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Oral Disease > Orofacial Trauma > Flashcards

Orofacial Trauma Flashcards

1
Q

Causes of facial trauma

A
  • Assault (aggravated by drugs and alcohol)
  • Road traffic accidents
  • Sports
  • Industrial accidents
  • Falls (18%)
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2
Q

Clinical approach to Facial trauma

A

HPC

  • Mechanism of injury (punch, weapon, kick etc.), drugs and alcohol
  • Time of injury
  • Any other injuries?
  • Evidence of intracranial injury (LOC, amnesia, nausea/vomiting/headache)
  • Facial numbness/weakness
  • Visual disturbance
  • Fractures teeth or malocclusion

MH
EO and IO examination
Radiographs: OPG and LCPA

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3
Q

What is the early management of orofacial trauma

A
  1. Airway, Breathing, circulation, control bleeding
  2. Look for other serious injuries (cervical spine, abdomen, thorax, head injury, CSF leak, ocular damage)
  3. Reduce and immobilise fascial fractures if compromising airway
  4. Lacerations, antimicrobial and tetanus prophylaxis, analgesia
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4
Q

When does primary teeth trauma affect the permanent successors the worst? What are the things to note when examining primary teeth trauma?

A
  • Most damage occurs before 3 years of age, during its developmental stage
  • Depends on type and severity of injury: worst with intrusions and labial displacement
  • EO: check for occlusal interference, direction of displacement; is permanent successor palatally positioned?
  • Remember age of child and stage of resorption
  • Note missing tooth fragments (can be displaced into lip, swallowed or aspirated)
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5
Q

What is the typical presentation of dentoalveolar fracture

A
  • Segment with two or more teeth being displaced axially or laterally
  • Cases with tenuous blood supply to fractured segments may also require closed treatment
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6
Q

What is the classification of dentoalvelar fractures

A
  • Class I: fracture of the edentulous segment
  • Class II: dentulous segment fracture with little or no displacement
  • Class III: fracture of dentulous segment with moderate to severe displacement
  • Class IV: fracture shares one or more fracture lines with other fractures of the tooth-bearing facial skeleton
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7
Q

What are the types of dentoalveolar fracture?

A

Simple (closed)
- No communication with an external surface

Compound (open)
- Communication with skin, mucosa or PDL

Comminuted
- Multiple fragments

Complicated
- Involves important structure e.g. artery

Greenstick
- Partial fracture, children

Pathological

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8
Q

How to reduce a dislocated jaw

A
  1. Press premolar teeth downwards

2. At the same time, press underneath of chin upwards and backwards

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9
Q

Fracture sites of the mandible

A 
Dentoalveolar
Condyle (intracapsular, extracapsular)
Coronoid
Ramus
Angle
Body
Parasymphsis
Symphsis
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10
Q

What is the clinical approach to fractures of the mandible?

A

History
Assess airway, breathing and circulation

EO exam
- asymmetry, ST injury, hard tissue tenderness, nerve function

IO exam

  • FOM (airway)
  • STs (sublingual haematoma)
  • Occlusion (has the bite changed?)
  • Count the teeth
  • Numbness

Radiological assessment

  • Always take 2 vies at different angles ideally 90 degrees
  • Always image the whole mandible to check for secondary fractures
  • Classical appearance: radiolucent line, radiopaque area, no line visible at all
  • Body or angle fractures: DPT and PA of jaws
  • Parasymphyseal fractures: True and 45 degree mandibular occlusal
  • Condylar neck fractures: DPT and Reverse Towne’s view (or PA with mouth open)
  • Coronoid process: occipito-mental view
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11
Q

What are the signs and symptoms of mandible fractures

A

Symptoms

  • Pain, swelling, bleeding
  • Limited movement
  • Abnormal bite, loose teeth
  • Numbness in lower lip
  • Dysphagia
  • Otorrhoa (ear discharge): blood or CSF

Signs:

  • Occlusal derangement
  • Tenderness
  • Haematoma: classically sublingual
  • Trismus
  • Paraesthesia, anaesthesia
  • Step deformity
  • Open bite
  • Mobility across fracture site
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12
Q

What at the treatment aims and what are the steps

A

Aims
- Restore function (occlusion, IDN, and mandibular movement) AND restore aesthetics

Treatment

  1. Reduction
    - Open - surgical exposure
    - Closed - fast (manipulation) or slow (elastic traction)
  2. Fixation
    - Indirect - intermaxillary fixation device with eyelets/archbars/cap splints/gunning splints/IMF screws
    - Direct - Bone plates/wires/screws/pins
  3. Immobilisation
  4. Rehabilitation
    - Soft diet, jaw exercises, elastics, occlusal adjustments
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13
Q

What are the complications of mandibular fractures?

A
  • Malunion
  • Delayed union
  • Non-union
  • Malocclusion
  • infection: osteomyelitis, infected plate or wire
  • Nerve injury
  • TMJ ankylosis
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14
Q

Why are fractures of the midface more complex than mandibular fractures?

A
  • Concerns multiple-bone fractures instead of the relatively simple one-bone fractures with the mandible
  • Middle third of face is pneumatised (have lots of sinuses) and serves as a shock absorber for the neurocranium
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15
Q

Where do most injuries to the midface occur?

A
  • Most injuries to the middle third of the face are from the front, forcing part or parts of facial skeleton downwards and backwards along the cranial base
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16
Q

Where do the fracture lines follow and how are midfacial fractures then classified?

A

The resulting lines of fracture follow the lines of weakness of the skeleton which allows broad classification based on site:

  1. Dento-alveolar
  2. zygomatic complex
  3. naso-ethmoidal complex
  4. orbits
  5. Le fort I ( separation of all or a portion of the midface from the skull base): horizontal maxillary fracture, separating the teeth from the upper face
  6. Le fort II: pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex
  7. Le fort III: transverse fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch/zygomaticofrontal suture
17
Q

How is the midface examined?

A
  • EO: symmetry, lacerations, obvious depressions, oedema, subconjunctival haemorrhage
  • IO: teeth, occlusion, intraoral haematoma
  • Cranial nerves: III, IV, V, VI, VII
  • Palpation for step deformities
18
Q

How are lateral midfacial fractures examined?

A
  • EO: facial asymmetry, flatness of zygomatic prominence, exophthalmos/enophthalmos/Hypoglobus (displacement of eyes), indentation of zygomatic arch, altered skin sensation, diplopia, visual acuity, retro-bulbar haemorrhage (post-septal haematoma)
  • IO: occlusion
  • Palpation for step deformities
19
Q

What radiographic images need to be to assess lateral midface fractures

A
  • Occipito-mental view 10/30 degrees, axial view - visualisation of arches
  • CT scan of orbital floor
20
Q

What are the types of lateral midfacial fractures and what is the treatment?

A
  1. Isolated fractures of zygomatic arch
    - Treatment: Gillies lift, hook elevation, no osteosyntesis (fixation of bone to re-establish arch)
  2. Fractures of orbito-zygomatic complex: always involves orbital floor and lateral wall
    - Signs: facial flattening, infra-orbital numbness, trismus, diplopia, restricted eye movements, altered pupillary level, pain on palpation, subconjunctival haemorrhage, crepitus, step deformities, epistaxis (nose bleed)
    - Tx: gillies lift, hook elevation, osteosynthesis
  3. Orbital fracture
    - Inner frame (isolated orbital wall/floor) or outer frame (orbit and other facial bone)
    - Presentation (Ecchymosis, diplopia, restricted eye movements, altered pupillary level, enopthalmos, paraesthesia, subconjunctival haem, surgical emphysema
    - Mechanism of fracture
    a. Hydraulic theory: fractures in thin orbital floor due to hydraulic forces transmitted via non-compressible virtuous humour filled globe and increased orbital pressure
    b. Bulking theory: direct trauma to inferior orbital rim causes buckling of floor
21
Q

Retro-bulbar haemorrhage signs and symptoms

A
  • Pain
  • Progressive loss of vision/blindness
  • Proptosis and chemosis
  • Painful movements;opthalmoplegia,
  • Pupil dilation
  • Ptosis
  • Papiledoma
22
Q

What are the surgical aims of lateral midfacial fractures

A
  • Fracture reduction
  • Reconstruct midfacial buttresses
  • Re-esablish facial width re-instate facial projection
  • Correct occlusion
  • Reduce telecanthus

Oral Disease (43 decks)

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