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4 - oral surgery > management of zygomatico orbital trauma > Flashcards

management of zygomatico orbital trauma Flashcards

1
Q

How are maxillofacial fractures classed?

A
  1. Naso ethmoidal
  2. Lateral middle third (zygoma)
  3. Central middle third
  4. Mandibular
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2
Q

What are the different types of central middle third fractures?

A
  1. Nasal bone
  2. Unilateral maxillary fracture
  3. Le Fort I fracture
  4. Le Fort II fracture
  5. Le Fort III fracture
  6. Various combinations
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3
Q

What makes up the orbitonasal ethmoid complex?

A

4 walls, an anterior surface and an apex:
Anterior wall
Medial wall
Lateral wall
Floor
Apex
Roof

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4
Q

What is found in the anterior orbitonasal ethmoid complex?

A

Eyelids
Cornea sclera

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5
Q

What is found in the medial wall of the orbitonasal ethmoid complex?

A

Medical rectus muscle
Nose
Lacrimal duct and sac
Medial canthal ligament
Ethmoid sinus
Cribriform plate

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6
Q

What is found in the superior orbital fissure?

A

CNIII occulomotor nerve
CN IV trochlear nerve
CN VI abducens nerve
Branches of the ophthalmic nerve CNV
Ophthalmic veins

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7
Q

What is found in the inferior orbital fissure?

A

Infraorbital nerve
Infraorbital vein
Infraorbital artery

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8
Q

How should clinical examination of the maxillofacial region be carried out?

A

Should be organised, sequential and methodical
A - soft tissues
B - nerves
C - skeleton
D - dentition

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9
Q

Name 4 clinical signs of Malar (zygomatic) fractures

A

Any from:
- periorbital bruising
- subconjunctival ecchymoses
- sensory deficit - infraorbital nevre
- diplopia (double vision)
- subcutaneous emphysema
- epistaxis (nose bleed)
- step deformity

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10
Q

How should the skeleton be examined for maxillofacial injuries?

A

Palpation for irregularities of supraorbital ridge
Palpation for irregularities of infraorbital ridge and zygoma
Palpation for depression of zygomatic arch
Manoeuvre to ascertain motion in maxilla

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11
Q

How should dentists initially manage maxillofacial injuries?

A

Exclude an ocular injury
Give prophylactic antibiotics
Avoid blowing nose

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12
Q

How are orbitonasal ethmoid injuries definitely managed?

A

Review once swelling has subsided
Further radiographs and possiblt CT
Get informed consent
Closed reduction and possible fixation
Open reduction and internal fixation by either:
- intra-oral incisions
- local facial incisions
- coronal flap exposure

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13
Q

Describe a zygoma fracture that is causing limited mouth opening

A

It is impinging on the coronoid process

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14
Q

What is the Howard Gillies approach?

A

Cut at temporalis to reach the zygomatic bone at level of the coronoid process
Leaves no scars except one high up in the temporal region

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15
Q

What is the trans-conjunctival approach?

A

Retracts the lower eyelid so no scarring

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16
Q

What other approach can be used to access fractures, leaving no scarring?

A

Bi-coronal approach

17
Q

What anatomy is found in the floor of the orbit?

A

Infraorbital nerve and vessels
Antrum
Nasolacrimal canal
Inferior rectus and oblique muscle

18
Q

Give 4 signs of floor of orbit fracture

A

Any from:
- enophthalmos (posterior displacement of eyeball)
- diplopia (double vision)
- positive forced suction test
- infraorbital anaesthesia
- antro-orbital communication
- naso-lacrimal duct damage

19
Q

What anatomy is found in the lateral wall of the orbit?

A

Lateral canthal ligament and muscle
CNVI
Lateral rectus muscle
Middle cranial fossa
Dura and temporal lobe of the brain

20
Q

Give 4 signs of lateral wall fracture?

A

Exophthalmos - protrusion of eyeball
Inward displacement
Lateral canthal displacement
Lateral rectus palsy

21
Q

What anatomy is found in the roof of the orbit?

A

Anterior cranial fossa
Dura and frontal lobe of brain
Superior rectus and oblique muscles
Frontal sinus
Supraorbital nerve

22
Q

Give 4 signs of roof fracture

A

Any from:
- dural tear and brain damage
- CSF leak
- trochlear damage
- diplopia
- frontal anaesthesia
- exophthalmos (protrusion of eyeball)

23
Q

What anatomy is found at the apex of the orbit?

A

Optic nerve
Ophthalmic artery and veins

24
Q

What are the signs of apex fracture?

A

Blindness

25
Q

Give 4 signs of medial wall fracture

A

Any from:
- nasal shortening
- bridge depression
- telecanthus
- diplopia
- naso-lacrimal apparatus damage
- cribriform plate damage
- CSF leak
- medial displacement of the eyeball

4 - oral surgery (19 decks)

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