Maxillofacial Trauma Flashcards
(27 cards)
What are the 3 options for imaging maxillofacial trauma?
Skull radiographs
Intraoral radiographs
Computed tomography (CT)
What are the 5 options for managing oral trauma?
Conservative
Maxillomandibular fixation
Intra-oral splinting
Inter-fragmentary wiring
Rigid fixation
Pros: Skull Radiographs
Can perform awake
Can use with general evaluation for other bony injury
Cons: Skull Radiographs
Difficult to interpret with superimposition
You need to obtain multiple oblique views
Pros: Intraoral Radiographs
Excellent detail
Fast, performed intraoperative
Aid in placement of fixation
Assess health of periodontal structures
Important if dental structures play role in fixation
Cons: Intraoral Radiographs
Need to be under anesthesia/sedation (can’t do with TBI patients!!)
Challenging for caudal mandibular, maxillary, or TMJ fracture
Pros: CT
Discern lesions hidden by superimposition (especially important in caudal mandibular, maxillary, and TMJ fractures and luxation)
Allows for more advanced treatment and planning
Shown to be more sensitive and specific than film
Cons: CT
Requires anesthesia
Not readily available
Expensive
What are the principles of oral fracture repair (in order of importance)?
Stabilize patient
Restore occlusion
Maintain blood supply (use the least invasive technique)
Early return to function
Rigid(ish) skeletal fixation
What are examples of conservative management? When is this type of stabilization appropriate?
Tape muzzles, soft blue muzzles
Young patients or non-displaced fractures
Pros: Conservative Management
Low cost
May be either adjunctive treatment or sole treatment
Maintains occlusion
Cons: Conservative Management
Possible malunion
Greatest risk of long term malocclusion
High risk for aspiration
What is maxillomandibular fixation? What is required for this type of repair?
Utilize interdigitation of the maxillary and mandibular canine teeth to align/stabilize fracture segments with interdental bonding or buttons
Must have all 4 canines!!
Pros: Maxillomandibular Fixation
Not technically challenging to perform
Cons: Maxillomandibular Fixation
Some patients are very resentful
Challenges with anesthesia (re-intubation)
Place feeding tube PRIOR to fixation
Patient at high risk of aspiration
Can have long-term malocclusions
What is inter-dental wiring?
Placement of wires between teeth with acrylic support, combination of both offers greater rigidity and strength
What is required for inter-dental wiring?
Must have large, healthy teeth on either side of fracture
Remove in 4-6 weeks
Focus on maintaining occlusion
Pros: Inter-dental Wiring
Can return to normal occlusion
Minimally invasive
Cons: Inter-Dental Wiring
Very technique sensitive
Challenging with missing teeth or comminuted fractures
What is the stabilization of choice for symphyseal separation in cats?
Interdental wiring
What is interfragmentary wiring?
Wire placement between bone fragments with a goal of placing wire perpendicular to fracture line
When should interfragmentary wiring be avoided?
Comminuted fractures
Large defects
Fractures secondary to periodontal disease
Pros: Interfragmentary Wiring
Can lead to very stable fracture repairs
Cons: Interfragmentary Wiring
VERY technique sensitive and invasive
Easy to traumatize tooth roots and the mandibular canal
