Trauma Flashcards
What is the most common trauma? What is the most prone group to trauma?
Approx 2300 injuries/yr w/bottles pacifiers sippy cups
<3 yo
Mouth lacerations most common
Anticipatory trauma guidance for infants? Toddlers? Children? Teens? Atheletes?
Infants: pacifier safety, danger of ‘walkers’
Toddlers: dont let babies run with scissors, ambulatory skills
Kids/Teens: bike helmets
Athletes: sports activities
Aspects of neurological exam
III-Occulomotor Penlight PERRLA
III, IV, VI Occulomotor tochlear and abducens- track movements
VII: Facial ask pt to close eyes, smile, frown. No asymmetry of movement
Injuries to which cranial nerves are more common after trauma?
III (occulomotor), IV-trochlear, VI-abducens, VII-facial
Post op instructions for observation post trauma?
Parents should watch out for:
Pt persistently sleepy, vomiting, severe headache, or abnormal behaviors
Comminuted fracture? Simple, compound?
Comminuted- bone is splintered. Simple overlying soft tissue are intact; compound bone exposed to skin or mucosa
Causes of craniofaction trauma in descending order?
Distribution of Craniofacial trauma?
How often do concomitant injuries occur? What kind of injury?
Causes: Falls 64% Traffic 22%, Sports 9%, Violence 5% Distribution: skull vault 54% Upper/middle facial third 37%
Concomitant injuries occur 1/3 of the time-usually a concussion
What facial bones are most likely to fracture? (midface fractures)
Nasal bone and zygoma
Describe LeFort fractures in children?
Least common midface fracture in children due to prominent calvaria
Many LeFort 1 tx, no fixation. Class II and III req open reduction w/caution for developing teeth.
From least (30G) to most (200G) force, order the following facial bones:
Zygoma, angle of the mandible, nasal, supraorbital rim, midline maxilla, frontal glabellar region, symphysis of mandible
Nasal 30 Zygoma 50 Angle of mandible 70 Frontal-glabellar region 80 Midline maxilla 100 Symphysis of mandible 100 Supraorbital rim 200
Diagnostic aid for facial fractures?
CT scan
pt with limited upward gaze, periorbital swelling suspect?
Zygomatic fracture:
hx of blow to the cheek, periorbital swelling, ecchymosis, hematoma, conjunctival hemorrhage, palpable step deformity, paresthesia in dist of 2nd division of trigeminal nerve, limited upward gaze
What is the most common facial skeletal injury in hospitalized pediatric trauma patients? What is the incidence, causes, and characterstics?
Mandibular fracture
Boys 2xgirls
Younger patients : condylar/subcondylar fractures
Adolescents: fracture of angle of the mandible-think developing 3rd molars
Causes: bicycles, steps, swings
What are signs and charactersitcs of a subcondylar/condylar fracture?
Blunt injury to chin
Bite is “off” (retrognathic when they werent before) or deviated
Unilater vs bilateral (deviated chin)
Palpate external auditory meatus
Which fractures carry the greatest risk of growth disturbance?
How is it treated?
And what are possible complications of the injury?
Likely outcomes?
Condylar fractures- ramus height may not be maintained and may cause a huge asymmetry
tx: not rigid fixation, elastic
- Possible complications: ankylosis of the jaw, asymmetry, development of malocclusion
- condylar head resorbs, and the ramus remodels to maintain height
Describe an intracapsular condylar fracture in mandibular fractures. Risks? and Treatment?
Ankylosis risk in children less than 3 years old
Crushing injury
Treatment mandibular exercises and jaw stretching
Fracture of the body of the mandible: age group, best tx? dx by? Signs/Symptoms
Older patients
Closed reduction better than open
Pano
Signs: bruising in the floor of the mouth, hematoma in buccal vestibule, mobility along fracture site on palpation, possible paresthesia
Radiographs for soft tissue lacerations?
1/4 usual exposure for intraoral xray and 1/2 usual exposure of an extraoral xray
Electric Burns: age? type of injury? and clinical course?
2-4 yo
Coagulation tissue necrosis
Immediately post injury- paresthesia or anesthesia and no hemorrhage.
W/in a few hours: edema that may last 7-10 days, drooling (lost sensation), after several days center of lesion becomes gray/yellow w/erythema
Spontaneous hemorrhage w/in first 3 weeks after born
fibrous tissue forms can result in microstomia
WHO classification of dental trauma Class 1, 2, 3
Class 1: injury to dental structures and pulp (enamel fracture, enamel/dentin frac, uncomplicated; enamel/dentin/complicated w/pulp exposure)
Class 2: injury to dental structures, pulp & alveolar process (crown root fracture, root fracture, alveolar fracture)
Class 3: injury to periodontal tissues (concussion, sublux, lux, avulsion)
Primary tooth root fractures require extractions T/F.
F: If the coronal section is not displaced, no occlusal interference, can allow tooth to remain.
Treatment for:
Extrusive luxation in primary teeth?
If interfering with occlusion, likely ext.
Intrusion in primary dentition:
Percent of which are intruded in which direction?
Duration and prognosis?
Later findings?
Intrusion if no movement after 6-8 weeks : EXT
80% of intruded teeth are pushed labially (away from permanent successor); majority re-erupt and survive >36mo
-PCO is a common finding as is ectopic position (rotation) following re-eruption.
What are the most common findings in primary teeth post trauma? Relative percentages?
Color changes 53% Premature tooth loss 46% Pulp canal obliteration 36% Pulp necrosis 25%' Gingival retraction 6% Disturbances in physiologic resorption 4%
Discolored primary teeth: differences in colors? When to extract?
> 50% dark coronal discoloration fades
Yellowish teeth develop less pathology
50% of dark teeth remain asymptomatic until eruption of permanent successor
-RCT of asymptomatic darkened primary incisors is unnecessary
Indications for EXT: swelling, sinus tract, increased mobility and sensitivity to percussion
What primary tooth trauma poses the greatest risk to the permanent successor? Timing of trauma associated with highest risk?
Intrusion and avulsion of primary teeth
Age less than 3 years at time of trauma
What kind of permanent teeth injuries need to see immediately?
Avulsion
Alveolar Fracture
extrusive or lateral luxation
Crown fracture of a permanent tooth with pulp exposure healing is dependent upon: ?
Degree of fracture
Any luxation of tooth, as this is the primary source of pulpal contamination
Stage of root development
Effectiveness of dentin seal
Reattachment of fractures segment w/GI or composite resin
Mechanism of Ca(OH)2 in pulpotomy for traumatized permanent teeth
- High pH causes necrosis that stimulates hard tissue bridge
- Excellent antibacterial property
- Hard tissue bridge my have vascular inclusions
Mechanism of MTA in pulpotomy for traumatized permanent teeth
- High pH causes coagulation necrosis
- zone of reparative dentinogenesis forms
- Dentin bridge w/fewer vascular inclusions
- Physical bond to dentin
MTA vs Ca(OH)2 for direct pulp cap and pulpotomy: speed? compatibility?
MTA faster formation of hard tissue bridge
- less pulpal irritation w/MTA; biocompatible
- more predictable pulp barrier w/MTA
- MTA aids in bone turnover via interleukin regulation
- no thining of dentinal walls, better fracture resistance over time
- may help stop inflammatory root resorption: stimulates interleukin regulation,
Likely outcomes post cvek pulpotomy?
Pulp survival (most likely outcomes)
PCO
Necrosis
Intra-alveolar root fractures should always be splinted and stabilized. T/F
False
- If there is no mobility, do not splint.
Mobile coronal segment reposition and splint for 4 weeks, if fracture is in cervical third reposition and splint for longer period of time
CaOH2 and MTA both decrease root fracture strength. T/F
True:
Initially both decrease the fracture strength, however MTA reverses the process and increases the fractures strength between 2-12 months which CaOH2 continues to decrease the strength
Intraalveolar Root fractures : survival/healing rates? outcomes? Poorest prognosis?
80% Surival; 20% No healing
- Poorest prognosis: horizontal fracture in cervical root (30% chance of surivival)
- Fracture in the cervical-middle, middle and apical have 88% survival
- likely outcomes: obliteration of the pulp, no effect on healing
Describe subluxation and likely outcomes
Subluxation: sensitive to percussion, no displacement, increased mobility, sulcular bleeding.
-observe
Describe Extrusive luxation
Tooth appears elongated
-excessive mobility
-widened PDL noted on rgs
reposition and splint 2 weeks
Definition of lateral luxation injury? Presentation clinically/radiographically?
Displacement of the tooth in a direction other than axial
Pulp supply is ruptured and the PDL is compressed
Possible outcomes of lateral luxation injuries? treatment?
Outcomes: root resorption, PCO (40%) most which get PCO have a closed apex. If PCO forms, less likely to see pulp necrosis.
Tx: reposition, splint w/light wire 4 weeks
Pulp Canal Obliteration: % discolor? Relation to PN?
Tooth discoloration occurs in up to 80% of teeth w/PCO
Color change alone not a predictor of pulp necrosis
- Teeth w/total PCO are more likely to have PN than teeth w/partial PCO
Factors involved in intrusive luxtions- what makes for better or worse outcomes?
If age of pt <12 less fewer complications
Concurrent gingival laceration = more necrosis
multiple intrusions more bone loss
Incidence of intrusion luxations?
Rare 7mm = more complications
intrusions 1-3 mm less root resorption
Avulsion : factors effecting prognosis
Extraoral dry time
- loss of PDL vitality
- storage media
- handling of tooth before replantation
- patient immune response
Avulsion storage media what is best/worst?
Worst: gatorade, contact lens solution
Cooler/ice solutions showed less apoptosis
Best: HBSS, cold milk
systemic antibiotics post avulsion if patient is older than 12? Younger than 12?
Older than 12: doxycycline
Younger than 12: Pencillin V
Post op avulsion instructions
Tetanus prophylaxis
Chlorhediine bid while splinted
soft diet
OH
f/u 1 week
Closed apex remove splint: 7-14 days; extirpate pulp w/in 14 days, place Ca(OH)2
Open apex: 7-14 days remove splint, observe for revasc, sings of pulp necrosis, resorption, apexification as indicated
Normal healing mechanism and timing post avulsion?
4 days: pulp revascularization- this continues at .5mm/day
1 week: gingival attachment re-est and PDL
2 weeks: PDL has regained nearly all of its strength
When do signs of negative sequala of traumabegin to show? What are they?
2 weeks on radiograph can see evidence of ankylosis and inflammatory resorption
Prognosis of a tooth is primarily related to the length of time it is splinted. T/F
False
Prognosis is related to the type of injury rather than splinting.
What children are at highest risk for child abuse?
Low birth weight (premature birth), physical/mental disability, hyperactive or aggresive, 1 of many (4 or more) siblings, age 2-4 yrs
-low SES neighborhood, vacant homes, high unemployment, etc
Characteristics of child abusers
Young maternal age, unmarried, low education, low employment, poverty, low self esteem, substance abuse, mother not living with her mother at age 14, presence of surrogate in home
Who is mosty likely to abuse the child
27% mother; 26% father; 13% mother’s partner
53% occurs in home
23% punched/slapped around head/neck/face
What is the name of a syndrome where parent put children through all sorts of unnecessary tests/fabricated illnesses?
Munchausen syndrome
Splinting times for the following injuries:
subluxation, extrusive luxation, avulsion, avulsion (>60min dry), lateral lux, root fracture (middle and apical), alveolar fracture, and root fracture (cervical third)
2 weeks: sublux, extrusive lux, avulsion
