Maxillofacial Trauma (Lecture) Dr.

Arsenio Pascual III January 26, 2012

IV-4

---------f Injury Sustained secondary to trauma----------     Abrasion Contusion-hematoma Laceration Avulsion Fractures

-Bones that stabilize the face -In suture lines ------------___---_____- Zygoma------_____------------4 superficial and 2 deep articulations Tripod fracture aka zygomaticomaxillary complex or malar fracture -articulations with 1) mastoid 2) maxilla 3) frontal bone 4) pterygoid PE: Midface: asymmetric may indicate zygoma is affected -palpate the periorbital area, can be a swelling -examine malar prominence from behind, look for asymmetry/depression __------------Zygomatic and Malar Fractures--------------Signs and Symptoms:         Diplopia – uneven pupillary level, orbit floor Anesthesia Trismus – pain on mouth opening Subconjunctival haemorrhage Periorbital ecchymosis Epistaxis – can come from maxillary sinus Step deformity – depression because the bone was pushed posteriorly Slanted palpebral opening

*the ear is the hardest part to reconstruct, it should be recovered and placed on NSS Priorities A. Airway and Ventilation B. Bleeding (arrest haemorrhage – pressure) C. Circulation (fluids and transfusion) *extend the neck to the side while removing debris on the injury to prevent aspiration j Principles of Management in facial soft tissue injuryv Careful history  Assess the entire airway, blood volume, chest, abdomen, extremities, sensorium, nerve and duct injuries, fractures  Thorough cleansing and debridement of the wound  Request for ancillary procedures: CXR, CT scan, etc. --------------fff-----Facial Buttresses------------------------

___---------------------Imaging-------------------------___  Waters view – chin-nose view, face is tilted upward Submentovertex – basket handle vie, hyperextended neck, view of zygoma

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travels horizontally above the teeth apices.**fracture extends from the nasal septum to the lateral pyriform rims.or intraoperative stenosis is avoided Open reduction internal fixation (ORIF) using titanium plates Coronal approach: Bicoronal/ hemicoronal o For frontal bone fractures o Advantage: scar not seen o Disadvantage: morbid.the rim is intact .Radiographic Signs   Fracture of either the body or arch of the zygoma Soft tissue air and fluid levels Signs and Symptoms:    Imaging   Waters view Caldwell’s view Diplopia Vision impairment Opthalmos _______------------Management-_____---------____    Reduction of fracture is ideally done within 57 days for resolution of edema Pre. crosses below the zygomaticomaxillary junction. and traverses the pterygomaxillary junction to interrupt the pterygoid plates Page 2 of 3 .the pupillary line is uneven because the floor collapsed due to the impact Anterior force .**may result from a force of injury directed low on the maxillary alveolar rim in a downward direction Orbital Blowout Fracture . difficult Gilles reduction: temporal forcing to zygoma o 6-weeks foley catheter post-op Lateral Brow Incision o Avoid shaving brow hairs o Goal is zygomaticofrontal suture Caldwell approach o Under the lip Orbital rim access – subciliary lower eyelid infraorbital o Used in eye bags removal Radiographic findings   Tear drop sign Maxillary sinus opacity     *Hyphema – blood in anterior chamber of the eye Force Duction Testing – to determine if the absence of eye movement is due to neurologic or mechanical cause Orbital Metallic Mesh – keep the bones in place ------------------------Maxillary Fracture-----------------------Le Fort I (horizontal or Guerin fracture) .

do Benedict’s test for glucose S/Sx: Epistaxis Imaging: Caldwell’s view – best modality Page 3 of 3 . through the zygomaticofrontal junction and the zygomatic arch. and inferiorly through the anterior wall of the maxillary sinus. ANNOUNCED ONE LAST LECTURE ON WEDNESDAY __----------------Frontal Sinus Fracture--------------------Anterior – no problem Posterior – possible CSF rhinorrhoea.done within a week or two after injury to prevent new ossification PE: palpate for midface instability . Intranasally. the fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolaterally through the lateral orbital wall.**start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones.**may follow impact to the nasal bridge or upper maxilla . and through the pterygoid plates Le Fort III (transverse or craniofacial dysjunction) . and through the interface of the pterygoid plates to the base of the sphenoid .Le Fort II (pyramidal) . usually in continuation with other Le Fort fractures Midface Disimpaction – may be necessary to restore facial dimensions before fixation .Palate . a branch of the fracture extends through the base of the perpendicular plate of the ethmoid. The thicker sphenoid bone posteriorly usually prevents continuation of the fracture into the optic canal.**may result from a blow to the lower or mid maxilla .Sublabial approach – leave mucosa to sew to layer Nasal Bone fracture  Epistaxis  Pain and tenderness  Gross cosmetic deformity  Crepitation  Nasal congestion  Swelling and periorbital ecchymosis  Septal hematoma (Saddle nose) o Most important to inspect ---------------------Mandibular Fracture-----------------------Signs and Symptoms  Malocclusion  Step deformity  Tooth mobility  Hypesthesia  Ecchymosis  Trismus Most common area injured is the condyle Imaging  Mandible: AP. oblique  Modified townes  Submentovertex  Panoramic – most useful Management  Intermaxillary plating  Intermaxillary arch bars LAST ENT TRANS DONE PROF. inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen. it then travels under the zygoma. across the pterygomaxillary fissure.**rare to occur singly.**pyramidal shape and extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla. through the vomer. Instead.

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