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Oral Surgery > Trauma > Flashcards

Trauma Flashcards

1
Q

WoS - aetiology for Trauma

-how many have alcohol in their system?

A
  • Assault: 65%
  • Fall: 15%
  • Sports: 9%
  • RTA: 9%
  • Industrial
  • Iatrogenic

-2/3rds have alcohol in system

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2
Q

Examination aspects - Observe (E/O)

A
  • asymmetry
  • laceration
  • swelling
  • haematoma
  • mouth opening
  • cranial N: facial / trigeminal
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3
Q

Examination: palpate for..? (E/O)

A
  • tenderness
  • bony step deformities
  • numbness
  • crepitation
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4
Q

Examination aspects: Observe (I/O)

A
  • asymmetry
  • bleeding
  • occlusion
  • swelling
  • haematoma
  • teeth: missing/damaged
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5
Q

Symps of Mandible # (8)

A
  • pain / loss of function / swelling
  • AOB
  • numb lip/chin
  • bleeding
  • occlusal derangement
  • loose/mobile teeth
  • facial asymmetry
  • deviation of mandible to opposite side
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6
Q

Classifcation of mandibular #

A-F

A 
A: invovement of surrounding tissue
-simple / compound / comminuted
B: No. of #'s
-single / double / multiple
C: side of #
-unilateral / bilateral 
D: site of #
-body / subcondylar / parasymphseal / angle / coronoid / ramus / alveolar process / condylar (intra/extracapsular)
E: Direction of fracture line
-favourable / unfavourable
F: Specific #'s
-Greenstick # / pathological #
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7
Q

Factors that cause displacement of # (6)

A
  • magnitude of force
  • direction of # line
  • surrounding soft tissue intact
  • opposing occlusion
  • mechanism of injury
  • other associated #’s
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8
Q

Sp Inv for Mandibular #

A

Rg:

a) 2 radiographs at right angles to each other - OPT / PA mandible
b) other views: occlusal / lateral oblique / CT scan

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9
Q

Treatment aims/priorities for Mandibular#

A
  • Control of pain/infection

- Reduction / Fixation

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10
Q

Treatment for Mandibular #’s

  • displaced
  • undisplaced
A
  • Displaced: ORIF- Open reduction / Internal Fixation, closed reduction / fixation
  • Undisplaced: No treatment
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11
Q

Name some surgical approaches for Mandibular #’s

A
  • retro-mandibular approach
  • Raisdon approach
  • preauricular approach
  • bi-coronal flap
  • endoscopic reduction / fixation
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12
Q

Other names for ZO #’s

A
  • ZOC
  • cheekbone
  • zygoma
  • malar
  • tripod
  • tetrapoid
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13
Q

Name some arteries surounding the eye - ZO #’s

A
  • supraorbital A
  • infraorbital A
  • lacrimal A
  • facial A
  • supratrochlear A
  • angular A
  • medial palpebral A
  • zygomaticofacial A
  • superficial temporal A
  • transverse facial A
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14
Q

Name some nerves surrounding the eye - ZO #’s

A
  • lacrimal N
  • supraorbital N
  • infraorbital N
  • infratrochlear N
  • supratrochlear N
  • zygomaticofacial N
  • zygomaticotemporal N
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15
Q

Symps of ZO #

A
  • asymmetry / deformity
  • altered sensation: cheek numbness (infraorbital N)
  • visual disturbance: decreased acuity / diplopia / swelling / motility / position
  • pain on eye movement
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16
Q

Name of classification of ZO #’

-significant ones to remember

A

Henderson’s Classification

  • type 5: orbital blowout
  • type 6: orbital rim #
17
Q

Clinical signs of ZO #’s

A
  • periorbital ecchymosis
  • swelling then flatness
  • lacerations / excoriations
  • sunconjuctival haemorrhage
  • numb cheek
18
Q

Sp Inv for ZO #’s

A
  • OM views 15/30 degrees (facial views)

- CT scan - blowout / complex #’s

19
Q

Examination of ZO # - important details

A
  • palpate cheek: bone margins/crepitus/altered sensation

- visual acuity: eye movement/position/reaction to light/diplopia

20
Q

Indications for treatment of ZO #

A
  • Symps: diplopia/asymmetry/numbness/enopthalmos

- Asymp: defect on Rg = significant deformity

21
Q

Indications for NO treatment of mand #

A

ASYMP

  • co-morbidities
  • fracture is > 1mth old
  • defect on Rg - no displacement
  • patient refuses treatment
22
Q

Treatment for ZO #

A

ORIF

  • GIllies lift
  • Malar hook
23
Q

Post op instructions given to patients with a ZO#

A
  • don’t blow nose
  • post op steroids: dexamethasone 4-8mg
  • eye observations overnight
24
Q

What MAJOR complication must be observed for ZO # cases

-symps/signs

A

RETROBULBAR HAEMORRHAGE

  • decreasing visual acuity
  • severe pain
  • proptosis
  • opthomoplegia
25
Q

Medical management of retrobulbar haemorrhage

  • drugs
  • surgical
A
  • IV acetazolamide 500mg
  • IV hydrocortisone 100mg

-Lateral canthotomy: emergency decompression of orbital compartment syndrome

26
Q

Aetiology of Maxillary #’s

A
  • blunt force trauma
  • iatrognenic: intentional/unintentional
  • pathological
27
Q

Initial assessment of maxillary #

A
  • Airway & C spine
  • Breathing & oxygenation
  • Circulation & haemorrhage control
  • Disability - GCS etc
  • other injuries
28
Q

Symps of Maxillary #

A
  • malocclusion
  • altered sensation
  • diplopia
  • facial asymmetry
  • decreased air entry
  • nose bleeds
29
Q

Signs of Maxillary #

A
  • swelling/bruising
  • hypoaesthesia
  • restricted eye movement
  • noe bleeds
  • malocclusion
  • ‘cracked cup’ - perc note
  • mobility: palatal split
30
Q

Sp Inv for Maxillary #

A
  • plain Rg
  • CT scan
  • study models
31
Q

Complications of Maxillary #

A
  • malunion
  • nonunion
  • infection
  • haemorrhage
  • persistent hypoaesthesia
  • late enopthalmos
32
Q

Explain the extent of:

  • Le Fort I #
  • what structures separate from rest of skull
A
  • fracture line extends over apices of maxillary teeth to pterygoid processes
  • teeth / alveolar processes / palate
33
Q

Explain the extent of:

  • Le Fort II #
  • what structures separate from rest of skull
A

Fracture line extends:

  • posterolateral wall of max sinus
  • medial wall of orbit
  • lacrimal bone onto bridge of nose
  • through floor of orbit
  • along infraorbital canal
  • through zygomatic process of maxilla

Displaced: entire anterior portion / central portion of face / palate / alveolar process

34
Q

Explain the extent of:

  • Le Fort III #
  • what structures separate from rest of skull
A

Fracture line passes bilaterally through:

  • zygomaticomaxillary suture
  • across the greater wing of the sphenoid,
  • through the superior orbital fissure,
  • ethmoid bone, lacrimal bone
  • maxilla at bridge of nose.

Displaced: almost entire face

Oral Surgery (4 decks)

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