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13 ENT > Maxillofacial Trauma 2 > Flashcards

Maxillofacial Trauma 2 Flashcards

(49 cards)

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1
Q

initial assessment of trauma patient

A

airway
breathing
circulation

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2
Q

evaluation of facial injuries

A
  • inspect but don’t explore
  • note for asymmetry, paralysis, weakness
  • basic visual acuity test
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3
Q

waters view is for the assessment of

A

nasal and malar bone, tripod fractures, rim and maxillary sinus, maxillary bones and orbit

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4
Q

townes view is for

A

mandible

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5
Q

lateral view is for

A

frontal bone and sinus, mandible

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6
Q

submentovertex view is for

A

zygomatic arch, other arches

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7
Q

postero-anterior mandible and oblique view is for

A

mandible

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8
Q

caldwell view is for

A

frontal sinus and ethmoid sinus

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9
Q

when is ct scan not necessary

A

nasal bone, malar bone, mandible

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10
Q

ct scan indicated for fractures of

A

orbit, frontal sinus, midface, condyles, temporal bone, larynx

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11
Q

___ is easiest to fracture, ___ is hardest to fracture

A

nasal is easiest, frontal is hardest

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12
Q

key principles in treatment of facial injuries

A

reduction: returning bones to their correct place
fixation: holding bones/fragments together (wires, metal splinting, plating)

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13
Q

closed reduction with maxillomandibular fixation is indicated for

A

nasal bone fracture

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14
Q

what is open reduction with internal fixation

A
  • fractures other than nasal bone
  • uses surgical stainless wiring to affix malar bones
  • uses titanium plates or screws for fixation
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15
Q

most common fracture of the face

A

nasal bone fracture

motion: inferolateral or posteroinferior displacement
visually: deviation of the nasal arch with distortion of one side

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16
Q

treatment for nasal bone fracture

A

closed reduction under anesthesia (uses boie’s elevator, asch forceps, walsham)

closed reduction, external splinting, septorhinoiplasty

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17
Q

indication for external splinting

A

nasal bone cannot be reduced by closed reduction

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18
Q

types of lefort fractures

A

type 1 (guerin): maxilla separates anteriorly (drawer sign)

type 2 (pyramidal): fracture separates the middle part of the nose and maxilla from the rest of the skull

type 3 (craniofacial disjunction): type 2 + fracture of zygomatic arch

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19
Q

management of maxillary fractures

A
  • open reduction with internal fixation (plates)

- tools: rowe disimpaction forceps

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20
Q

how to inspect for fractures of the mandible

Study These Flashcards
A
  • malocclusion: ask patient to bite

- angle fractures are most common, then condylar process and symphisis

21
Q

elevators of the mandible

Study These Flashcards
A

temporalis, masseter, medial pterygoid, lateral pterygoid

22
Q

depressor retractors in mandible

Study These Flashcards
A

digastric, geniohyoid, genioglossus, mylohyoid

23
Q

protrusors in mandible

Study These Flashcards
A

lateral pterygoid

24
Q

favorable fracture lines

Study These Flashcards
A
  • natural action of muscles will keep bony fragments in place
  • fragments are pressed firmly together when muscles act on mandible
25
unfavorable fracture lines
- natural action of muscles will dislodge bony fragments | - fragments are pulled away from each other when muscles act on mandible
26
most important xray for mandible fractures
panoramic radiograph of the mandible
27
most common method used to manage mandible fractures
open reduction with internal fixation - open reduction: reset bones - internal fixation: attach and fix screws
28
method used in mandible fractures when microplates and miniplates were not yet available
external fixation
29
what is interdental wiring and intermaxillary fixaiton
- management for mandible fracture | - pulling arch bars and rubberbands to bind teeth for 6-8 weeks
30
how to inspect for frontal sinus fractures
note depressions of arch above nose
31
complications of untreated frontal sinus fractures
- mucocele formation-> eye proptosis -> brain erosion | - meningitis
32
treatment for frontal sinus fractures
- prevent complications!! - obliteration: remove all sinus mucosa and obliterate sinus cavity, use autologous tissue to fill obliterated sinus - cranialization: indicated if there is csf leak, bone is removed and allow the brain to collapse forward
33
contraindication for obliteration of sinuses in frontal sinus fracture
if posterior wall is absent or not intact (csf leak)
34
most common site for orbital fracture
orbital floor (blowout fracture) - eye absorbs energy and gets displaced - maxillary sinus roof collapses - eye muscles can be entangled in bone
35
indications for surgery in orbital fractures
double vision due to muscle entrapment or posterior displacement of eyeball
36
2nd most common facial fracture and most common cause
zygomaticomaxillary complex fractures commonly caused by interpersonal violence (unilateral)
37
classification of zygoma fractrues
read
38
symptoms of zygomaticomaxillary complex fractures
diplopia, anesthesia-hypesthesia, trismus, epistaxis, subconjunctival hemorrhage, periorbital ecchymosis
39
signs of zygomaticomaxillary complex fractures
facial contour flattening, slanted palpebral opening, extraocular muscle limitation of movement, ptosis, enopthalmos, step-offs, point tenderness, mucosal ecchymosis
40
how is the eye displaced
fracture -> orbit gets larger > eye sinks deeper / displaced inferiorly (whitnall's tubercle pulls the eye downward by the ligament of lockwood via lateral canthus)
41
what is a step off
can be palpated when there is a fracture at the lower rim (where zygomatic and maxillary meet) = disconnection of bones, zygomatic is disconnected, maxillary intact
42
____ bleeds causing epistaxis in tripod fractures
maxillary sinus
43
fracture line can pass through ___ causing anesthesia-hypesthesia
infraorbital nerve
44
direct signs of tripod fracture in radio
- cortical break, defect, separation - cortical overlap - abnormal linear density or intensity - abnormal cortical angulation - absent bony fragment - osseus displacement
45
indirect signs of tripod fracture
- soft tissue swelling / hematoma - soft tissue emphysema - soft tissue displacement - paranasal sinus fluid or blood
46
indications for ct scan in tripod fracture
- suspected orbital floor fracture - comminuted or severely displaced fracture - injuries associated with other facial fractures
47
continuity of ___ indicates a lack of fracture
3 lines of dolan
48
treatment for tripod fracture
- open reduction internal fixation - maxillary packing technique - kazanjian method - wire pin extension
49
treatment of zygomatic fracture
- gilies approach | - insert instrument to lift arch

13 ENT (18 decks)

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