Zygomatic fractures Flashcards
1
Q
What are maxillofacial fractures classified into
A
- nasoethmoidal
- lateral middle third
- central middle third
- mandibular fractures
2
Q
What is a nasoethmoidal fracture
A
- Involves disruption of the inferior orbital rim, lateral nasal bones, medial orbital wall and frontal process of the maxilla
- Injuries of the orbital & nasoethmoidal anterior wall, medial wall, floor, lateral, wall, roof, apex, superior orbital fissure, inferior orbital fissure
3
Q
What nerves are in the superior orbital fissure
A
- CN 3 oculomotor
- CN 4 trochlear
- CN 6 abducens
- Branches of ophthalmic nerve
- Ophthalmic veins
4
Q
What nerves are in the inferior orbital fissure
A
Infraorbital nerve
Infraorbital vein
Infraorbital artery
5
Q
What fractures fall into lateral middle third
A
zygomatic
6
Q
What fractures fall under central middle third fractures
A
- Nasal bone
- Unilateral maxillary fracture
- Le fort 1 fracture
- Le fort 2 fracture
- Le fort 3 fracture
7
Q
What do we look at when examining the maxfax region
A
- soft tissue
- nerves
- skeleton
- dentition
8
Q
What are clinical signs of malar fractures
A
- periorbital bruising
- swelling
- subconjunctival echymoses
- nose bleed
- sensory deficit (infraorbital nerve)
- diplopia
- subcutneaous emphysema
- epistaxis
- step deformity
9
Q
What does the clinical examination consist of
A
- Palpate for irregularities of the supraorbital ridge (looking for step deformity)
- Palpate for irregularities of the infraorbital ridge and zygoma
- Palpate for depression of the zygomatic arch
- Manoeuvre to ascertain motion in maxilla
- Want patient to look in all directions to assess double vision, eye mobility etc
10
Q
What is the initial care for zygomatic fractures
A
- Exclude ocular injury
- Prophylactic antibiotics
- Avoid blowing nose
11
Q
What is the definitive management for zygomatic fractures
A
- Review when swelling subsided
- Further radiographs +/- CT scans
- Informed consent
- Closed reduction +/- fixation
- Open reduction + internal fixation
