Define Maxillofacial surgery?
A specialty concerned with diagnosis and surgical correction of diseases affecting the mouth, jaws, face and neck.
The 3 major areas Maxfax deals with
Head and neck cancer
Who’s involved in treating facial deformity?
A MDT including an orthodontist, maxillofacial technician and a surgeon.
How do we investigate and plan facial deformity surgery?
We also make models to plan deformity correction.
We use the rule of 3rd and 5ths (like photography). Split the face into 3rds or 5ths top to bottom and plan reconstructive surgery using the grid to form an aesthetically pleasing/normal face.
What kind of cancers does maxfax deal with?
- Oral Malignancy
- Metastatic Skin Cancer
- Maxillary Cancer
What histological type of cancer is most oral maligancy?
Mainly Squamous cell Carcinoma
Whats survival like for oral malignancy?
Overall 40% Stage 1 = 90% Stage 2 = 76% Stage 3 = 44% Stage 4 = 20%
What are the worrying signs for oral malignancy?
- Speckled red/white lesions
(White = Leukoplakia ## Red = Erythroplakia)
- Hardened areas
- Ulceration > 3 wks
- New melanin pigmentation
Explain nodal involvement in oral cancer?
Nodal involvement halves 5yr survival N1 = 1 node <3cm N2a = 1 node 3-6cm N2b = 2 nodes same side N2c = 2 nodes opposite N3 = Large Lymph Node
How do we manage oral canceR?
- Resection & Reconstruction
- Cut out a good margin
- Maintain as much anatomy and function as possible
- Best supportive Care
Where does maxillary cancer tend to spread?
To the infratemporal fossa:
- Thats the space between the pharyngeal wall, mandibular ramus and skull base
Whats the aetilogy of facial trauma?
Assault (mostly related to alcohol) Road Traffic Accidents Sports Falls Industrial accidents
How do we assess a facial fracture?
Follow the Advanced Trauma Life Support (ATLS) principles.
- Check the airway
- secure the C-spine
- Check breathing
Main subtypes of Facial trauma?
- Soft Tissue
Generally due to penetrating trauma
- Bone Injury
Generally a high energy trauma causing a panfacial injury
Whats the most common bone injury?
What are the sections of the mandible?
- Dentoalveolar Segment
- Symphysis & Parasymphysis
What is the presentation of a mandibular injury?
A history of a blow to the lower face
- Pain on biting/swallowing
- Numb Lip
- Poor occlusion/Teeth dont meet properly
- Step Deformity
- Gingival laceration
What is a step deformity?
Where two normally aligned bones are out of place and dont align, so they appear like steps.
How do we investigate and treat a mandibular injury?
- Oral Pantomogram (OPT)
Treat with Osteosynthesis = Implanted plates to reduce and internally fixate the broken bone
What is an OPT?
Oral Pantomogram or Panoramic Radiograph.
Its a type of X-ray that shows a 2 dimensional view of a semicircle from ear to ear
What kinds of midface fractures are there?
How does a maxilla fracture present?
Sometimes you can get a massive bleed if theres disruption of the maxillary art or its branches
How do we classify maxillary fractures?
Le Fort Fractures
1 = across lower maxilla below nose
2 = From lower maxilla in front of zygoma and up over the bridge of the nose
3 = across upper maxilla
How does a zygoma fracture present?
Usually after assault
Theres a lot of pain and swelling
It involves the lateral orbit, orbital floor, upper maxilla and the zygomatic arch
Whats special about a naso-orbito-ethmoidal fracture?
- They have to be reconstructed very quickly
- You can use a CT scan to diagnose it