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Oral Surgery > Facial Trauma > Flashcards

Facial Trauma Flashcards

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1
Q

most common etiology of facial trauma

A

43% vehicular accidents
34% assaults

7% work related
7% fall
4% sporting
5% miscellaneous

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2
Q

most common mandibular fracture location

A

condyle 29.5%
- shape implicaton

symphysis 22%

body 16%

alveolar 3.1%

ramus 1.7%

coronoid 1.3%

body 16%

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3
Q

classification of mandibular fractures

A

displaced (doesnt stay in position) or undisplaced fracture

  • location
  • direction of the line of fracture
  • direction of the muscular forces

horizontal favorable or unfavorable

vertical favorable vs unfavorable

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4
Q

neurological examination

A

cranial nerves examination

II- optic
III- occulomotor
IV- trochlear
V- trigeminal
VI- abducens
VII- facail
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5
Q

mandibular fracture by type

A

simple or closed

compound or open

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6
Q

simple or closed mandibular fracture

A

a fracture that does not produce a wound open to the external environment, whether it be through the skin, mucosa, or periodontal membrane

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7
Q

compound or open mandibular fracture

A

a fracture in which an external wound, involving skin, mucosa, or periodontal membrane, communicates with the break in the bone

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8
Q

comminuted mandibular fracture

A

a fracture in which the bone is splintered or crushed

  • like gun shot
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9
Q

greenstick

A

a fracture in which one cortex of the bone is broken, the other cortex being bent

  • INCOMPLETE
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10
Q

pathologic fracture

what to note

A

a fracture occuring from mild injury because of pre-existing bone disease

LOOK FOR EDENTULOUS ARCH – may be more likely to be pathologic if less bone present

  • different than injury - something going on before
  • like pre-exisitng patholgy - cyst tumor cancer, osteonecrosi, etc
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11
Q

radiographic examination of mandible series

A

LEAST PREDICTABLE

  • towne’s view
  • anterior - posterior view
  • lateral oblique right and left
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12
Q

panorex use

A

most common

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13
Q

most predictable radiographic examination uses

A

CT scan

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14
Q

general principles of fracture treatement

A

reduction

stabalization

fixation

rehabilitation

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15
Q

4 types of overarching fractures

A

mandible fractures

lefort fractures

zygomatic complex fractures

naso-orbital ethmoidal fractures

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16
Q

treatment of mandible fractures

A

objectives
re-establish
OCCLUSION

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17
Q

open bite suggestive of

A

fracture

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18
Q

primary objective of treatment of mandibular fracture

A

OCCLUSION then restore the form and function

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19
Q

common indications can do closed reduction tx

A

non displaced favorable

grossly communicated fractures

deficient or lack of overlying soft tissues

fractures in children with developing dentition

cornoid process fractures

majority of condylar fractures

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20
Q

physical examination should include

A
  1. general examination
    when, where, etc
  2. soft tissue
    - lips, cheeks, etc
  3. neurologic examination
    - facial injury in combination with brain injury - cranial nerve checking
  4. bony examination
  5. ocular examination
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21
Q

right side under the ear - what other structures should you think of?

A

facial nerve – 5 terminal branches

parotid gland – + the duct

facial artieries

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22
Q

bony fractures broken down into

A
  1. mandibular
  2. lefort fractures
  3. zygomatic complepx fractures
  4. naso-orbital ethmoidal fractures
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23
Q

muscle and fracture pattern

A

pull of muscle - may
displace fracture - take fracture away = displaced

sometimes muscle pull – brings fragments closure – favorable

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24
Q

if muscle pull
masseter on buccal and medial pterygoid on lingual?
fracture pulls up

A

pterygo-masseter SLING
if ledge of bone above – FAVORABLE -

horizontally favorable

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25
no superior ledge of bone and fragment travels posterior and DOWN - leaving unsupported bone sling is free
horizontally unfavorable
26
displaced or undisplaced fracture gets further catagorized into
location of the fracture direction line of the fracture direction of the muscular forces
27
if looking at a fracture in a PANO - what orientation
horizontal aspect
28
muscle pull together brings fracture fragment UP with no superior ledge of bone
horizontally unfavorable
29
no superior ledge of bone
fragment piece may go posteriorly DOWNWARD - and then with no superior ledge of bone the masseteric and medial pterygoid together pull the fragment superiorly unopposed horizontally UNFAVORABLE
30
looking at a fracture from below or from the top will catategorize it as
vertically favorable or unfavorable
31
medial pterygoid sling on the lingual - but no muscle pulling it buccally - but buccal bone present
vertically FAVORABLE - muscle alone cannot displace it fragments wont get displaced
32
no buccal or lingual bone ledge looking from the top
vertically unfavorable the medial pterygoid muscle can pull the fragment and displace it
33
reduction to happen
need minimal displacement to happen
34
simple =
closed
35
compound =
open
36
Which locations of mandibular fractures do you think would be involved with simple/ closed or compound/ open fractures?
coronoid or condyle in isolation may be simple other areas --- teeth involved - pdl space -- considered a point of entry - compound / open fracture then
37
picture of radiograph with pano showing left mandibular fracture and asked to classify it - looks completely broken - no teeth
good example of PATHOLOGICAL FRACTURE | - mandible gets weak and then completely fractures
38
x-ray shows displacement of the mandible superiorly
horizontally
39
altered sensationo of lip?
inferior alveoolar canal affected | - can get pulled with displacement
40
intra oral picture suggesting mandibular fracture - what to note
BREAK IN GINGIVA OCCLUSAL STEP open bite sublingual hematoma or ecchymosis
41
open bite?
suggestive of mandibular fracture
42
pathonemonic for mandibular fracture
floor of the mouth ecchymosis sublingual hematoma
43
panorex with radio graph exam
mot common
44
CT scan rx use?
most predictable
45
mandible series?
1. towne's view 2. anterior - posterior view 3. lateral, oblique, right and left LEAST PREDICTABLE
46
general principles of fracture treatment
1. reduction 2. stabilization 3. fixation 4. rehabilitation
47
primary objective in tx of mandibular fractures
RE-ESTABLISH OCCLUSION then form and function *
48
types of treatment for madnibualr fractures
1. no treatment / liquid diet 2. closed reductiono 3. open reduction (most complicated - exposing the sites and re-aligning)
49
two mandibulr areas that can likely be treated by closed reduction
1. coronoid -- not going to invasively go into the mandible and 'hunt down' this area MAJORITY of condylar
50
best indication to do closed reduction
have a non displaced favorable fracture
51
tx of comminuted fractures
closed reduction if try and get all pieces and put togethre- may strip off periosteum which is the life of the bone
52
closed reduction tx modalities
1. ivy loops 2. arch bars 3. splints - gunning splints - denture - lingual splints - cap splint 4. external pin fixation - most unsightly form of
53
arch bars basiclaly
bar on top and botoom hold them together intermaxillary fixation - get teeth righ t-- to then hold bone to the right place Mand F maxillary and mandibular arch fixation
54
capping splint
closed reduction tx technique pass wires over and under - NO TEETH - need another area for fixation
55
dentures used in tx?
yes for mandibular fixation with denture -- closed technique modify the existing denture to hold onto the bars
56
external fixation
bar around all of the mandible with screws fixated in
57
tx modalities for open reduction - general
non rigid fixation semi rigid rigid fixation
58
arch bar splints can use
patients denture
59
example of non rigid fixation - include type of tx
for mandibular fracture - OPEN REDUCTION | - WIRES
60
example of semi-rigid fixation - include type of tx for
for madnibular fracture - tx by OPEN REDUCITON | - MONOCORTICAL SCREWS/PLATES (CHAMPY)
61
wires in open reduction example of
non rigid fixation tx
62
monocortical screws/plates tx for
semi-rigid fixation uses open reduction tx for mandibular fractures
63
compression plates and reconstruction plates used in
open reduction rigid fixation treatment for mandibular fracture
64
rigid fixation for open reduction tx options
compression plates and reconstruction plates not really used as much but much thicker
65
examples of mid face fractures
1. lefort I,II, III 2. zygomatic complex fracture 3. zygomatic arch fracture 4. naso-orbital ethmoidal fracture
66
lefort I
horizontal fracture over apices of maxillary teeth
67
lefort II
pyramdal fracture goes more superior crosses zygomatic maxillary suture on orbital floor along the nasal frontal and maxilo-frontal suture shape -- triagular / pyramidal
68
lefort III
goes even more superior than the lefort II zygomatic arches and frontal zygomatic suture - more lateral maxillary boe separted from cranium bone ** craniomaxillary dysjunction fracture
69
zygomatic complex fracture
outside of orbit -- look at slide picture patient will present with zygomatic ecchymosis and edema lateral eye and where zygomatic bone - frontal bone come together too from view below can see the disjunction of zygomatic arch
70
from view below can see the disjunction of zygomatic arch
ZMC complex fracture
71
most common symptoms for midface fractures
KNOW this 1. pain, edema, and ecchymosis of cheeks and eyelids 2. malar flattening 3. step defect at INFRAORBITAL SUTURE 4. step defect at FRONTOZYGOMATIC SUTURE 5. TRISMUS
72
Occlular eye exam important in
all really but with midface fractures may find - infra-orbital nerve parasthesia or anesthesia - enopthamlmos (posterior displacement of eyeball) or proptosis (protrusion of eyeball) - diplopia (double vision) - decreased mobility of extra ocular muscles (upward gaze)
73
ZMC cranial nerve examination
``` same as others CN II CN III CN IV CN V CN VI CN VII ``` (2-7)
74
scan of choice for midface fractures
CT scan
75
imaging facial series for midface fractures
plain film submental-vertex view townes, AP views Waters View
76
CT scan with ZMC fracture
sinus will look all grey because of the inflammation - bones fractured to fluid and edema gets in normally should be all black
77
typically appearing like a v
TRISMUS fracture of zygomatic arch
78
trismus a sign for
zygomatic arch fracture

Oral Surgery (26 decks)

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