Station 1

Question 1

Which artery passes into the pterygomaxillary fissure?

Answer 1

Maxillary artery

Question 2

Which artery supplies the maxillary artery?

Answer 2

External carotid

Question 3

What nerve can be injured in a zygomatic arch fracture?

Answer 3

Infraorbital nerve

Question 4

What nerve is the infraorbital nerve a branch of?

Answer 4

Maxillary (V2)

Question 5

What would be the clinical result of a zygomatic arch fracture? (infraorbital nerve)

Answer 5

Loss of V2 (maxillary) sensation

Question 6

What are Le Fort fractures?

Answer 6

Fractures of the midface, involve separation of all or a portion of the midface from the skull base. In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved (these separate mid-face to brain base)

Question 7

How are Le Fort fractures classified?

Answer 7

Type I, II, III

Question 8

Which bones are fractured in Le Fort I fractures?

Answer 8

The alveolar ridge, lateral nose and inferior wall of the maxillary sinus

Question 9

Which bones are fractured in Le Fort II fractures?

Answer 9

Pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex.

Fracture arch passes through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones

Question 10

What is floating in a Le Fort I fracture?

Answer 10

Floating palate (palate separated from maxilla)

Question 11

What is floating in a Le Fort II fracture?

Answer 11

Floating maxilla (maxilla separated from face)

Question 12

Which bones are fractured in Le Fort III fracture?

Answer 12

Nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch / zygomaticofrontal suture

Question 13

What is floating in Le Fort III fracture?

Answer 13

Floating face (craniofacial dysfunction)

Question 14

What are two prehosp considerations of upmost importance with facial fractures? (+ more for extra brownie points)

Answer 14

1. Airway compromise
2. Base of skull fracture (Type III)

Others:

3. haemorrhage
4. increased secretions
5. dislodged teeth
6. traumatic brain injury (C-spine precautions needed)

Question 15

Which artery is in the cavernous sinus?

Answer 15

Internal carotid artery

Question 16

Where does the sphenoid air sinus drain into?

Answer 16

The sphenoethmoidal recess

Question 17

Which structures are in close proximity to the cavernous sinus?

Answer 17

The sphenoid air sinus, the sella turcica and the orbit

Question 18

A 26 year old male strikes his face on a road sign whilst roller blading. He sustains a fracture to the sphenoid bone. Which artery/arteries may be responsible for the torrential bleeding?

Answer 18

Opthalmic artery

the first branch of the ICA distal to the cavernous sinus

Question 19

Why might someone with a sphenoid fracture develop monocular blindness?

Answer 19

Severed their optic nerve