Trauma

Question 1

25 yr old pt attends practice with 2 day Hx of painful and loose left mand FPM after being hit in the face with a cricket ball. What would you ask?

Answer 1

Ask about the accident, any associated injuries of more importance (LoC), when, was tooth #, did it fall out, is occlusion deranged, any abnormal feelings in soft tissues

Question 2

25 yr old pt attends practice with 2 day Hx of painful and loose left mand FPM after being hit in the face with a cricket ball. What images would you request?

Answer 2

OPT to see all the dentition (more than LL FPM might have been damaged)
PA of LL FPM to check PA status, #s

Question 3

25 yr old pt attends practice with 2 day Hx of painful and loose left mand FPM after being hit in the face with a cricket ball. you determine it is from # mand - how would you proceed? what images would you take?

Answer 3

Refer urgently to maxfacs
tell patient not to eat or drink on the way there in case of surgery
OPT/PA mand
CBCT

Question 4

What is the treatment for a displaced fractured mandible?

Answer 4

open reduction, internal fixation

Question 5

What is the difference between and dento alveolar # and an alveolar fracture?

Answer 5

dento-alveolar # involves the alveolar process and the dental socket, alveolar # does not

Question 6

What clinical presentation would lead you to suspect a dento-alveolar #?

Answer 6

Hx of trauma
teeth move as segment
teeth in segment are TTP
deranged occlusion due to segment moving

Question 7

What investigations would you do for a dento-alvevolar #?

Answer 7

vitality tests of all involved teeth (-ve)
Rx - 2 views at right angles. PA and upper standard occlusal, OPT/CBCT
- expect to see radiolucent fracture line between fragments, discontinuity of PDL, associated # of root/tooth

Question 8

How would you manage a dento-alveolar #?

Answer 8

LA
reposition segment with forceps
stabilise fragment with 4 weeks flexible splint

radiographic follow up 2/4/8/16/24/52-260 weeks. RCT all teeth involved

advise soft diet, CHX, good OH, sequelae (necrosis, ankylosis, resorption, loss of tooth)

Question 9

What would make you think trauma has been non-accidental?

Answer 9

labial frenum tear on non-mobile child
bruising on soft tissues
bruising in the triangle at the back of neck
inconsistent story/presentation
delayed presentation of the trauma

Question 10

What do you assess during a trauma review?

Answer 10

Colour
sinus formation
radiographic appearance
percussion - sound and feel
mobility
sensibility testing