Week 4 Thomson: Maxillofacial Injuries Flashcards
What are predisposing factors for max fax injuries?
- Interpersonal Violence
- RTA
- Falls
- Sport
- Males 15-35yrs
- Mandible
What is carried out in initial assessment of max fax injury?
- Rapid Survey of Vital Functions & Prioritize Management Options (pulse, BP)
- ABCDE
- Head Injury
- Prevent Infection
- Pain Management
- Temporary Immobilisation / Fixation
What is important to prevent secondary brain injury?
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
What structures can be predisposed to mx fax injuries?
- Parotid gland and duct
- Facial nerve
- Supraorbital and infraorbital nerves
- Nasolacrimal duct
How are fractures managed?
- Reduction (reduce fracture)
- Fixation (hold bones in correct position)
- Immobilisation (IMF- may need to wire teeth together to stabilise)
- Rehabilitation
What is the best thing to do for nasal fractures?
Place nasal bones into place straight away. Waiting too long will prevent bones going back into place due to oedema.
What is the most common md fracture?
- Direct fracture of body and parasymphyseal (chin)
- Indirect fracture to condyle or angle of md (md 3rd molars can weaken this area)
What are features of unilateral fractured condyle
- 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
What are diagnostic features of bilateral condyle fractures?
- Pain, tenderness, swelling over both joints
- Premature contact on posterior teeth and anterior open bite
- Restricted lateral movements
- Absence of movement of condylar heads
What are diagnostic features of md body fractures?
- 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
What are diagnostic features of zygoma fractures?
- 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
What is this?
Retrobulbar haemorrhage. Bleeding near eye creates pressure and pushes eye forward which spasms ciliary artery.
What is this?
Retrobulbar haemorrhage. Bleeding near eye creates pressure and pushes eye forward which spasms ciliary artery.
What is lefort I, II vs III
- 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
What are diagnostic features of lefort I fracture?
- Floating palate
- Blood in antrum
- Bilateral haemotoma in B sulcus
- Deranged occlusion with anterior open bite
What are diagnostic features of lefort II fracture?
- 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
What are diagnostic features of lefort III fracture?
- 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
What is this?
Isolated orbital floor fracture
