facial trauma

Question 1

What does an examination of the injured face include

Answer 1

1. Extra oral
2. Intra oral
3. Radiological

Question 2

What must we check first when examining a patient with facial trauma

Answer 2

ABC
Airway
Breathing
Circualtion

Question 3

What does the physical examination of the injured face include

Answer 3

1. Inspection
2. Palpation
3. Percussion
4. Auscultation

Question 4

Define fracture

Answer 4

A break in the continuity of a bone

Question 5

Define displacement

Answer 5

The extent to which the two sides of the fracture have moved from their normal position

Question 6

Define angulation

Answer 6

The angle by which one fragment has moved in comparison to its previous position

Question 7

Define compound

Answer 7

A fracture which is open to external environment through a tear/ laceration in overlying skin/mucosa AKA open fracture

Question 8

Define comminuted

Answer 8

A complex fracture pattern with more than two bone fragments at the fracture site

Question 9

What is a pathological fracture

Answer 9

Fracture that occurs in an area of bone that has been critically weakened by disease eg cancer, osteoradionecrosis, MRONJ or very large cyst

Question 10

What forces are the bones of the skull designed to withstand

Answer 10

Chewing forces

Question 11

What happens to the alveolar ridge over time after losing teeth

Answer 11

Alveolar ridge is resorbed in both the upper and lower jaw where teeth have been lost

Question 12

Why is resorption of the mandible a problem

Answer 12

Can lead to the mandible becoming really thin- atrophic mandible
This can increase risk of fracture

Question 13

What problems can the muscle of mastication pose on an atrophic mandible

Answer 13

Can act to cause further displacement of fractures as the master muscle pulls the mandible upwards, the digastric muscle pulls the mandible down
this can lead to the fracture becoming unstable

Question 14

What unique problem is associated with a zygomatic arch fracture

Answer 14

As the temporals run below the zygomatic arch impingement of this muscle may cause trismus

Question 15

What can patient with a fracture of the orbital floor suffer from

Answer 15

Diplopia on looking up
Numbness of the cheek, upper lip and nose is common
retrobulbar haematoma

Question 16

What can a fracture of the mandible past the lingual cause

Answer 16

Lower lip numbness due to damage of the inferior alveolar nerve

Question 17

What can happen if a retrobulbar haematoma is not treated

Answer 17

Can lead to death of the retina and the pt could permanently lose their vision

Question 18

Name the different sites of the mandible that can fracture from most to least likely

Answer 18

1. Condyle (30%)
2. Angle of mandible (25%)
3. Body of mandible (25%)
4. Mental region (15%)
5. Ramus (3%)
6. Coronoid process (2%)

Question 19

Where might compound fractures occur in the mandible

Answer 19

1. Body of the mandible
2. Mental region

Question 20

What is the advantage to us if a patent has a compound fracture over a closed fracture

Answer 20

Compound fractures are easier to access

Question 21

Where might a closed fracture occur in the mandible

Answer 21

Condyle
Coronoid porcess
Ramus

Question 22

What is the disadvantage to us if a patent has a compound fracture over a closed fracture

Answer 22

Compound fractures can become infected

Question 23

Mandible fractures are often…

Answer 23

bilateral

Question 24

What does the zygoma form

Answer 24

What is the zygoma attached to Your cheek prominence
Also makes up part of the orbital floor

Question 25

What is the zygoma attached to

Answer 25

1. Maxillary wall 2. Orbital floor 3. temporal bone (zygoamtic arch)

Question 26

What problems can a zygoma fracture cause

Answer 26

1. Disturbed vision 2. Damage to the infraorbital nerve 3. flattening of the prominence of the cheeks

Question 27

What classification can we use to classify fractures

Answer 27

Le forts classification

Question 28

What categories make up le forts classification

Answer 28

Le fort 1,2 OR 3

Question 29

What is a le fort 1 fracture

Answer 29

A fracture above the apices of the upper teeth

Question 30

What is a le fort 2 fracture

Answer 30

A fracture over the maxilla and nose

Question 31

What is a le fort 3 fracture

Answer 31

A fracture involving the maxilla, zygoma and orbital floor

Question 32

What does the physical examination of the injured face include

Answer 32

1. Inspection 2. Palpation 3. Percussion 4. Auscultation

Question 33

What is the medical term for a bruising around the eye

Answer 33

circumorbital bruising

Question 34

What Is the medical term for a blood shot eye

Answer 34

subconjunctival haematoma

Question 35

What is the mechanism for getting a subconjunctival haematoma (blood shoot eye)

Answer 35

Pt must sustain direct trauma to the eye ball (subconjunctival haematoma with a posterior limit) OR Pt may have a fracture around the floor of the orbit which may lead to bleeding which can tract forward into the conjunctiva leading to a blood shot eye (subconjunctival haematoma without a posterior limit)

Question 36

What do we look for when examining an injured face

Answer 36

1. Swelling 2. Bleeding 3. Brusing 4. Flattening 5. Eye movements 6. Check for double vision

Question 37

If we identify the pt has a swelling what should we do

Answer 37

Feel the swelling to determine if the patient has a surgical emphysema

Question 38

What is a surgical emphysema

Answer 38

When air gets trapped in the tissues

Question 38

What is another term for a fracture of the floor of the orbit

Answer 38

Blow out fracture

Question 38

How do we assess flattening

Answer 38

By looking at the patient from below to see if there is a lack of prominence in the chin or cheeks

Question 38

After carrying out a visual exam what should we do next to examine the injured face

Answer 38

Palpate the head and neck to assess sensation

Question 39

After carrying out a visual exam what should we do next to examine the injured face

Answer 39

Palpate the head and neck to assess sensationN

Question 40

Name the three divisions of the trigeminal nerves

Answer 40

1. Ophthalmic 2. Maxillary 3. Mandibular

Question 41

Give examples of common findings we may find during an intra oral exam if a pt has a mandibular or zygomatic fracture

Answer 41

1. Gap in the occlusion 2. Gingival tear 3. step in the occlusion 4. Malocclusion

Question 42

What can a gap/ step in the occlusion look like

Answer 42

A missing tooth this is why its important to count the teeth

Question 43

What might you see in a patient with bilateral fractures at the condyles

Answer 43

An anterior open bite

Question 44

What radiographic assessments do we take to assess facial traumas

Answer 44

2 radiographs at different angles usually

Question 45

Why do we need to take 2 radiographs at different angles when assessing facial trauma

Answer 45

1. Fractures may be missed 2. Assess displacement 3. Assess angulation

Question 46

which radiographs do we usually take when we suspect a mandibular fracture

Answer 46

OPT and postero anterior mandible can also take a reverse Townes view

Question 47

What might we take to assess the condyles further

Answer 47

CT scan or reverse Townes view in a Hospital without a CT scan

Question 48

which radiographs do we usually take when we suspect a mid face fracture

Answer 48

Occipto mento view radiograph (facial view) Submentovertex view CT scan

Question 49

What can a Occipto mento view radiograph (facial view) show us

Answer 49

1. Fluid levels 2. Infraorbital Margin fracture 3. Zygomatic buttress fracture 4. Zygomatic arch fracture