Trauma Symposium Quiz Flashcards
How does the incidence of facial fracture change with age
Triphasic (variable with 3 peaks)
1. children (less than 5 years old)
2. Young people (late teens-30’s)
3. Elderly
What factors result in a change in incidence of facial fractures with age
- Falls:
children have a developing neurological system (e.g muscle and balance)
Elderly: neurological generation
- Assaults: (more common 20-25) antisocial/ risk behaviour
3.Road traffic accidents (20-25), 75+ increase risks
In patients with multiple injuries, why are injuries to brain, thorax, abdomen, pelvis and lower limbs sometimes treated more urgently than facial fractures
Brain: associated with facial injury, may disrupt airway or stop breathing
Thorax: disrupt breathing due to collapsed lung, pneumonothorax, broken rib
abdomen/ pelvic:
- large vessels in abdomen & spaces
- lose a lot of blood and not aware
- potentially life threatening
Lower limbs: long bone injury affect QoL associated spinal/ cervical
Who was Le Fort?
- How did he conduct his research?
-What is the significance of different levels of Lefort fractures
Lefort fractures applied to Transverse Fractures of the midface
- Conducted research on Cadavers in 1901
Le forte 1:
- horizontal maxillary fracture, seperating the teeth from the upper face
- fracture line through alveolar ridge, lateral nose and inferior wall of maxillary sinus
Le forte 2: maxilla and nose
- pyramidal fracture with teeth at pyramid base, nasofrontal suture at its apex
-fracture arch passes through posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rims and nasal bones
Le forte 3:
maxilla, zygomas and orbital floor
Will involve the occlusion
- craniofacial disjunction
-transverse fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and azygomatic arch/ zygomaticofrontal suture
-highest rate of CFS leakage
What is a pathological fracture?
Fracture that occurs in an area of bone that has been critically weakened by disease
What condiitons can be associated with a pathological fracture
cancer, osteoradionecrosis, MRONJ, large cysts
Why are mandible fractures often bilateral
Mandbile has 2 fixed points (limited mobility at each end)
- mandible is curved so forces applied to the front of the mandible causes forces also at the condyle
A patient presents with a history of assault and a punch to their lower jaw. They have complete anaesthesia in the distribution of the left inferior dental nerve.
Which region of the mandible is likely to be fracture ?
Angle of body
What is the difference between displacement and angulation when describing fractures
displacement : degree to which the fractured ends are out of alignment with each other (mm/ bone %)
Angulation:Angle by which distal fragment has moved in comparison to its previous position
Why is examination of the eye important for patients who have sustained fractures of the zygomatic complex?
Fractures of zygomatic complex can affect vision due to changes in volume of orbit and muscle & fat interacment
What is the difference between subconjunctival haematoma and periorbital ecchymosis
Subconjunctival haematoma: bloodshot eye due to trauma to eyeball/ bleeding from fractures of floor or bony orbits
Periorbital ecchymosis (raccoon eye): produced by blood tracking into periorbital tissues, causing blue or purple discolouration of the upper and lower eyelids
what is the significance of the posterior limit of subconjunctival haematoma
Haemorrhage without posterior margin extends posteriorly so that the whole extent of the haemorrhage cannot be seen. Potentially associated with intracranial bleed or orbital floor fracture
A patient who has been hit in the eyeball with a tennis ball complains of doublevision when trying to look upward. Plain facial X-rays show no obvious fractures but opacification of the maxillary sinus on the affected side. What is the likely diagnosis?
Orbital floor fracture
An OPG shows a fracture of a patients mandible through the left body at the level ofthe lower left first molar and a second fracture of the right condylar neck. What clinical signs would you expect to see in this patient
- pain, bleeding, swelling
-difficulty speaking, chewing and breathing - loose teeth (lower molars)
deviation of the jaw towards the side of the fracture (left) - premature contact on the left & open bite on right
A patient has been assaulted and has some left periorbital bruising and mild subjunctival haematoma with no posterior limit. Their eye movements are normal and there is no palpable fracture on examination. They have had a minor nose bleed on the left side and when they blow their nose they develop a sudden swelling around the left eye and cheek. On examination now you can feel air bubbles under the skin. What is the diagnosis and what is the mechanism?
Fractured zygomas & maxillary sinus
mechanism: increased nasal pressure & itnranasal pressure & sinus
consequence: lots of swelling & closing of eye& bubble wrap feel under the skin as air bubbles move beneath and crack
