treating facial traum a Flashcards
List the stages of bone healing
- Inflammatory phase (due to bleeding)
- Proliferative phase
- bone callus formation
- Remodelling
What are the requirements for bone healing
- Reducing the fracture
- Restoring the length of bone
- Restoring angualtion
- Stabilisation
- Holding the correct position
- Preventing excessive movements
- Allowing for remodelling
What are some options for treating fractures
- Plaster Paris splint
- Operation of placing a plate in the bone
How long is a splint requited for a pt who breaks a bone
6 weeks
What are the priorities in treating facial fractures
- Restore function ie occlusion, eyesight
- Restore appearance
What are the principles of fracture management
- Speed
- Safety
- Stability
- Mobility
Give examples fo different ways we can manage fractures
- Conservative amangemtn
- Manipulation under anaesthesia (MUA)
- Intermaxillary fixation
- Plating
Name a fracture we may manage with conservative treatment
Green stick fracture
What is a green stick fracture
A fracture where the bone is broken but it doesn’t involve both cortices so the fracture is undispalced
What is a green stick fracture
A fracture where the bone is broken but it doesn’t involve both cortices so the fracture is undispalced
What is MUA
Manipulation under anaesthesia where we move the bone back into place
What is inter maxillary fixation
A method of treating fractures where we wire the teeth together in the correct position with elastic bands
How is an isolated zygomatic arch fracture treated
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
How do we manage condyle fractures
- 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
What is the downside to intermaxilalry fixation
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
What is an alternative to upper and lower arch wire bands
Elastic IMF which allow for a little bit of movement
How can we plate a condyle fracture
2 plates are put across the fracture to hold it into position to allow for healing
involves an operation
What risk is there associated with plating a condyle fracture
Working really close to the facial nerve so risk of developing facial weakness
In whom can a mandibular fracture be harder to manage
Patients with Atrophic mandible or edentulous mandible
Why is it difficult to treat a mandible fracture in a pt with atrophic mandible
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
How do we manage an atrophic mandible fracture
- Place a big plate across the whole mandible - reconstruction plate
- Gunning splint
- External fixation
What are problems associated with a reconstruction. plate
Offers no mobility so mandible can become weaker over time as no physiological stress is being placed on it
What is a gunning splint
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
When might we consider placing external fixations to manage a mandibular fracture
In high energy injurys where there has been a lot of bone has gone missing and contamination to fracture site
What are patients who have had tx of a zygoma or orbital fracture be at risk of
Retribulbic Haemotoma
What do we need to monitor in patients who are undergoing zygoma or orbital fracture treatments
Must monitor patients eye sight, visual acuity and pain levels
What can happen if a Retribulbic Haemotoma is gone untreated
Can lead to blindness and loss of vision
What do we need to monitor in all patients undergoing treatment for a facial fracture why
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
What is one of the main problems associated with inter maxillary fixation
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
What can complications of fractures be divided into
- Complications as a result of the fracture/ tx
- Problems with fracture union
What are some complications that can arise as a result of the fracture/ tx
- Cosmetic
- Eyesight
- Nerve damage
- Scarring
- infection
What problem can arise with fracture union and healing
- Malunion
- Delated union
- Non union
What can malunion be caused by
Incorrect length or angulation of fractured bone
What is malunion
Where the bone heals in the incorrect position, length or angle
Where is malunion the biggest concern when treating a facial fracture
Around the condyles where they may heal in an incorrect postion leading to an anterior open bite which can be difficult to treat
What is delayed union
When bone hasn’t healed in 6 weeks
What are the problem associated with delayed healing
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
What is a non union
Where the bone does not heal at all
What can non union lead to
Pseudo arthrosis
What is Pseudo arthrosis
Formation of a new joint or rounding of bone without union
