theme 13 Flashcards by Sophie Lynch

primary survey for assessing maxillofacial injuries

ATLS

ABCDE

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how to assess D in ABCDE

AVPU or GCS (below 8 = coma)

abnormal signs

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sign of increased cranial pressure

pupil dilation

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when is secondary survey carried out

after life threatening injuries dealt with

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sections of secondary survey

extra-oral
intra-oral
functional assessment
radiographic

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what to look for in extraoral exam

laceration
ecchymosis
oedema 
deformity/step deformities
CSF leak
eye injuries
palpation for tenderness
numbness
crepitus

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what to look for in intraoral exam

missing teeth
broken teeth/dentures
lacerations
ecchymosis
step defects in occlusal plane
palpation - tenderness, steps, mobility
numbness

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what to assess in functional assessment

occlusions
mandibular movements
eye movements
nerve injury

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types of soft tissue injury

abrasions
contusions
lacerations
avulsions
animal/human bite
gunshot

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how to assess wound

extent
tissue loss
contamination
foreign body - don't remove
nerve function
vessel involvement 
other structures involved

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how to prevent infection

early closure - even if temporary

if delayed - need to wash out first

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how to avoid dead space in primary closure

close in layer, also reduces scarring

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how to reduce tension in primary closure

undermine edges

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how to reduce chance of inversion in primary closure

ensure wound edges well apposed + slightly everted

invert due to contraction across + along length due to collagen + fibroblast mutations

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ladder for replacing lost tissue

leave - allow granulation
split thickness skin graft
full thickness graft
local flaps
regional flaps
free flaps

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complications of soft tissue injuries

infection
dehiscence/breakdown
scarring - poor technique, keloid patient
loss of function - nerve injury, structural involvement

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4 principles of treatment of fractures

reduction
fixation
immobilisation
restoration of function

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4 ways to categorise mandibular fractures

site
direct/indirect
description
favourability

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signs and symptoms of angle or body fracture

Pain, bleeding/swelling(haematoma), deformity, mobility of bone ends, deranged occlusion, loose teeth (if the fracture is in the alveolar process), paraesthesia

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signs and symptoms of condylar fracture

Pain, bleeding/swelling(haematoma), deformity, mobility of bone ends, deranged occlusion, loose teeth (if the fracture is in the alveolar process), paraesthesia

bilateral - early posterior contacts
unilateral - affected side early bite, other side openbite

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options to treat dentoalveolar fracture

flexible splint
plating
flowable composite capping - space maintenance + bone maintenance

radiographs to assess mandibular fracture

DPT + PA +/- townes

are fractures regarding tooth bearing area of jaw classed as open or closed

open

points of weekness of mandible

third molar
socket of canine
condylar neck
mental foramen

4 types of mandibular fracture

simple
wedge
segmented
comminuted

3 options for managing mandibular fractures

conservatively
mandibulomaxillary fixation - old school
miniplate fixation

considerations when assessing condylar fracture

location
amount of vertical reduction of ramus
degree of angulation of fragment
degree of laxation of condylar head out of fossa
fragmentation pattern
association with other mandibular injuries
dental occlusion
foreign body in TMJ

4 indications to use load bearing osteosynthesis

atrophic edentulous fractures
comminuted fractures
defect fractures
other complex mandibular fractures

options to conservatively manage fractures

soft diet, analgesics
Elastic intermaxillary fixation with early mobilisation
Open reduction & antibiotics (not no fixation)

when would you use conservative management of fractures

non displaced, non-mobile, normal occlusion,
compliant patient agrees for follow ups
patient refuses operative treatment
conditions making ORIF difficult - medically unstable
plates/screws unavailable

what is load bearing osteosynthesis

plates that bear forces of function at the fracture site

what is mandibulomaxillary fixation

rigid fixation in dentate patient - fixation of occlusion

indications to remove teeth in line of fracture

tooth luxated and/or interfering with reduction
tooth fractured
gross caries/perio
mobility which would not contribute to stable occlusion
existing pathology

principles of ORIF

passive action - don’t want to create tension

plates at sites of tension

3 contraindications for ORIF

gross comminution
infection
bone loss

complications of healing

malunion/non-union
failure of fixation
infection
ankylosis
necrosis

how to manage infection

exposure, debridement, sequestrectomy
temporary fixation
recon plate
same stage grafting
plate removal

mid 1/3 face fractures include which bones mainly

nasal, maxilla, zygomatic bones

when are nasal fractures treated

if aesthetic or functional problem - so not diagnosed radiographically

treatment of nasal fractures

MUA if within 2 weeks + splint

septo/rhino-plasty if over

what are buttresses

thicker areas of bone that face is suspended from - canine, zygomatic, middle third

signs of zygomatic arch fracture

pain from cheek
facial flattening
restricted opening + lateral excursion

what radiographs are used to assess mid third fractures

occipital-mental views, OM10 + 30

management for zygomatic arch fracture

Gillie’s approach/Rowe’s elevator

or intra-oral approach

~5 days when swelling reduced but bone not begun to heal

what is a zygoma tripod fracture

across all 3 sutures - infra-orbital, Z-F, zygomatic

+/- orbital involvement
+/- antral involvement

what are le fort fractures

transverse fractures involving the obital, zygomatic & nasal bones

signs of zygoma fracture

pain
peri-orbital ecchymosis/oedema/altered facial profile
subconjunctival haemorrhage
step deformities at IO rim/ZF/arch
parasthesia
diplopia/enophthalmos

management of zygoma fracture

only act is aesthetic or functional problem, otherwise conservative

reduction- poswillo hook, gillies, intra-oral, rowes elevator

fixation - ZF via lateral eyebrow, zygomatic buttress via sulcus incision, IO rim via skin crease/transonjunctival

signs of le fort fracture

face flattening/elongation
bilateral facial + periorbital oedema
epistaxis
anterior or lateral open-bite/malocclusion
ecchymosis in maxillary vestibule 
parasthesia of midface

management of le fort fractures

ORIF

how to diagnose le fort fracture clincally

manipulation of maxilla to see what moves with it

what is an orbital floor fracture

blow out fracture caused by blunt trauma

orbital contents into maxillary sinus

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theme 13 Flashcards

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