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5th yr- CMS2- Facial trauma > treating facial traum a > Flashcards

treating facial traum a Flashcards

1
Q

List the stages of bone healing

A
  1. Inflammatory phase (due to bleeding)
  2. Proliferative phase
  3. bone callus formation
  4. Remodelling
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2
Q

What are the requirements for bone healing

A
  1. Reducing the fracture
  2. Restoring the length of bone
  3. Restoring angualtion
  4. Stabilisation
  5. Holding the correct position
  6. Preventing excessive movements
  7. Allowing for remodelling
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3
Q

What are some options for treating fractures

A
  1. Plaster Paris splint
  2. Operation of placing a plate in the bone
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4
Q

How long is a splint requited for a pt who breaks a bone

A

6 weeks

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5
Q

What are the priorities in treating facial fractures

A
  1. Restore function ie occlusion, eyesight
  2. Restore appearance
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6
Q

What are the principles of fracture management

A
  1. Speed
  2. Safety
  3. Stability
  4. Mobility
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7
Q

Give examples fo different ways we can manage fractures

A
  1. Conservative amangemtn
  2. Manipulation under anaesthesia (MUA)
  3. Intermaxillary fixation
  4. Plating
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8
Q

Name a fracture we may manage with conservative treatment

A

Green stick fracture

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9
Q

What is a green stick fracture

A

A fracture where the bone is broken but it doesn’t involve both cortices so the fracture is undispalced

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10
Q

What is a green stick fracture

A

A fracture where the bone is broken but it doesn’t involve both cortices so the fracture is undispalced

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11
Q

What is MUA

A

Manipulation under anaesthesia where we move the bone back into place

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12
Q

What is inter maxillary fixation

A

A method of treating fractures where we wire the teeth together in the correct position with elastic bands

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13
Q

How is an isolated zygomatic arch fracture treated

A

MUA- Manipulation under anaesthesia
An incision is made in the hairline
Dissect down onto the external temporal fascia and size through the temporal fascia
Instrument is then passed down deep to the fascia to the zygomatic arch which can now be levered into position

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14
Q

How do we manage condyle fractures

A
  1. Plating
    2.Using intermaxilalry fixation by manipulating the bone back into position holding the patient in occlusion and holding the teeth in position using upper and lower arch bars
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15
Q

What is the downside to intermaxilalry fixation

A

Pt has to keep there upper and lower arch bar in for at least 6 weeks meaning they can’t eat or speak
ramification to nutriton

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16
Q

What is an alternative to upper and lower arch wire bands

A

Elastic IMF which allow for a little bit of movement

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17
Q

How can we plate a condyle fracture

A

2 plates are put across the fracture to hold it into position to allow for healing
involves an operation

18
Q

What risk is there associated with plating a condyle fracture

A

Working really close to the facial nerve so risk of developing facial weakness

19
Q

In whom can a mandibular fracture be harder to manage

A

Patients with Atrophic mandible or edentulous mandible

20
Q

Why is it difficult to treat a mandible fracture in a pt with atrophic mandible

A

The muscles of mastication pull in opposite directions (temporals and master pull up whereas mylohyoid pulls down) meaning atrophic mandibles are unstable
Difficulty in finding a place to put a plate on as bone is thin and plates are quite big

21
Q

How do we manage an atrophic mandible fracture

A
  1. Place a big plate across the whole mandible - reconstruction plate
  2. Gunning splint
  3. External fixation
22
Q

What are problems associated with a reconstruction. plate

A

Offers no mobility so mandible can become weaker over time as no physiological stress is being placed on it

23
Q

What is a gunning splint

A

An upper and lower denture that is wired together to allow the occlusion to be maintained
Anterior teeth can be removed to allow for a feeding hole

24
Q

When might we consider placing external fixations to manage a mandibular fracture

A

In high energy injurys where there has been a lot of bone has gone missing and contamination to fracture site

25
Q

What are patients who have had tx of a zygoma or orbital fracture be at risk of

A

Retribulbic Haemotoma

26
Q

What do we need to monitor in patients who are undergoing zygoma or orbital fracture treatments

A

Must monitor patients eye sight, visual acuity and pain levels

27
Q

What can happen if a Retribulbic Haemotoma is gone untreated

A

Can lead to blindness and loss of vision

28
Q

What do we need to monitor in all patients undergoing treatment for a facial fracture why

A

Nutrition
Pain may lead to pt not eating
some tx requited pts to wire jaw close so need to consider how we will feed them

29
Q

What is one of the main problems associated with inter maxillary fixation

A

They can act as a plaque trap so if a pt is having a high suigar diet to get their daily calories in this can be detrimental to their teeth and gums

30
Q

What can complications of fractures be divided into

A
  1. Complications as a result of the fracture/ tx
  2. Problems with fracture union
31
Q

What are some complications that can arise as a result of the fracture/ tx

A
  1. Cosmetic
  2. Eyesight
  3. Nerve damage
  4. Scarring
  5. infection
32
Q

What problem can arise with fracture union and healing

A
  1. Malunion
  2. Delated union
  3. Non union
33
Q

What can malunion be caused by

A

Incorrect length or angulation of fractured bone

34
Q

What is malunion

A

Where the bone heals in the incorrect position, length or angle

35
Q

Where is malunion the biggest concern when treating a facial fracture

A

Around the condyles where they may heal in an incorrect postion leading to an anterior open bite which can be difficult to treat

36
Q

What is delayed union

A

When bone hasn’t healed in 6 weeks

37
Q

What are the problem associated with delayed healing

A

Plates that we place in the body do not have a long lifespan after 6 weeks they may not be as effective, plate may fracture, screws may pull out through the bone

38
Q

What is a non union

A

Where the bone does not heal at all

39
Q

What can non union lead to

A

Pseudo arthrosis

40
Q

What is Pseudo arthrosis

A

Formation of a new joint or rounding of bone without union

5th yr- CMS2- Facial trauma (5 decks)

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