Week 4 Thomson: Maxillofacial Injuries Flashcards

1
Q

What are predisposing factors for max fax injuries?

A
  • Interpersonal Violence
  • RTA
  • Falls
  • Sport
  • Males 15-35yrs
  • Mandible
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2
Q

What is carried out in initial assessment of max fax injury?

A
  • Rapid Survey of Vital Functions & Prioritize Management Options (pulse, BP)
  • ABCDE
  • Head Injury
  • Prevent Infection
  • Pain Management
  • Temporary Immobilisation / Fixation
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3
Q

What is important to prevent secondary brain injury?

A

Face can absorb impact and prevent primary brain injury. However, important thing is to prevent secondary brain injury by ensuring pt does has adequate cerebral circulation.

  • 100% Oxygen
  • Breathing- chest injury
  • Control haemorrhage, treat hypovolaemia, isotonic fluid therapy
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4
Q

What structures can be predisposed to mx fax injuries?

A
  • Parotid gland and duct
  • Facial nerve
  • Supraorbital and infraorbital nerves
  • Nasolacrimal duct
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5
Q

How are fractures managed?

A
  • Reduction (reduce fracture)
  • Fixation (hold bones in correct position)
  • Immobilisation (IMF- may need to wire teeth together to stabilise)
  • Rehabilitation
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6
Q

What is the best thing to do for nasal fractures?

A

Place nasal bones into place straight away. Waiting too long will prevent bones going back into place due to oedema.

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7
Q

What is the most common md fracture?

A
  • Direct fracture of body and parasymphyseal (chin)
  • Indirect fracture to condyle or angle of md (md 3rd molars can weaken this area)
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8
Q

What are features of unilateral fractured condyle

A
  • Affected side: pain in joint, worse on moving, tenderness & swelling, absent/abnormal movements of condylar head, deviation of md on opening, premature contact on molars
  • Opposite side: lateral open bite, limited lateral excursion
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9
Q

What are diagnostic features of bilateral condyle fractures?

A
  • Pain, tenderness, swelling over both joints
  • Premature contact on posterior teeth and anterior open bite
  • Restricted lateral movements
  • Absence of movement of condylar heads
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10
Q

What are diagnostic features of md body fractures?

A
  • Pain on Moving Jaw
  • Trismus
  • Movement / Crepitus at Fracture Site
  • Step Deformity Lower Border
  • Derangement of Occlusion
  • Mental Anaesthesia
  • Haematoma Floor of Mouth / Buccal Sulcus
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11
Q

What are diagnostic features of zygoma fractures?

A
  • Depression of Cheek Prominence
  • Step Deformity Infra-Orbital Ridge
  • Subconjunctival Haemorrhage & Diplopia
  • Infra-Orbital Nerve Anaesthesia
  • Trismus (Impaction into Coronoid Process)
  • Blood in Antrum
  • Circumorbital Ecchymosis
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12
Q

What is this?

A

Retrobulbar haemorrhage. Bleeding near eye creates pressure and pushes eye forward which spasms ciliary artery.

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12
Q

What is this?

A

Retrobulbar haemorrhage. Bleeding near eye creates pressure and pushes eye forward which spasms ciliary artery.

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13
Q

What is lefort I, II vs III

A
  • Lefort I: fracture through inferior maxilla just above roots of teeth
  • Lefort II: pyramidal shaped fracture along the nasal bridge, involving the inferomedial orbital rim and orbital floor, and causes separation of the midface from the skull base
  • Lefort III: seperates whole face from cranium
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14
Q

What are diagnostic features of lefort I fracture?

A
  • Floating palate
  • Blood in antrum
  • Bilateral haemotoma in B sulcus
  • Deranged occlusion with anterior open bite
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15
Q

What are diagnostic features of lefort II fracture?

A
  • Gross Swelling then Dish-Faced Deformity
  • Subconjunctival Haemorrhage & Diplopia
  • Bilateral Infra-Orbital Nerve Anaesthesia
  • Bilateral Haematoma Intra-Orally over Malar Buttress
  • Retroposed Upper Dental Arch with Anterior Open Bite
16
Q

What are diagnostic features of lefort III fracture?

A
  • Gross Swelling then Dish-Faced Deformity
  • Subconjunctival Haemorrhage & Sometimes Diplopia
  • Retroposed Upper Dental Arch with Anterior Open Bite
  • CSF Leak from Nose (rhinorrhoea)
  • Head Injury
17
Q

What is this?

A

Isolated orbital floor fracture

18
Q

What are complications of max fax injuries?

A
  • Psychological Trauma
  • Scarring
  • Soft Tissue / Bone Loss
  • Infection
  • Malunion / Non-Union
  • Trismus