Oral Surgery Flashcards
1
Q
Where in the mouth do you not have minor salivary glands?
A
Gingivae
anterior hard palate
2
Q
What is the most common pathology within minor salivary glands?
A
mucous extravasation cyst
3
Q
How would you treat a mucous extravasation cyst?
A
excision with overlying mucosa and underlying granular tissue
4
Q
How would you treat a benign/malignant tumour of a minor salivary gland?
A
excision with a margin or normal tissue
5
Q
What duct opens at U7’s from parotid gland?
A
Parotid/Stenson’s duct
6
Q
What kind of gland is the parotid?
A
Seromucous (predominantly serous)
7
Q
What duct does the submandibular gland drain through?
A
Wharton’s duct
8
Q
What kind of gland is the submandibular?
A
Mixed - seromucous
9
Q
What % of salivary gland tumours are in minor salivary glands?
A
15-20%
10
Q
What % of major salivary gland tumours are in the parotid?
A
90%
11
Q
What % of parotid gland tumours are benign?
A
80%
12
Q
What ducts does the sublingual gland drain through?
A
Rivini’s ducts / Bartholin’s duct
13
Q
What kind of gland is the sublingual gland?
A
Mucous
14
Q
What is the most common causes of pathology in major salivary glands? (4)
A
inflammatory disorders
obstructions / trauma
neoplasms
autoimmune / degenerative
15
Q
What % of submandibular tumours are benign?
A
50%
16
Q
What % of sublingual tumours are benign?
A
25%
17
Q
What would you look for when diagnosing a salivary gland tumour?
A
swelling - intermittent/persistent, uni/bilateral
pain - prandial
salivary flow - xerostomia/sialorrhea
palpation - size, consistency, stones
18
Q
What investigations would you carry out for salivary gland tumours?
A
radiographs/sialography
FNA
CT/MRI
ultrasound
labial gland biopsy
scintigraphy
blood tests, microbiology, sialochemistry
19
Q
What are the indications for surgery of salivary glands?
A
chronic pain / symptoms (refractory)
repeated acute/chronic sialadenitis
benign/malignant tumours
20
Q
What would you advise pt to expect post submandibular gland removal?
A
pain, bruising, swelling
scar
numbness of tongue
weakness of lower lip
weakness of tongue movement
21
Q
What are the 4 kinds of parotid surgery?
A
extracapsular dissection
lobar resection
superficial parotidectomy
total parotidectomy
22
Q
what are the post-op complications of parotid surgery?
A
pain, bruising, swelling, infection
facial nerve injury
gustatory sweating
numbness around ear lobe
salivary fistula
recurrence
23
Q
What virus causes sialadenitis?
A
Paramyxovirus (mumps)
cytomegolovirus
HIV
24
Q
How do you treat a viral infection?
A
self-limiting;
analgesics and hydration
25
what is the most common cause of bacterial sialadenitis?
stasis - gland not being used (starvation/obstruction)
26
How would you manage acute bacterial sialadenitis?
antibiotics
fluids
siologogues
analgesics
27
When would you drain sialadenitis?
only if abscess has formed
28
Which gland is more affected by sialadenitis?
submandibular
29
What is the most common cause of obstruction of a salivary gland?
sialolithiasis (stone)
30
what age group is most commonly affected by sialolithiasis?
>20 years
31
what else can cause a blockage of ducts (apart from stones)?
mucous plug
duct structure (trauma)
32
what are prandial symptoms?
symptoms associated with eating/meal times
33
what are the clinical signs of bacterial sialadenitis?
oral discharge of pus from salivary ducts
34
why is the submandibular gland more affected by sialolith?
long duct
more alkaline pH (causes calcification)
35
what are the tx options for sialolithiasis caused by obstruction?
sialogogues
surgical removal
removal of gland
eliminate trauma
basket retrieval of stones
36
how does lithotrypsy work?
ultrasonic waves to break up stone so it can be shed naturally
37
What is a ranula?
a large mucous retention cyst in the floor of mouth
38
What is the tx for a ranula?
marsupialisation
if high recurrence, removal of sublingual gland
39
what salivary glands have higher proportion of carcinomas?
minor
40
what is pleomorphic adenoma?
most common neoplasm of salivary gland
41
what is sialometaplasia?
benign, ulcerative lesion usually on hard palate
42
when would you refer to oral medicine?
red/white patches
erosions/ulcers
vesiculobullous lesions
burning mouth syndrome
facial pain
xerostomia
43
what are the different types of biopsy?
excisional and incisional
44
what are the different incisional biopsy techniques?
exfoliative cytology
aspirational (FNAC)
labial gland biopsy
45
when would you use excisional biopsy?
small, benign lesions
46
what is the advantage of excisional biopsy?
biopsy = treatment
47
what problems can arise with biopsies?
inappropriate specimen
specimen too small or macerated
can't orientate specimen
tissues distorted by diathermy or LA
lab not informs need for frozen section
48
what is the advantages of frozen sections?
allow rapid diagnosis of malignancy
exclude carcinoma at time of surgery
results within 1 hour
49
what is exfoliative cytology?
removal of surface cells by scraping with a spatula or cytobrush
50
how is Sjogrens syndrome diagnosed?
labial gland biopsy
51
what is toluidine blue used for?
detecting oral epithelial dysplasia
selectively binds in vivo to acidic tissue components of DNA and RNA
52
what is the vizilite system used for?
used to detect the mucosal tissues undergoing metabolic or structural changes
53
what are the muscles involved in displacement of mandibular fractures?
medial pterygoid
lateral pterygoid
temporalis
masseter
54
what action will medial and lateral pterygoid muscles have on mandibular fractures?
pull inwards and upwards
55
what action will the temporalis have on a mandibular fracture?
pull upwards and backwards
56
what will likely happen if a large piece of tooth ends up in the antrum?
heavily bacterially infected
chronic sinusitis
57
what should be done if a large piece of tooth ends up in the antrum?
preventative medication
review
refer if communication persists
58
how would a large piece of tooth be removed from the antrum in secondary care?
cauldwell luc
59
what 2 reasons make edentulous fractures more complicated?
lack of anatomical landmarks
more atrophic = less vascularised, poorer healing
60
what is prescribed post-op of mandibular fracture?
antibiotics - IV then oral
steroids to minimise swelling
iv fluids
61
name 8 complications of tx of mandibular fractures
mon/mal union
altered occluson
tmj problems
scars from trauma/tx
infection
bone necrosis
numb lip
exposed plate
62
what should be done if there is doubt that a mandible can withstand forces of XLA?
refer
63
what specific extraction is fracture of a maxillary tuberosity associated with?
upper 8's
64
what factors may make tuberosity fracture more likely?
thin bone at tuberosity
ankylosis of 8's
divergent roots
65
what 2 signs may indicate a fractured tuberosity?
dull thud + crunching sound
tooth moves not independent of underlying bone
66
how does a displacement fracture happen?
root is shifted from within its anatomical position in the socket
67
name 7 places a tooth may be displaced?
infratemporal fossa
subperiosteal
lingual tissues
inferior alveolar canal
maxillary antrum
osophagus
lung/airways
68
what is the management of alveolus fracture during xla?
remove small fragments, leave large ones
record in notes in case large fragments become non-vital
69
how common is fractures mandible during xla?
very rare
70
name 3 wats how mandible fracture may happen during xla
excessive force
thin mandible due to pathology, age or congenital condition
wrong instrument used
71
where does the zygomatic bone join the mandible?
coronoid process
72
what is a type 1 zygomatic fracture?
no significant displacement
73
what is a type 2 zygomatic fracture?
fracture of zygomatic arch
74
what 2 bones does fracture of the zygomatic arch involve?
zygomatic
temporal
75
what is a type 3 zygomatic fracture?
rotation around the vertical axis
76
what are the 2 types of rotation around the vertical axis on a type 3 zygomatic fracture?
internal
external
77
what is a type 4 zygomatic fracture?
rotation around longitudinal axis
78
what is a type 5 zygomatic fracture?
displacement en bloc
79
what are the 3 types of displacement en bloc?
medially
inferiorly
laterally
80
what is specific about a lateral displacement en bloc fracture?
rare - high force impact fracture
81
what is a type 6 zygomatic fracture?
displacement of the orbital-antral part
82
what is a type 7 zygomatic fracture?
displacement of orbital rim segments
83
what is a type 8 zygomatic fracture?
complex comminuted fractures
84
what is specific about a complex comminuted zygomatic fracture?
high force impacts
85
what are the 2 most common causes of zygomatic fracture?
road traffic accident
interpersonal violence
86
what symptom of zygomatic fracture may be difficult to see because of swelling?
depression over malar prominence
87
how clinically would a depression over malar process be confirmed?
palpate
88
where should the zygoma be palpated for deformation during suspected fracture?
zygomatic arch
malar prominence
infra-orbital margins
maxillary buttress
89
what name describes when there is no posterior limit of iris due to bleeding?
subconjunctival haemorrhage
90
which 2 nerves may be damaged in a zygomatic fracture as a consequence of the extension to the orbit?
infraorbital
maxillary trigeminal CNV2
91
how likely is it for the orbital floor/wall to be damaged during a zygoma fracture?
very - almost always
92
what may a pt experience if the zygomatic joint to the mandible is fractured?
restricted opening
trisumus
93
what advantage does ORIF have?
improved alignment
94
what type of support does fixation of zygomaticomaxillary buttress provide?
vertical
95
what does orbital rim exposure allow for during ORIF?
inspection of orbital floor
96
what radiographs should be taken for Le Fort fractures?
CT scan
97
what fractures are needed to be a le fort 1?
pterygoid plates
lateral poriform aperture
98
what fractures are needed to be a le fort 2?
pterygoid plates
inferior orbital rim
zygomatic buttress
99
what fractures are needed to be a le fort 3?
pterygoid plates
lateral orbital wall
zygomatic arch
100
where does force apply for a le fort 1 fracture?
above dentoalveolar segment
101
what is a le fort 1 fracture less commonly known as?
guerin fracture
102
where does force apply for a le fort 2 fracture?
nasal bones
103
what shape is a le fort 2 fracture?
pyramidal
104
what are 2 indications for 3-point fixation?
instability of fragments with 2 point fixation
exploration of orbital floor required
105
when might there be indication for 4 point fixation?
zygomatic arch has major traumatic event
106
what is the aim of fixation?
rigid immobility of fractured segment to correct anatomical position
107
what is different about management of complex comminuted zygomatic fractures?
major reconstruction
larger flap exposure
reconstruction of buttress
108
how is a non displaced zygomatic fracture diagnosed/confirmed?
CT scan
109
what is the tx for displaced and minimally comminuted zygomatic fracture?
reduction alone
110
what is the name for when force is applied directly to the eye, causing the floor of one orbit to be disrupted and resulting in contents being herniated into maxillary sinus?
orbital blowout
111
which fracture complication causes bleeding from behind the eye and risks blindness?
retrobulbar haemorrhage
112
what is the management of retrobulbar haemorrhage?
immediate surgical management
113
what are 5 indications for orbital floor exploration post zygomatic fracture?
defects >5mm on ct scam
severe displacement
comminution
soft tissue entrapment with limited upward gaze
orbital contents herniation into maxillary sinus
114
what are 3 indications for reconstruction of orbital floor?
enopthalmos
larger defects 5-10mm
defects posterior to the axis of the globe
115
what may make airway management worse in a midface fracture?
loss of conciousness
116
which vessel may cause haemorrhage on a midface fracture?
maxillary artery
117
what scale should be used to assess a head injury?
glasgow coma scale
118
what is the name for when one eye appears at a different level to the other and how does this happen?
orbital dystopia
severe injury where suspensory ligaments are disrupted
119
what is enopthalmos? and how does this happen?
globe appears sunken in
change in volume of the orbit
120
what is the name for when the globe appears extruded and how does this happen?
exothalmus
decrease in orbital volume - bones pushed together
121
how would an exothalmus be identified clinically?
stand behind patient and look downwards to see if difference between eyes
122
what is the first step of 'outside-in' approach of treating a panfacial fracture?
reconstruct outer face and struts first
123
what determines where reconstruction will start on panfacial fractures?
most reliable reference structures with least comminution
124
what is the closed technique for management of mandibular fractures?
no incision
just IMF
125
what are the 2 types of fixation?
load bearing
load sharing
126
what is the direct technique of placing mini plates for fixation of mandibular fracture?
transoral approach
127
what is the indirect technique of placing mini plates for fixation of mandibular fracture?
transbuccal approach
128
what type of fracture is one which involves a tooth socket?
compound
129
why is a fracture involving a tooth socket predisposed to infection?
fracture line runs through PDL to oral cavity, exposing it to oral microbiota
130
what is a greenstick fracture?
bone flexes, outer cortices will fracture but inner cortices will flex so there is no displacement
131
who are greenstick fractures associated with?
children
132
what are the 3 most common types of mandibular fracture?
condylar
angle
parasymphysis
133
how does a condylar fracture happen?
condyle is a point of weakness
when mandible is presented with force it is pushed into the base of the skull and condyle will crack
134
how might an angle fracture of the mandible happen?
unerupted/partially erupted 8's will present a point of weakness
135
why is parasymphisis fracture common?
long rooted canine
136
if there is a coronoid fracture, why is there often displacement?
due to insertion of temporalis
137
describe a guardsman's fracture of the mandible
one midline symphisis fracture and bilateral condylar fractures
138
why do the condyles break in a guardsman's fracture of the mandible?
force travels back to the point of weakness (condyles) from the chin
139
what action will the masseter have on a mandibular fracture?
pull upwards and inwards
140
what % do mandibular fractures make up of all facial fractures?
36-70
141
what is the most common cause of mandibular fractures?
interpersonal violence
142
what are the 5 different types of fractures?
simple
compound
comminuted
greenstick
pathological
143
what does the amount of fixation depend on?
severity of injury
144
what is the requirement for proper reduction?
direct visualisation
145
where are the 3 points of reduction for a zygomatic fracture?
frontozygomatic suture
zygomatico maxillary buttress
inferior orbital areas
146
what is a possible tx plan for an early non-comminuted with minimal displacement zygomatic fracture?
reduction alone
147
what is a possible tx plan for older minimally comminuted minimally displaced zygomatic fracture?
ORIF
148
what is the most reliable indicator of proper reduction for a zygomatic fracture?
zygomaticosphenoidal suture
149
alignment of which suture along with reduction will likely to restore symmetry and orbital volume after a zygomatic fracture?
zygomaticosphenoidal suture
150
what does orif stand for?
open reduction internal fixation
151
what does internal fixation mean?
screws and plates
152
what does external fixation mean?
headgear + immobilisation
153
what approach is used for extra-oral open reduction?
submandibular approach - incision in neck
154
when is the extra-oral open reduction indicatied?
displaced fractures involving lower border of mandible
edentulous pts
155
why is extra-oral open reduction advised for edentulous fractures of mandible?
avoids stripping periosteum of the mandible to minimise effect on the vascularity of the bone
156
what is a pathological fracture?
where the pathology predisposes the bone to fracture
157
name 8 types of mandibular fracture
dento-alveolar
condylar
coronoid
ramus
angle
body
parasymphisis
symphisis
158
how long might jaws be wired together if closed technique used?
up to 6 weeks
159
what are 5 advantages of open reduction?
improved alignment + occlusion
fracture immobilised
avoid need for IMF
low rate of malunion
lower rate of infection
160
name 3 disadvantages of open reduction
morbidity of surgical procedure
expensive
need for GA
161
what is the difference between intraoral and extraoral reduction?
intraoral - stripping of periosteum
extraoral - minimise stripping of periosteum
162
what are the number and placement of screws dictated by?
champy's principles
163
where are miniplates placed?
line of osteosynthesis to counteract distraction forces along fracture line
164
describe for anterior, body + angle of mandible where plates would be placed to maximise load bearing capacity?
anterior - 2 low down
body - under mental foramen
angle - at external oblique ridge
165
who is most likely to have mid-face fractures?
young/old males
166
what are the 4 major parts of the zygomatic bone?
frontal
medial
maxillary
temporal
167
what structure does the zygomatic bone primarily protect?
maxillary sinus
168
what is the name of the area which when fractures can be felt intraorally in the buccal sulcus?
zygomaticomaxillary complex
169
which zygomatic fracture complication happens when the fracture extends posteriorly to the eye into the superior orbital fissure and which cranial nerves are at risk as a result?
superior orbital fissure syndrome
CN3,4,5,6
170
what is diplopia?
double vision
171
how is a zygomatic fracture investigated?
occipitomental radiographs
ct scan if suspected orbital floor
opthalmology review
172
why is closed technique used in mandibular fractures in children?
tx cannot inhibit growth i.e plates
173
what are 3 advantages of closed technique?
cheap
simple - can be done under LA
no foreign body - decreased risk of infection
174
what are 5 disadvantages of closed technique?
not absolutely stable
prolonged period of fixation
possible TMJ sequelae
decreased oral intake
pulmonary considerations if reflux
175
when would reconstruction plates be used in open reduction of a mandibular fracture?
edentulous mandible
176
what are 7 indications for closed reduction of a mandibular fracture?
non-displaced favourable fractures
grossly comminuted fractures
significant loss of overlying tissue
edentulous mandibular fractures
fractures in children
coronoid process fractures
undisplaced or minimally condylar fractures
177
what are the requirements for a fracture to be classified as simple?
undisplaced
overlying periosteum is intact
178
what are the requirements for a fracture to be classified as compound?
fracture has perforated through overlying periosteum
179
what are the requirements for a fracture to be classified as comminuted?
fracture pattern has multiple fracture lines
bone broken into multiple small fragments
180
what will attachment of the lateral pterygoid muscle mean in a guardsman's fracture of the mandible?
attaches to the condyle, contracts to drag the condylar head inwards causing medial displacement of coronoid process
181
If a condylar fracture with displacement is not treated, what will happen?
Shortening height of mandible
Shorter on one side
Open bite on opposite side
182
What could complete immobilisation of mandible in an intracapsular condylar fracture cause?
Ankylosis of joint - trismus
183
How is a paediatric green stick fracture of mandible managed?
Splints
184
Why is surgery in paediatric condylar fractures avoided?
Risk to condylar growth plate
185
What is the ideal management of le fort fractures?
ORIF
186
What is often seen (dentally) on a panfacial fracture?
Loss of occlusal relationship
187
What is the first step of ‘inside-out’ approach when treating a panfacial fracture?
Reconstruct maxillary mandibular unit
188
What clinical indications (3) might there be that there is maxillary sinus involvement on a zygomatic fracture?
Epistaxis - nose bleed
Subcutaneous emphysema
Buccal sulcus ecchymosis
189
What causes subconjunctival haemorrhage?
Bleeding from the conjunctival or episcleral blood vessels into the subconjuctival space
190
What is opthalmoplegia and how would this be recognised clinically?
Entrapment of muscles in the eye
Trouble looking in one specific direction
191
What will attachment of the lateral pterygoid muscle mean in a guardsman’s fracture of mandible?
Attaches to the condyle, contracts to drag the condylar head upwards and inwards causing medial displacement of coronoid process
192
What does the anatomy of the mandible cause 1/3rd of all fractures to have?
2 breaks
193
When is a bucket handle fracture of the mandible common?
Edentulous mandible
194
When might we see intramural bleeding on a zygomatic fracture?
If fracture extends to maxillary buttress
195
How can we tell if a zygomatic fracture has extended to the maxillary buttress?
Palpate intraorally
196
During a zygomatic fracture, if the pt blows their nose and there is a rapid and painful swelling of one cheek, what might this indicate?
Maxillary sinus disruption
197
What can be used to reconstruct mandibular fractures, especially when there are multiple present?
CBCT
198
What 4 factors will determine the amount of displacement in a mandibular fracture?
Pattern of fracture
Degree of comminution
Teeth in fracture line
Muscle pull
199
What effect can teeth in a fracture line sometimes have?
Keep the fracture together
200
Where is the incision made for oral approach during reduction of zygoma?
Intraoral vestibular incision
201
Where is incision made for the Gillies Temporal approach?
2cm in hairline
202
Which artery do we have to be careful not to touch during the Gillies temporal approach?
Superficial temporal
203
Which 2 instruments are used in the gillies temporal approach?
Bristow
Rowe
204
Where are the 3 main points of fixation in a zygomatic fracture?
Frontozygomatic suture
Zygomaticomaxillary buttress
Infraorbital region
205
What are most complications of zygomatic fracture management linked with?
Injuries with eye
206
What is the incidence of superior orbital fissure syndrome?
0.3-0.8%
207
What does the inferior orbital fissure contain?
Oculomotor nerve
Abductees nerve
Nasocillary nerve
Inferior orbital vein
208
What nerve damage results in opthalmoplegia?
Occulomotor
Trochear
Abductees
209
What nerve damage results in ptosis?
Superior branch of oclulomotor
210
What is ptosis?
Decreased tension of the extraocular muscles
211
What is my mydriasis?
Fixed dilated pupil
212
what nerve damage causes anaesthesia of the forehead/upper eyelid
Lacrimal + frontal branches of trigeminal V1 - ophthalmic
213
If a mandibular fracture is undisplaced, what might be one of the only clinical signs?
Small gingival laceration or tear
214
What is a tx possibility if a mandibular fracture is undisplaced with no mobility?
Heal without further management
215
What does it mean if there is any mobility of a mandibular fracture?
Margins are constantly moving and not given any other time to heal
Needs further management
216
What is the most common material used for fixation now?
Titanium plates + screws
217
What is another more expensive option for fixation?
Resorbable plates + screws
218
What is the name for drilling holes distant from fracture site and then threading wires across to bind them together?
Wire osteosynthesis
219
What causes mal/non union of a mandibular fracture?
Mobility of fracture
220
What is the incidence of infection post mandibular fracture?
0.4-32%
221
What might cause a numb lip after mandibular fracture?
Damage to IAN or mental though tx or injury
222
What happens if a plate becomes exposed?
Have to remove
223
What would be done if a mandibular fracture involves an 8?
XLA 8
224
What would be done if mandibular fracture involves a 2?
RCT
225
What are the 2 types of condylar fracture?
Intracapsular
Extracapsular
226
Why is intracapsular condylar fracture difficult to treat?
Small fragements
227
Which 3 mid-face bones have low tolerance to impact?
Nasal
Zygomatic
Maxillae
228
What is the purpose of crumple zones?
Protect from brain injuries
229
What is a dental outcome of a mid-face fracture?
Anterior open bite
230
What are mid-face fractures usually consistent with?
Le fort pattern
231
When would management of zygomatic fracture ideally be stared?
A week or so
232
Why is management of zygomatic fracture not started after 1 month?
Bony healing may occur in unfavourable/unaesthetic positions so bones would have to be cut and repositioned
233
Why is management of zygomatic fractures may started immediately?
To allow reduction of swelling and better understanding of anatomy
234
What is likely in a high energy impact zygomatic fracture?
Comminution
235
Where is force applied for a le fort 3 fracture?
Level of orbits
236
What are the 3 forms of initial management of midface fractures?
Airway management
Haemorrhage control
Head injury assessment
237
Which bone is usually displaced, and where, to cause obstruction of the airway in a midface fracture?
Maxilla
Brings soft palate down onto dorsum of tongue to cause obstruction
238
What is the dental presentation clinically, of a le fort 1 fracture?
Mobility of tooth - bearing segment
239
Where will a haematology appear intraorally in a le fort 1 fracture?
Buccal sulcus
240
What is the clinical presentation of eyes in a le fort 2/3 fracture?
Subconjunctival haemorrhage
241
Which 2 places generally have 2-point fixation after zygomatic fracture?
Frontozygomatic
Zygomaticomaxillary buttress
242
What are 3 indications for 2-point fixation of zygomatic fracture?
Minimal displacement
Zygomaticomaxillary buttress remains stable after reduction
Minimal changes to orbital volume and no globe displacement on ct scan
243
What radiographic assessment is usually used for mandibular fractures?
DPT
PA mandible - 2 views
244
What might happen if a mandible fracture is not managed?
Permanent malocclusion
245
How long after mandibular fracture should a pt receive tx?
72 hours
246
Why is fracture of the mandible commonly prone to infection?
Often involves tooth or socket, exposing fracture to the commensals in the mouth
247
What is significant about teeth involved in mandibular fracture and what tx do the require?
Rendered non-vital
Endo in primary care
248
Where should a fracture of the mandible be referred?
Max fax
249
Why would close reduction be used for non-displaced favourable fractures and minimally dispalvced condylar fractures if not severe?
Only short period of IMF
Used in condylar only if bilateral
250
Why can we not use open technique for grossly comminuted mandibular fractures?
Too many pieces of bone to fit back together
251
Why is closed technique used for significant loss of overlying tissues?
No soft tissue to cover plates
252
What type of zygomatic fracture causes a subconjunctival haemorrhage?
Periorbital / intracranial
253
When might there be altered sensation of eye during zygomatic fracture?
If fracture involves infraorbital margin + nerve
254
when might there be numb teeth, upper lip or cheek in a zygomatic fracture?
If fracture involves CNV2
255
Describe a bucket handle fracture of the mandible
Bilateral parasymphiseal fractures
256
Which muscles pull the anterior segment downwards and backwards in a bucket handle fracture?
Mylohyoid
Genioglossus
Digastric
257
What is a clear clinical sign of displacement in fracture of mandible?
Malocclusion
258
Why might there be otorrhoea of external auditory meatus in a mandibular fracture?
Condylar head sits immediately in front of it and may have been driven into middle cranial fossa
259
What is ‘Coleman’s sign’ in a mandibular fracture?
Haematoma in FOM
260
Why does Coleman’s sign happen?
Periosteum overlying the bone has torn and haemorrhaged into tissues
261
What nerve damage causes anaesthesia of cornea/bridge of nose?
Sensory nasocillary nerve
262
What is the treatment for superior orbital fissure syndrome?
Conservative observation
Surgical management
263
What risk comes with surgical mangement of SOFS?
Risk of further damage
264
What is the incidence of retrobulbar haemorrhage with compartment syndrome post-zygomatic fracture?
1%
265
What are 2 symptoms of RBA + OCS?
Intense globe pain
Diplopia
266
What is a severe consequence of RBA + OCS?
Permanent loss of vision
267
Describe 8 signs of retrobulbar haemorrhage with compartment syndrome?
Ptosis
Conjunctival haemorrhage
Subconjunctival haemorrhage
Tense globe to palpation
Reduced visual acuity
Sluggish pupil response
Relative afferent pupillary defect
Opthalmoplegia
268
What are 4 non-surgical management options for retrobulbar haemorrhage with compartment syndrome?
Fluid deplete
Niannitol - decreases pressure
Acetazolamide - decreases pressure
Steroids
269
What is the surgical management option for RBA + OCS?
Lateral craniotomy - surgical decompression
270
What is the name for drilling one hole into solid bone with another hole in the mobile fragment and then screw engages both to pull them together?
Lag screw fixation
271
What is the aim of reduction?
Reapproximare the bone to original position
272
What are the 3 methods of reduction?
Percutaneous bone hook
Bone hook
Screw insertion to provide traction
273
How does reduction using subcutaneous bone hook work?
Stab incision and introduction of instrument to provide traction
274
How does reduction using a bone hook work?
Intrraoral vestibular incision and introduction of instrument to provide traction
275
What are the 2 sites of approach for reduction of zygomatic fracture?
Oral
Gillies temporal
276
What us conservative management of condylar fractures?
Soft diet
NSAIDs
277
What would be the tx if trauma caused disruption to capsule with no breakage but inflammation of joint?
2 weeks of NSAIDs
278
What is the name for trauma causing disruption to the capsule with no breakage but inflammation of the joint?
TMJ joint diffusion
279
What is the tx for a displaced condylar fracture?
ORIF
