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Oral Surgery > Trauma > Flashcards

Trauma Flashcards

1
Q

Why might someone with a fractured mandible present with an anterior open bite

A

The ramus has shouted due to bi-lateral subcondylar fracture the mandible

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2
Q

What clincal signs and symptoms might someone with a mandibular fracture present with?

Name 5

A

Pain, swelling and limitation of function
Occlusal derangement
Numbness of the lower lip
Loose of mobile teeth
Bleeding
Facial asymmetry
Deviation of mandible
Sublingual haematoma

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3
Q

What are the three classifications of a fracture with regards to the surrounding tissues

A

Simple - fracture in bone but the soft tissues are intact
Compound - soft tissues damaged/lacerated exposing the soft tissue
Comminuted ;bone broken into mutiple pieces

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4
Q

Any fracture involving the teeth bearing area is classified as what kind of fracture and why

A

This is a compound fracture as it is in direct communication with the PDL

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5
Q

Direction of the fracture line - relates to the displacement
What are the two kinds of fracture line

A

Favourable - in the direction that minimises displacement
Unfavourable - encourages displacement

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6
Q

What is a green stick fracture

A

This is a fracture that happens in children because of the organic content of the bone - the bones are soft so fracture may not cause complete separation

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7
Q

Name 6 factors which can cause displacement of mandibular fractures

A
  1. Direction of the fracture line ; favourable or unfavourable
  2. Opposing occlusion ; if they have a good opposing occlusion the displacement will be minimised as the opposing occlusion will act as a stop for displacing the mandible
  3. Magnitude of the force
  4. Mechanism of injury
  5. Intact soft tissues - displacement unlikely
  6. Other associated fractures
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8
Q

What two radiographs would you want to assess a mandibuar fracture

A

OPT
PA mandible
- postero anterior mandible radiograph

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9
Q

What kind of mandibular fracture is most likely to get infected and therefore requires antibiotics

A

Compound

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10
Q

What are the two basic principles of treatment of a mandibular fracture

A

Reduction ; put the fracture segments into the right anatomical alingment

Fixation ; fix in postion

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11
Q

What are the two treatment options for displaced or mobile fractures

A
  1. Closed reduction and fixation
    - do not open the fracture ( i.e dont raise a flap), you depend on the patients occlusion to guide the reduction process
  2. Open reduction and internal fixation
    - expose the bony edges surgically and reduce them directly with vision and fix in place with screws
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12
Q

When doing closed reduction with fixation - the patients occlusion is used to guide reduction, what else is needed to do this

A

Inter-maxillary fixation

Teeth are wired together

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13
Q

What group of people is intermaxillary fixation contraindicated in

A

Epileptics - if they are sick they will die

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14
Q

If a patient is edentulous and closed fixation is being used what kind of split is used

A

A gunning splint - dentures are utilised

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15
Q

What treamtent option do majority of patients now have for displaced or mobile mandibular fractures

A

Open reduction and internal fixation

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16
Q

What is a possible complication of ORIF

A

Damage to IAN

17
Q

While most children’s injury’s are innocent we need to be able to spot signs of non accidental injury in children. What are some signs of this ?

A

Injuries sustained that are non Consistent with the history provided by the parent
Delayed presentation
Apparent lack of concern or apparently over anxious parents
Clinical or radiographic evidence of multiple injuries - especially if of different ages
Withdrawn or frightened child

18
Q

Name 5 disadvantages of Intermaxillary fixation

A

The airway is partially compromised and is at increased risk in the event of postoperative swelling, regurgitation or swelling
Patients are unable to take a solid diet
It is difficult to maintain good oral hygiene
Poor patient tolerance
Post treatment stiffness of the TMJ and risk of ankylosis

19
Q

When may be open reduction with internal fixation be contraindicated

A

Significant comminution or infection
In children where unerupted teeth are still present in the jaws

20
Q

What are the signs and symptoms of a maxillary fracture

A

Pain
Asymmetry
Diplopia
Altersed sensation
Mobility
Swelling
Nose bleed

21
Q

What are the three le fort classifications

A

1 - tooth bearing area detached
2 - fracture involving nasal IO rims
3- whole maxilla detached from the base of the skill

22
Q

What radiographs would you request for a maxillary fracture o

A

Occipitomeatal at 15 and 30 degrees

23
Q

6 signs of zygomatic-orbital fracture

A

Numbness of cheek
Diplopia
Asymmetry
Subconjunctival haemorrhage
Flattening of zygoma
Pain on eye movement
Decreased visual activity

24
Q

What are three treatment options for fractures

A
  1. Conservative management ; monitor and analgesia
    2, open reduction and internal fixation
  2. Closed reduction and intermaxillary fixation
25
Q

What are 8 signs and symtoms of mandibular fracture

A

Asymmetry
Pain
Swelling
Occlusal derangement
Limited opening
Numbess
AOB
Step deformity

26
Q

What radiographs would u want for a fractured mandible

A

PA mandible and OPT

27
Q

What are two indications for orthognathic surgery

A

Restore function and aesthetics
Severe skeletal discrepancy

28
Q

What are risks with orhtognathic surgery

A

Relapse
Nerve damage
TMD
Bleeding
Unobtainable results for high paitent expectations
Infection

29
Q

Name two types of mandibular surgeyr

A

Bilateral saggital split osteotomy
Vertical subsigmoid osteotomy

30
Q

Give two types of maxillary surgery

A

Le fort 1
Anteior maxillary osteotomy

31
Q

Why might a paitent present with a nosebleed when they have a zygomatic fracture

A

Because there has been blood into the maxillary sinus and the maxillary sinus drains though the nose via semi-lunar hiatus in middle meatus

32
Q

Why might patien wiht an zygomatic-orbital fracture have a numb lip cheek or nose

A

This because the infra-orbital nerve lies in the orbital floor so truama to this can cause numbness in the areas that it supples

33
Q

What fissure do all the nerves that control the eye come out of

A

Superior orbital fissure

34
Q

What are the three main characteristics of a zygomatico-orbital complex fracture

A

Subconjunctival haemorrhage
Subconjuncitval ecchymoses
Flatness of face

35
Q

Why might someone with a zygomatic fracture present with limited mouth opening

A

Because the zygomatic fracture is impinging on the cornoid process

36
Q

Before any orthognathic surgery is ruled out which mental disorder must be the patient be proven not to have

A

Body dismorphic disorder

37
Q

What is the most popular technique for mandibular surgery

A

Saggital split mandibular osteotomy

38
Q

What happens in a saggital split osteotomy

A

It enables the body of the mandible to be moved forwards or backwards by moving the split angle and ramus - thus providing a large amount of Bone overlap for healing

39
Q

What is the most common maxillary osteotomy

A

Le fort 1

Oral Surgery (5 decks)

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