Facial Trauma Flashcards
(19 cards)
What is a Le Fort 1 fracture?
Only the maxilla is broken
What is a Le Fort 2 fracture?
The maxilla and nose are broken
What is a Le Fort 3 fracture?
Whole middle face- maxilla, nasal bone and zygoma are all broken
What 3 branches does the infraorbital nerve split into?
Where do they supply?
Superior labial - top lip
Lateral nasal - lateral side of the nose
Palpebral- around the cheek and lower eye lid
What are the 3 different sutures involved in a tripod fracture?
Zygomatical frontal suture
Zygomatical maxillary suture
Zygomatical temporal suture
What are the common features of a Zygomaticoorbital fracture?
Haemorrhage- subconjunctival haemorrhage -eye red under conjunctiva
Circumferential ecchymoses - infraorbital haemorrhage, bruising
Swollen cheek but flatness of cheekbone
Limited mouth opening- zygoma impinges on the coronoid process
What areas do you palpate for facial fractures?
Palpation for irregularities of supraorbital ridge
Palpation for irregularities of infraorbital ridge and zygoma
Palpation for depression of zygomatic arch
What are the ATLS principles for facial trauma?
A- Airway plus C-spine control)
B- breathing
C-circulation plus haemorrhage control
D-are they head injured
What is the treatment for mandibular fractures?
Reassure and explain why any numbness may be occurring
Fast the patient
Analgesia
Antibiotics for open fractures
Immediate discussion with OMFS team
What are the signs and symptoms of midface fractures?
Epistaxis (nose bleed) without a blow to the nose
V2 numbness without a direct blow to the nerve
Subconjuctival bleed
Midface mobility
Malocclusion
Surgical emphysema around the eye
Swelling after nose blowing
Diplopia (double vision)
CSF fluid out of the nose or ears
What are the 2 surgical approaches to facial fractures?
Closed reduction + internal fixation
Open reduction + internal fixation
What is an open reduction of a fracture vs closed reduction?
Open reduction is where you open the fracture and can see it - put them back together and fix them
What are the 3 classes of mandibular fractures
Simple- fracture in bone and surrounding soft tissue intact
Compound- soft tissue surrounding is damaged, lacerated or exposing the fracture
Comminuted- when bone has been broken into multiple small pieces (gunshot wound)
What do you classify mandibular fractures by?
Involvement of the surrounding tissue
Number of fractures
Side of the fracture
Site of fracture
Direction of fracture line
What are green stick fractures?
Happens in children due to organic component of the bones
Bone is softer- fracture happens and does not have complete separation
What are the surgical approaches to a condylar fracture?
Retro-mandibular approach - behind mandible
Raisdon approach
Preauricular approach - from front of the ear
Bi-coronal flap - cut from 1 ear to other
What E/O exam would you complete for a suspected mandibular fracture?
Ask about pain
Check for - lacerations, bleeding, swelling, asymmetry
Palpate mandible bilaterally
Limitation/deviation on opening
Tenderness of TMJ
Examination of sensation of lower lip/chin region
Condylar fracture= bleeding around the ear
What would an I/O exam include for a suspected mandibular fracture?
Lacerations
Bruising/swelling/sublingual haematoma
Occlusal derangement and step deformities
Broken or mobile teeth
Anaesthesia/paraesthesia of teeth in lower jaw/lip on side of fracture
AOB due to bilateral ramus/sub-condylar fracture
What would be included in an E/O exam for middle third face fractures?
Look and feel
Lacerations
Nasal bleeding/deviation/patency
Palpation of zygoma bilaterally
Facial asymmetry
Limitation of mandibular movement
Examination of infraorbital nerve - upper lip, lateral nose, lower eyelid
