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Dentistry in a Nutshell > os - trauma > Flashcards

os - trauma Flashcards

1
Q

symptoms of # zygoma

A
  1. ocular symptoms due to proximity of zygoma to orbital floor
  2. maxillary sinus fills with blood so epistaxis as max sinus drains through nose via semi lunar hiatus
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2
Q

supply of eye muscles

A

CN VIII oculomotor
except
LR7 - lateral rectus CN VII
SO4 - superior oblique CN IV trochlear

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3
Q

clinical symptoms of zygomatico-orbital trauma (8)

A
  1. step deformity
  2. epistaxis - unilateral
  3. periorbital bruising & swelling
  4. subconjunctival ecchymoses
  5. sensory defect via infraorbital nerve i.e. numbness in the cheek
  6. diplopia
  7. subcutaneous emphysema
  8. flatness of the face
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4
Q

inital mx of ZO #

A
  1. exclude ocular injury - warn signs re retrobulbar haemorrhage
  2. prophylactic ABs
  3. avoid nose blowing
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5
Q

definitive mx of ZO #

A
  1. r/v when swelling subsided
  2. CBCT / occipitomental 15 & 30 degree views
  3. informed consent
  4. closed reduction +/- fixation
  5. OR +/- IF
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6
Q

muscles that close mandible

A

masseter
medial pterygoid
temporalis

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7
Q

muscles that open mandible

A

anterior belly digastric
mylohyoid
geniohyoid

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8
Q

damage to IAN manifests as

A

numbness of lower lip & chin

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9
Q

causes of numbness to IAN (4)

A
  1. direct trauma
  2. impacted M3M
  3. infection of bone i.e. osteomyelitis
  4. resorption of bone due to pathology i.e. cyst
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10
Q

signs & symptoms of mandibular #

A

pain, swelling, loose / mobile teeth, deviation of mandible to opp side of #, facial asymmetry, AOB (# can cause shortened ramus), numbness of lip, bleeding limited to # site
important to look at FoM for sublingual haematoma

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11
Q

to classify mandibular # (5)

A
  1. involvement of surrounding tissue i.e. simple / compound / comminuted
  2. no of # i.e. single / multiple
  3. site of # lines i.e. uni / bi / multi
  4. direction of # line i.e. favourable / unfavourable
  5. if displaced or undisplaced
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12
Q

involvement of surrounding tissue

A
  1. simple = everything intact
  2. compound = soft tissue damaged thus exposing # to environment
  3. comminuted = bone broken into may small pieces
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13
Q

what causes displacement of #

A

1 group of muscles will pull the segment up and the other group of muscles will pull the segment down therefore causing displacement

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14
Q

direction of # line

A

favourable - minimises displacement
unfavourable - encourages further displacement

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15
Q

causes of # displacement (6)

A
  1. magnitude of force
  2. mechanism of injury
  3. other associated #s
  4. opposing occlusion; if v good displacement minimal as acts as stopper
  5. direction of # line
  6. if soft tissues intact# unlikely to be displaced
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16
Q

pathological causes of # (3)

A

expanding cystic lesions
osteoporosis
osteomyelitis

17
Q

greenstick #

A

in children where bone is softer due to organic content so bends rather than breaks

18
Q

mx of mandibular #

A
  1. clinical exam
  2. radiographs i.e. OPT & PA // CBCT
  3. control pain & infection i.e. compound requires ABs
  4. undisplaced potentially no tx but displaced requires tx
19
Q

any # in tooth bearing area

A

is a COMPOUND #
why ? direct communication with pd which is in communication with oral cavity
only not the case in edentulous pt

20
Q

to identify # on radiograph (3)

A
  1. radiolucent line
  2. loss / deformity of medial border of mandible
  3. step in occlusion
21
Q

2 main methods of tx for any #

A
  1. reduction = putting segment back into correct position
  2. fixation = if displaced it MUST be reduced and fixed
22
Q

closed reduction & fixation

A

no cutting or raising of flaps, do not open #, depends on pt occlusion to guide process
uses intramaxillary fixation to assume if teeth are re placed in correct position then mandible must be in correct position
involves wiring jaw shut for 6wks

23
Q

CR & intermaxillary fixation contraindicated in pts with

A

epilepsy

24
Q

open reduction & internal fixation

A

expose bony edges surgically i.e. raise flap and reduce directly with vision then fixed with plates & screws

25
Q

indications for ORIF of condylar #

A
  1. bilateral subcondylar # with AOB
  2. displaced # middle cranial fossa
  3. displaced # causing occlusal derangement
  4. displaced condylar # causing limited mouth opening
  5. displaced # causing ramus shortening
26
Q

le fort I

A

line passes through alveolar ridge / lateral nose / inferior wall of maxillary sinus

horizontal maxillary # separating teeth from upper face
MAXILLA ONLY

27
Q

le fort II

A

pyramidal # with teeth at base & nasofrontal suture at apex
inferior orbital rim = type II; if not then excludes this
MAXILLA & NOSE

28
Q

le fort III

A

zygomatic arch involved = type III if not then excludes this type
risk to temporalis
MAXILLA, NASAL BONE, ZYGOMA

29
Q

any combination of le fort

A

is possible
# of pterygoid plates is mandatory to diagnose le fort

30
Q

basic principles of distraction osteogenesis (5)

A
  1. osteotomy (location & direction)
  2. latency
  3. remodelling
  4. consolidation
  5. distraction (vector / rate / rhythm - want 1mm / day)
31
Q

where you get bone for graft from

A

chin / ramus / hip (iliac ridge)

32
Q

signs of retrobulbar haemorrhage

A

pain
proptosis
blurred vision
tx lateral canthotomy to decrease pressure behind eye

33
Q

initial mx of zygomatico orbital #

A

conservative
exclude ocular injury
antibiotic prophylaxis
nose blow instructions / anything that creates pressure i.e. same as OAC
r/v after 7-10 days to allow for reduction in swelling

Dentistry in a Nutshell (30 decks)

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