trauma Flashcards
what is the ellis classification of dentoalveolar fracture
based on the extent of tooth structure involved
class I: only enamel
class II: enamel and dentin
class III: enamel, dentin, pulp
what type of splint to use for avulsion and intrusion
even though its not exactly an alveolar fracture, so by guidelines it says flexible splint but dr teo says that they do rigid splint because we want bony stabilization whenever there is a bony injury
what bone fracture to suspect if mouth opening is limited
zygomatic bone fracture because when its fractured, the condyles will be blocked and cant open mouth
what are the 4 points of fixation of the zygoma
- zygomaticomaxillary articulation and inferior orbital rim
- zygomaticosphenoid articulation in the lateral orbital wall
- zygomaticofrontal articulation and the lateral orbital rim
- zygomatic arch
two types of closed reduction for ZMC fractures
1) gillies approach
- incision made within temporal hairline to access zygomatic arch, fracture reduced using an elevtor placed between temporalis muscle and deep temporal fascia, elevating displaced bone back to proper position
2) Keen’s approach
- incision through maxillary vestibule
- minimally invasive method, hidden incision site
what kind of fracture do we suspect when we see ecchymoses on chin
parasymphyseal fracture
- also if patient says theres a gap between lower anterior teeth, wasnt present intiially but now is there
what is guardsman fracture
anterior mandible fracture combined with bilateral condylar fracture
how to manage a mandibular fracture in an edentulous patient
closed reduction by gunning splint for 4-6 weeks
they are bite blocks secured to bone using wire or screws to immobilise jaw
initial mx of trauma pt
primary survey ABCDE
1) airway and crvical spine
- head tilt chin lift to check for debri, vomitus
- make sure airway is patent
- but for unconscious patients, assume cervical spine injury until it is ruled out and immobilise spine using cervical collar
2) breathing and ventilation
- CPR. if pulse is absent
- pulmonary status - should count RR. look out for pneumothorax, hemothorax etc
3) circulation
- assess hypovolemia and CO by examining skin prefusion
- hemorrhage control: apply direct pressure
- administer 2L of Hartman’s solution aka Ringer’s lactate IV for patients with hypovolemia
4) disability (neurological status)
- GCS
5) exposure
- remove all clothing and inspect from head to toe
- prevent hypothermia
why is retrobulbar hemorrhage an emergency
- accumulation of blood in retrobulbar space can lead to blindness
- bleeding into this space causes stretching of optic nerve or blockage of ocular perfusion
- ## is a compartment syndrome of the eye
how to examine for zygomatic fracture
stand behind patient and compare maximum convexity of zygomas
signs of lefort fractures
classification of soft tissue injuries
1) abrasion
- a wound cause by friction between an object and the surface of the tissue
- if abrasion is not deep, re epithelialisation occurs without scarring
- if abrasion extends into dermis, healing occurs with scarring
2) contusion
- aka bruise
- when contusion is seen, dentist should look for osseous fractures
3) laceration
- a tear in epithelial and subepithelial tissues usually caused by a sharp object
what does an open fracture mean
open if the fracture communicates intraorally to the oral mucosa or to the overlying skin
open = compound = contaminated
green stick vs simple vs comminuted fracture vs segmental fracture?
green stick = incomplete fracture, the bone never break from end to end
simple = complete fracture of bone with minimal fragmentation at the site
comminuted = fractured bone left in multiple segments ie gunshot wound or other high impct injuries
segmental - 2 complete fracture lines at the same location then the whole fracture can move
how to tell if its a favourable or unfavourable fracture
depending on the angulation of fracture relative to the muscle pull from the pterygomasseteric sling
horizontally favourable is when the fracture line runs downward and forward so the muscle pull resists displacement of the fracture
vertically favourable is when the fracture runs from the outer buccal plate obliquely backwards and lingually because the medial pterygoid exerts a superomedially directed force on the medial surface of the ramus of mandible
classification of condylar process
LIndahl classification into 3 levels
- condylar head aka intracapsular
- condylar neck
- subcondylar
clinical presentation of condylar fracture
- might have distraction of joint due to effusion or hemarthrosis at the injured condyle and hence an ipsilateral posterior open bite and a midline shift to the contralateral side
- if bilateral then AOB
lefort I borders
horizontal fracture extending from the lateral margin of the piriform aperture, traversing the lateral antral wall through the maxillary sinus and the lower third of the nasal septum to separate at the pterygoid plates
lefort II borders
pyramidal fracture extending from the frontonasal suture, along the maxilla to the zygomaticomaxillary suture to include the medial third of the orbit floor, through the nasal bones to include the lower 2/3 of nasal septum and the pterygoid plates
lefort iii borders
fracture line extends from frontonasal suture passing posteriorly along the medial wall of the orbit and following the inferior orbital fissure to the lateral wall of the orbit, then extending to the zygomaticofrontal suture
what does a ZMC fracture refer to
disruption of 4 articulating surfaces:
- zygomaticofrontal ZF
- zygomaticosphenoid ZS
- zygomaticomaxillary ZM
- zygomaticotemporal ZT
and then there is always an orbital component for ZMC fractures because th zygomatic bone contributes to the lateral wall and floor of orbit
clinical signs of ZMC fractures
- depression at malar eminence
- periorbital ecchymosis with crepitus
- subconjunctival hemorrhage
- infraorbital nerve numbness
- downslanting of the lateral palpebral fissures
- diplopia due to restricted extraocular movements
write short notes about GCS
is a neurological assessment tool used to assess a person’s level of consciousness fter a brain injury, scores range from 3 to 15
3 indicates a coma, 15 indicates full consciousness
- GCS assesses 3 aspects of responsiveness: eye opening, verbal response and motor response
severe: score 3 to 8
moderate: score 9 to 12
mild: score 13 to 15
What tetanus to give if the patient doesnt have tetanus vacc before
250mg IM
tetanus toxoid booster injection
surgical mx scheme (list out the stuff we consider)
1 surgical aim
- function
- aesthetics
- psychological
2 establishment of occlusion
- closed reduction
- open reduction
3 surgical access
- incisions
- pre existing lacerations
4 fixation (closed versus open)
5 ORIF as tx of choice
6 maxillomandibular fixation
- wires
- arch bars
- elastics
7 soft tissue repair
8 rehabilitation
- implant
- dentures
- secondary surgery
