ORAL SURG midface fractures Flashcards
what is the terminology for midface fractures?
middle 1/3rd
Le Fort type(s)
Panfacial
Complex
Major Facial Trauma
what are the potentially serious outcomes and associations with midthird fractures?
airway
haemorrhage
head injury
orbital/ eye injury
other trauma
define the superior anatomy of the mid third facial skeleton?
frontozygomatic
frontonasal
frontomaxillary
define the inferior anatomy of the mid third facial skeleton?
occlusal plane upper teeth
alveolar ridge
define the posterior anatomy of the mid third facial skeleton?
pterygoid plates sphenoid
how is stability gained in the mid third facial skeleton?
paired buttressing system:
- vertical
- horizontal
- sagittal
how does the mid third facial skeleton protect the brain?
mid face collapse so energy absorption
what are the horizontal buttresses of the mid third face?
superior orbital rim
inferior orbital rim
maxillary alveolus
palate
serrated edges greater wings of sphenoid
zygomatic arches
what are the vertical buttresses of the mid third face?
nasomaxillary
zygomaticomaxillary
pterygomaxillary
what is the primary role of the vertical buttresses of the mid third face?
transmit masticatory forces to the skull base
what are the sagittal buttresses of the mid third face?
zygomatic arches
palate
floor of orbit
what are the weakest bones of the face?
nasal bones
zygomatic arch
maxillae
what are results of trauma to the mid third facial skeleton?
anterior open bite
facial lengthening
soft palate obstruct airway (extreme)
nares blood clot conscious
coincident head injury
dish face deformity (severe)
describe La Fort fracture I?
‘floating palate’
horizontal maxillary fracture, separating teeth from upper face
fracture line passes through alveolar ridge, lateral nose and inferior wall of maxillary sinus
describe a La Fort fracture II?
‘floating maxilla’
pyramidal fracture with teeth at the base of the pyramid, and nasofrontal suture at the apex
fracture passes through posterior alveolar ridge, lateral walls of maxillary sinus, inferior orbital rim and nasal bones
describe a La Fort fracture III?
‘floating face’
craniofacial disjunction
transverse fracture passes through nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch
what is the initial management of midface fractures?
airway
haemorrhage
head injury
how may an airway be affected following midface fracture?
anatomy changes
swelling
bleeding
foreign body
how may a haemorrhage come about following mid third face fracture?
maxillary artery rupture
nasal wall bleed
retrobulbar haemorrhage
septal haematoma
how can a haemorrhage of the mid third face be managed?
nasal packing/ tamponade
how is head injury assessed?
Glasgow coma scale
explain the glasgow coma scale?
measurement of head injury using 3 parameters: eye opening, verbal response, motor response
3 being the worst
15 being the best
motor response is the predominant factor
what is the secondary survey of mid third fracture?
assessing the head and neck extra and intra orally
in the extraoral assessment following a midthird fracture, where do you palpate?
frontal bones
supraorbital rims
frontonasal suture
lateral orbital rims
zygoma
zygomatic arch
what do you assess head and neck for extraorally following mid third fracture?
asymmetry
laceration
ecchymosis
discharge nose/ ears
systematic/ bilateral palpation of bones
what do you assess head and neck for intraorally following mid third fracture?
max incisal opening
maxillary vestibule
zygomaticomaxillary buttress
palate
occlusal steps
malocclusions
mobility of maxillary
what is the presentation and clinical findings of a le fort I fracture?
mobility of tooth-bearing segment of the upper jaw
crepitus in buccal sulcus
‘cracked-pot’ percussion note from upper teeth (dull)
intra-oral haematoma in buccal sulcus
fractured teeth cusps
bruising of the upper lip and lower mid-face
occlusal discrepancy
anterior open bite tendency
dentures not fitting
what are the presentations and clinical findings of le fort II/III fractures?
bilateral peri-orbital bruising
subconjunctival haemorrhage
lengthening of face
malocclusion
gross oedema of face
nasal deformity
CSF rhinorrhoea
diplopia and other visual problems
mobility of upper jaw
palatal haematoma
concurrent mandibular fractures
nasal septal haematoma
palatal split
what are the mandatory fracture lines which must be present in order to diagnose le fort I fractures?
lateral piriform aperture
what are the mandatory fracture lines which must be present in order to diagnose le fort II fractures?
Inferior orbital rim and zygomatic buttress
what are the mandatory fracture lines which must be present in order to diagnose le fort III fractures?
lateral orbital wall and zygomatic arch
what are the mandatory fracture lines which must be present in order to diagnose all le fort fractures?
pterygoid plates
what are the aims of management of mid third facial fractures?
restoration of normal function (ocular, nasal, oral, dental) and aesthetics
what is the technique of management of mid third facial fractures?
ORIF
*reduction may be open or closed however
when reconstructing the face where do you start?
with the most reliable structures with the least comminution
what instrument is used for reduction and disimpaction?
rowes disimpaction forceps
how are rowes forceps used?
introduced into the nose and palate - provides leverage to fracture in order to manipulate the lower face
what buttresses are generally fixated in le fort fracture I?
nasomaxillary
zygomaticomaxillary
what buttresses are generally fixated in le fort fracture II?
infra orbital
naso frontal
zygomaticomaxillary
what buttresses are generally fixated in le fort fracture III?
frontozygomatic
naso frontal
zygomatic arches
what types of incisions are cut for midface access?
bicoronal flap
intra oral vestibular
zygomatic/ orbital
direct lacerations
symptoms of a le fort I #?
bilateral bruising of buccal sulcus
disturbed occlusion
symptoms of le fort II and III#?
gross oedema of soft tissues
bilateral black eyes
subconjunctival haemorrhage
mobile mid face
extensive bruising of soft palate
what is a unique symptom of le fort II #?
infra-orbital nerve paraesthesia
step deformity in orbital rim
what are symptoms of le fort III#?
tenderness and separation of the frontozygomatic suture
deformity of zygomatic arches
mobility of entire facial skeleton
