Ayoubs lectures

Question 1

What classifications of maxillofacial fractures are there

Answer 1

1. Baso ethmoidal
2. Lateral middle third (zygoma)
3. Central middle third
4. Mandibular fractures

Question 2

What is meant by a lateral fracture

Answer 2

Fracture of the zygoma

Question 3

In orbital and naso-ethmoidal injuries what must you consider

Answer 3

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

Question 4

What does the anterior of the NOE have

Answer 4

eyelids
cornea
sclera

Question 5

What does the medial wall of the NOE are have

Answer 5

medial rectus muscle

nose

lacrimal duct and sac

medial canthal ligament

ethmoid sinus

cribriform plate

Question 6

What does te superior orbital fissure contain

Answer 6

Occulomtor nerve III

Trochlear nerve IV

Abducent nerve VI

branches of ophthalmic nerve

ophthalmic veins

Question 7

What does the inferior orbital fissure contain

Answer 7

Infraorbial nerve, vein and artery

Question 8

What would a symptom of a maxilla sinus fracture be

Answer 8

Bleeding nose through the semilunar hiatus

Question 9

What is a malar fracture

Answer 9

A fracture that primarily involves the suture lines of the zygomatic bone

Question 10

What are symptoms of a zygomatic fracture

Answer 10

Flat face

Double vision

Restricted eye movement

Numbness to face

Limited jaw movement

Question 11

Wha are clinical signs of a malar fracture

Answer 11

Periorbital bruising & swelling

Subconjunctival ecchymoses

Sensory deficit -Infraorbital nerve

Diplopia / Visual impairment

Subcutaneous emphysema

Epistaxis

Step deformit

Question 12

What is a sign of a sub-conjunctival haemorrhage

Answer 12

Circumorbital ecchymosis

Question 13

Why could there be a limitation of jaw movement in a zygoma fracture

Answer 13

The fracture impinges of te coronoid process

Question 14

Wha would the eye look like in a orbital fracture

Answer 14

Would appear sunken in

Question 15

What is an open reduction

Answer 15

the broken bone is realigned during surgery

Question 16

What is a closed reduction

Answer 16

a procedure to set (reduce) a broken bone without cutting the skin open

The broken bone is put back in place, which allows it to grow back together in better alignment

Question 17

What is the gilles approach

Answer 17

Most common way to reduce a fracture and it is a closed reduction

Involves a temporal hairline incision placing an elevator superficial to the surface of the temporalis muscle under the deep temporal fascia and sliding the elevator under the arch to lift it into reduction

Question 18

What TMJ diseases are there

Answer 18

TMJ dysfunction

Jaw dislocation

Osteo-arthritis

Rheumatoid arthritis

Chondromatosis

Foreign body granuloma

Infection

Traumatic damage

Radiation damage

Ankylosis

Tumours

Question 19

What is the aetiology of TMD

Answer 19

Macrotrauma

Microtrauma – chronic joint overloading
secondary to stress related repetitive
clenching or Bruxism

Occlusal factors
a) deep bite
b) occlusal disharmony
c) lack of teeth

Anatomical factors- Class II jaw relation

Question 20

What does the articulator cartilage consist of

Answer 20

Chondrocyts

Collagen fibres in proteoglycan
matrix

Question 21

Wha tcould cause TMJ pain

Answer 21

Compressive forces – may damage proteoglycans which protects collagen

Inflammation produces proteases & hyaluronidase

Synovitis > chronic adhesive capsulitis & disc
displacement

Shearing forces may then cause break up of
collagen fibrils

Question 22

What are the functions of a bite appliance

Answer 22

Eliminates occlusal interferences

Prevents the joint head from rotating so
far posteriorly in the glenoid fossa

Reduces loading on the TMJ

Question 23

What investigations of the TMJ asre there

Answer 23

Arthrogram

MRI scan

Arthoscopy

Question 24

What can you carry out in arthoscopic procedures

Answer 24

Diagnosis

Biopsy

Lysis and lavage

Disc reduction – release, cautery, suturing

Removal of loose bodies

Eminectomy

Question 25

What is the bilaminer zone and whats in it

Answer 25

located between the posterior band of the TMJ disc and the posterior portion of the TMJ capsule

It has collagen fibres that allow anterior translation of the disc over the articular eminence and also help to maintain relationship with the mandibular condyle

Question 26

What surgical procedures are there that involve the TMD and ramus

Answer 26

Disc plication

Eminectomy

High condylar shave

Condylotomy

Meniscectomy

Condylectomy

Question 27

What is a disc plication

Answer 27

When the TMJ disc is repositioned

Could involve removing segment of bilamner zone

Question 28

What is an eminectomy

Answer 28

A surgical procedure that reduces the articular eminence to correct chronic dislocation or closed lock of the mandible

Question 29

What is a condylotomy

Answer 29

surgery in which the mandibular condyle is partially or completely removed

Question 30

What are the indications for TMJ reconstruction

Answer 30

Joint destruction:
(a) Trauma
(b) Infection
(c) Tumours
(d) Previous surgery
(e) Radiation

Ankylosis

Developmental deformity

Tumours – usually
slow growing
(i) Giant cell lesions
(ii) Fibro-osseous
lesions
(iii) Myxomas

Question 31

What are the ankylosis classifications of TMJ

Answer 31

Type I – Flattening deformity of condyle, little
joint space & extensive fibrous adhesions

TypeII – Bony fusion at outer edge of articular surface

TypeIII – Marked fusion bone between upper part of ramus of mandible & zygomatic arch

TypeIV – Entire joint replaced by mass of
bone