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DEN4SKE > Oral surgery - Trauma > Flashcards

Oral surgery - Trauma Flashcards

1
Q

List the 7 bones of the orbit

A

Maxillary, Facial, Zygomatic, Ethmoid, Lacrimal, Sphenoid, Palatal

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2
Q

What makes up the upper facial skeleton?

A

Frontal bone and orbital cavity

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3
Q

What are 3 potential consequences of fracture of the facial skeleton on the brain?

A

Direct brain injury
secondary injury due to bleeding at fracture site
tear of dura

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4
Q

What structures travel through the Optic canal?

A

optic nerve
opthalmic artery

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5
Q

What structures travel through the superior orbital fissure?

A

CNIV, CNIII, CNVI
superior opthalmic vein

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6
Q

What structures travel through the inferior orbital fissure?

A

Zygomatic br of CNV2
Inferior Opthalmic artery

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7
Q

Why does fracture of mid-facial skeleton affect cranial base? What is the sequelae of this in the case of a mid-face fracture?

A

Mid facial skeleton articulates with the cranial base
Fracture may cause displacement of cranial base
Signs: Anterior open bite cuasing premature occlusion of posterior teeth
Soft palate pushed down to occlude airway

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8
Q

What is a life threatening sequelae of a mandibular fracture?

A

Bleeding at FoM causing elevation of tongue and airway occlusion
May cause injury to the cervical spine

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9
Q

List the areas of high impact in the facial skeleton

A

supraorbital rim
symphysis of mandible
Glabella - frontal
angle of mandible

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10
Q

List the areas of low impact in the facial skeleton

A

Zygoma
nasal bone

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11
Q

What 4 conditions necessitate emergency medical care after a facial fracture?

A
  1. Airway involvement
  2. Massive haemorrhage
  3. cervical spine innjury
  4. orbital fracture with inferior rectis muscle entrapment
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12
Q

By which mechanism can mass haemorrhage occur with facial fracture

A

A maxillary fracture that involves the pterygoid plexus or internal maxillary artery

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13
Q

After checking airways/haemorrhage, what is the next area to check?

A

Peri-orbital

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14
Q

What does the peri-orbital exam involve?

A

Visual acuity
Pupils - size, reaction
Lacterations
Occular muscle movement (CN III,IV,VI)
Orbital palpation - step off, sensation

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15
Q

If the patient has a penetration of the globe what should you do?

A

Refer to opthalmologist

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16
Q

What is CSF Rhiborrhea?

A

Cervical Spinal Fluid leakage from nose

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17
Q

What is CSF Rhinorrhea a sign of?

A

skull base fracture

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18
Q

What are the 3 signs of scull base fracture?

A

Battle’s sign
Racoon Eyes
CSF Rhinorrhea

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19
Q

What is Battle’s sign?

A

ecchymosis behind ears

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20
Q

What are racoon eyes?

A

Bilateral periorbital ecchymosis

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21
Q

Deviation of the mandible on opening is a sign of what?

A

Condylar fracture

22
Q

What are the 3 most common facial bones to fracture?

A

Mandible
Zygomatic
Orbital floor

23
Q

Which parts of the orbital wall most commonly fracture and why?

A

Floor or medial wall
Thin bone

24
Q

What is the hydrolytic theory?

A

A sudden blow to the orbit will result in sudden expansion within the orbit causing increased pressure, which may cause fracture of orbit.

AKA blow-out fracture

25
Q

What are the symptoms of an orbital wall fracture?

A

Enopthalmus
Anaestehsia of infra-orbital area
Diplopia
Infra-orbital step off
subcutaneous emphysema
decreased visual acuity

26
Q

What is enopthalmus?

A

orbital content herniates into maxillary sinus causing one eye to appear sunken

27
Q

What is diplopia?

A

Double vision when patient looks up
caused by herniation of inferior rectis muscle into fracture

28
Q

What is the management for orbital floor fracture?

A

Immediate surgery if inferior rectus muscle entrapment or retrobulbal haemorrhage
OMFD + Opthalmologist referral
nasal decongestants (avoid blowing nose)
CT scan

29
Q

Retro-bulbal haemorrhage is a risk of what surgery?

A

orbital floor surgery

30
Q

Symptoms of retro-bulbal haemorrhage

A

Proptosis (bulging)
loss of vision
severe pain
non-reactive pupil
muscle palsy
blindness

31
Q

Describe LeFort I fracture

A

horizontal fracture invovling low level maxilla, and pterygoid plate
Causes separation of maxilla from mid-face at the base of the nasal cavity

32
Q

Describe LeFort II fracture

A

pyrimidal fracture from pterygoid plate, high level maxilla, low level zygomatic bone, infra-orbital foramen

33
Q

Describe LeFort III fracture

A

fracture causing craniofacial dislocation from cranial base
zygomatic frontal suture involved
orbital floor
ethmoid sinus and bone

34
Q

How to you differentiate between LeFort fractures on a CT scan?

A

I - anterolateral margin of nasal fossa fractured
II - inferior orbital rim fractured
III- zygomatic arch fractured

35
Q

Repair of a LeFort I fracture involves incision where?

A

Buccal vestibule

36
Q

What is used to reduce a LeFort fracture?

A

miniplates and screws

37
Q

What are the two types of zygomatic fractures?

A

Tripod fracture - fractures from 3 suture points
Arch fracture - limited to zygomatic arch

38
Q

what does ORIF stand for?

A

Open reduction and internal fixation

39
Q

Which 4 bones does the zygomatic bone articulate with?

A

superior : frontal
Medial: maxillary
Posterior: temporal
Lateral: sphenoid

40
Q

Which bony structure will a zygomatic fracture commonly involve?

A

orbital floor
zygomatic bone forms part of orbital floor

41
Q

What important structure do you need to check in a zygomatic fracture?

A

orbit
check for orbital floor fracture

42
Q

7

What are the signs of a zygomatic fracture?

A

asymmetry
depression of zygomatic prominence
step-off
paraesthesia
ecchymosis
subconjunctival haemorrhage
decreased range of mtoion of mandbile (if impinging on coronoid process)

43
Q

What is a common surgical technique for management of a simple zygomatic fracture?

A

Gilies incision at hairline
pass instrument along temporal facial to zygomatic bone
elevate fracture portion of zygomatic bone

44
Q

What are the signs of a mandibular fracture?

A

Malocclusion
Intra-oral lacerations
sublingual ecchymosis
nerve injury

45
Q

Why do mandibular fractures often present as multiple fractures, not just one?

A

U shape of mandible = force transmitted to contralateral side of initial site of impact

46
Q

What are the 8 classification of mandibular fractures?

A

Dentoalveolar
condylar
coronoid
ramus
angle
body
parasymphysis
symphysis

47
Q

Which 3 areas of the mandible are most commonly fractured?

A

body
angle
condyle

48
Q

If a mandibular fracture is open, what do you need to do?

A

prescribe antibiotics

49
Q

What is IMF

A

inter-maxillary fixation

50
Q

In which cases is IMF still used?

A

comminuted fractures
condylar fractures (surgery impossible here)

DEN4SKE (8 decks)

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