S2 - Maxillofacial Injuries Flashcards
Name 3 common causes of maxillofacial injuries
- interpersonal violence
- RTA (road traffic accident)
- falls
also sport
Which pt group is most susceptible to maxillofacial injuries
males, age 13-35
Most common maxillofacial fracture
- nasal fractures (most common)
- mandibular fractures (next most)
Components of treating a pt who has maxillofacial injury
- initial assessment
- applied anatomy (what is broken, fractured, lacerated etc)
- diagnosis
- treatment planning
- principles of treatment
- definitive treatment
- complications of fractures
What should be done in initial assessment? (6)
- rapid survey of vital functions & prioritize management options
- ABCDE (airway, breathing, circulation)
- head injury
- prevent infection
- pain management
- temporary immobilisation/fixation of fractures (helps stop pain and haemorrhage)
*During head injury, the face might be very injured/broken by absorbing the force from the injury but this may have prevented PRIMARY brain injury. E.g. a patient with severe face injury is conscious and alert, but what is now important to prevent?
prevent secondary brain injury from inadequate cerebral circulation:
- airway - 100% oxygen
- breathing - chest injury
- circulation:
- control haemmorhage
- treat hypovolaemia
- isotonic fluid therapy (to raise blood pressure in pt w hypovolaemia)
For context: haemorrhage vs hypovolaemia
haemorrhage - loss of blood from ruptured/injured blood vessels
hypovolaemia - fall in circulatory volume
can have hypovolaemia due to haemmorhage
What to know about head injury?
- frequently associated with facial injury
- may be milder when associated with severe facial injury
- often associated with alcohol/drug use
Applied anatomy of the face which may be affected by maxillofacial injuries
- dento-alveolar
- mandible
- middle 1/3 of face
- zygoma
- orbit
- nasal bones & naso-ethmoidal complex
- cranio-facial (shared)
How to diagnose the injury?
- history (to understand what happened)
- examination
- recognition of diagnostic features**
- imaging
- study models (e.g. to show how broken maxilla or md fit tgt)
What are some soft tissue structures often damaged?
- parotid gland
- parotid duct (Stensen’s duct)
- branches of facial nerve
- muscles of facial expression
- sensory nerves (supraorbital, infraorbital)
- nasolacrimal duct
Branches of the facial nerve
TZBMC
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
**4 principles of managing a fracture
- Reduction: reduce fracture by putting broken ends tgt in anatomical position
- Fixation (ORIF): open reduction internal fixation - open wound and fix bones in correct position
- Immobilisation (IMF): intermaxillary fixation - wiring teeth together to stabilise face/jaws
- Rehabilitation
Best way to treat a nasal fracture and why?
push nasal bones back into place straightaway, if you wait too long oedema wont allow pushing it back
can put splint on after to protect broken bones
How does mandibular fracture commonly occur?
- direct injury to parasymphyseal/mental region
- can lead to indirect injury to the condyle and angle (areas of weakness in md) - on opposite side
(angle = where horizontal body meets vertical ramus, can have impacted 3rd molars in this area too, neck of condyle is thin and narrow - postulated that it has evolved so injury to chin doesnt cause md to go into temporal area and cause cranial damage and instead the condyle neck fractures)
Types of mandibular fractures (by region) and how
parasymphyseal/mental and body - direct injury
angle and condyle - indirect
ramus and condyle - very rare, may be associated with severe, communited fractures in multiple fragments(??)