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Maxillofacial Injuries Etiology of injury -road traffic accidents -sport accidents

- fights - fire

& falls

arms (gun shots and shot guns)

Factors affecting the displacement of the fractured segments 1234-

the degree of force the direction of the force the resistance offered by the facial bones to the force the cross-sectional area of the agent or object struck the attached muscles Classification of fractures

5-

12-

simple compound

linear fractures which are not in communication with the exterior an extra oral or intra oral wound is present involving the fracture line with a consequent potential for infection.
3-

Comminuted Complicated Impacted

shattering of bone into multiple fragments (gunshots)
4-

the injury also involves the adjacent nerves ,vessels or joints.
5-

linear fractures interdigitate to such an extent that there is no appreciable clinical movement . 7Pathological Spontaneous fracture of bone as a result of a normal degree of muscle contraction or following a minor trauma should always arouse suspicion that there is some underlying pathological condition(hyperparathyroidism) 89- Single or multiple Favorable and unfavorable 10-Unilateral or bilateral Clinical presentations of the fractures History 123- History of trauma Pain at the site of trauma Malfunction (inability to open or to close the mouth)] Facial swellings Facial wounds Oral bleeding Facial oedema Facial wounds (internal or external) External bleeding 456Inspection 123- . 6- Green stick In children due to the elasticity of the bones ( fractures of the neck of the condoyle).

4- Malocclusion or step in the occlusion Difficulty and sometimes inability to open or to close the Facial asymmetry marked tenderness at the site of fracture crepitus at the site of fracture Malocclusion Bleeding from the fracture site during manipulation 56Palpation 1234- mouth Radiological diagnosis A.ray B- CT scan of the facial bones -coronal CT -3 DCT ( Three dimentional ) Sites of mandibular Fractures 1.posteroanterior -lower occlusal x.panoramic . .submento – vertex x – ray .occipito-mental .Fractures not involving the basal bone of the mandible ( Dentoalveolar Fractures ) which is most frequently observed in the incisor region .Conventional X-rays x-rays x-ray – x – ray .

Single unilateral Fractures 1.Zygomatico – maxillary buttress . they may be single . unilateral on bilateral . multiple .2- Fractures involving the basal bone of the mandible .Ramus of the mandible – Fractures distal to the angle 6- Condoyle – Extracapsular& Intracapsular MIDFACE FRACTURES 7.Frontozygomatic -Infra orbital margin .Body of the mandible – factures distal to the canine tooth 4.Symphyseal – Midline Fracture between the two centrals . 2- Parasymphyseal – Fracture distal to the central incisor 3.Coronoid SITES OF MIDFACE FRACTURES 1- Dentoalveolar Fractures Fractures of the nasal bones Fractures of the zygoma Fractures of the maxilla Le Forte Fractures Nasoethmoidal fractures Orbital wall fractures Fractures of the zygoma 23- 4567- .zygomatic arch suture .The zygoma may be Fractured at one of 4 sites .Angle of the mandible – fractures at the junction of the body and ramus 5.

nasal suture.tripodal . Fractures of thy zygoma may be . laterally in the anterior maxillary wall and ends in the lower part at the pterygoid plate.The zygoma may rotate around a vertical axis or around a horizontal axis . Le forte II :It is a pyramidal shaped fracture .monopodal . Le fort III :- .it begins in the fronto. descends in the medial orbital walls.Fractures of the zygoma is usually associated with depression of the midface and limited mouth opening due to compression of the fractured zygomatic arch on the moving mandibular coronoid process Le Forte Fractures Le Forte I :.bipodal . runs beneath the zygomatico-maxillary suture.so .tetrapodal ..It is a horizontal Fracture line above the level of the floor of the nose . traverses the lateral wall of the antrum and ends in the middle of the pterygoid plate . It passes horizontally from the piriform apertures . descends in the infra orbital margin.

This condition is called orbital blow out due to increased orbital volume .Maxillofacial inuries may compromise the airway due to one or more of the pollowing factors 1.Airway and cervical spine control B. 2. limited ocular mobility and diplopia Treatment of facial Fractures .obstruction of the nasal and oral airways by blood clot . saliva.Circulation and haemorrhage control . teeth or parts of dentures .Obstruction of the nasopharynx and oropharynx by backward displacement of the tongue and its attchments in bilateral parasymphyseal fractures . ventilation C. Entrapment of the extraocular muscles inside the fracture lines may occur . bone . .Inhalation of any the above 3.Breathing .It separates the mid face from the cranial base.Fractures of the orbital floor may be associated with herniation of the orbital fat iside the maxillary sinus . This is associated with enophthalmos . The zygomatic arch is fractured . The fronto-zygomatic sutures bilaterally and the frontonasal sutures are opened . Fractures of the orbital walls .Threats to life should be recognized and treated without delay :A.

Fixation may be done by one of two ways 1.Occlusion of the oropharynx by downward and backward displacement of a fractured maxilla .Oxygen mask .Nasopharyngeal airway . Therefore .Closed reduction ( Indirect fixation ) Utilizing the standing teeth to place the teeth in the normal occlusion and immobilize them in that position and so indirectly reduce the bone fragments is the simplest and most commonly used method of treating mandibular fractures ( IMF or intermaxillary fixation ) .Chin traction .4.Airway Control may entail .It is important to recognize the risk of cervical spine injury and to prevent movement of the cervical spine while attempting to achieve a patent airway . . .The aim of treatment of any fractures is to approximate and fix the fractured segments . Management of bony injuries . the patient's head and neck should not be hyperextended or hyperflexed to establish or maintain an airway .Good suction - Inserting an airway(oropharyngeal) Endotracheal intubation .

IMF may interfere with nursing and suction in head injuried patients 4- weight loss ( 6-5 kg per month ) Needs general anaesthesia Expensive Disadvantages of direct fixation :1- 2- .2.needs postoperative close monitoring 2- secretion retention in patients with chronic airway disease 3. It is done by performing anatomical reduction and direct fixation of the fractures utilizing titanium plates and screws Disadvantages of indirect fixation :1.The method of choice in the majority of displaced facial fractures .Open reduction(Direct fixation) .