity at the zygomatic buttress of the maxilla
* Periorbital ecchymosis and edema
* Pain and tenderness on palpation
- Trismus
- Paresthesia (Infraorbital nerve)
- Epistaxis
- Subconjunctival ecchymosis
- Unequal pupillary levels
- Diplopia
- enophthalmos
Zygomatic fracture
(Increased distance between Medial Canthi)
Telecanthus
What tendon is typically an issue in a NOE fracture?
Medial canthus tendon
What is the main goal of treating midfacial fractures?
Restore form (esthetics) and function
