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ENT > Maxillofacial Trauma > Flashcards

Maxillofacial Trauma Flashcards

1
Q

Enumerate your treatment priorities in maxillofacial trauma patients. In the right order

A
  1. CNS injuries (GCS)
  2. thoracoABD (ABD rigidity etc.)
  3. Soft tissue injuries (larynx etc.) (facial extremity trauma)
  4. Fractures (last)
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2
Q

Differentiate open reduction from closed reduction

A

Open – incisions to directly expose the bone to be repaired

Closed – fracture will not require any incision to position the bone

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3
Q

With limited resources, what is the best radiographic imaging you can request for?

A

Upright waters view to also see the air-fluid level

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4
Q

Fracture that is the most common bone injury involving the face.

A

Nasal fractures

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5
Q

Enumerate the usual signs of nasal fractures

A

• The usual signs of nasal fracture are:

(1) depression or displacement of the nasal bones
(2) edema of the nose
(3) epistaxis
(4) fracture of the septal cartilage with displacement or mobility

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6
Q

What is the management for nasal fracture complication->septal hematoma?

A

Incision and drainage, septoplasty

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7
Q

2nd most common fracture of the facial skeleton

A

mandibular fracture

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8
Q

Enumerate at least 5 anatomic weaknesses of the mandible

A
  • Incisive fossa/ mental foramen
  • Impacted/unerupted teeth
  • Cysts/abscesses
  • Edentulousness
  • Angle & condyle- poorly resistant to lateral forces
  • Thin alveolar process
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9
Q

Enumerate the anatomic strengths of the mandible

A
  • thickened lower margin

- crests

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10
Q

List the incident of commonly fractured regions of the mandible

A

Boies-ABC (Angle, Body, Condyle)

Doc- CBA

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11
Q

When is a fracture of the mandible’s body favorable? When is it unfavorable?
A- diagonally from the first molar to the chin (postero-anterior)
B- diagonally anteroposterior

A

favorable -A

unfavorable-B see page 4 of trans

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12
Q

Diagnostic of mandibular fractures (as per Dr. Alcira)

A
  • Malocclusion/ open bite deformity

- palpable step-ladder deformity

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13
Q 
Which of the following cannot be observed in mandibular fractures?
A. abnormal taste
B. ecchymosis
trismus 
C. ear bleed
D. open bite deformity
A

A. abnormal taste

ear bleeding can happen

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14
Q

What does it mean if there is ear bleeding in a patient with mandibular fracture? explain why.

A

Condyle was fractured and the force was strong enough to rupture the external canal. Condyle is near to the canal making this possible

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15
Q

Imaging to be requested for in mandibular fractures

A

AP view or waters, lateral oblique. never lateral because of superimpositions

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16
Q

Initial management for mandibular fractures

A

asses ABC

  1. fracture immobilization
  2. fracture alignment
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17
Q

Type of bandaging for mandibular fractures

A

figure-of-8 or Barton’s bandage technique

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18
Q

Definitive for fractures of the body of the mandible accdg to favorable and unfavorable fractures

A

DEFINITIVE MGT: fracture reduction

  • FAVORABLE BODY & CONDYLAR: CLOSED reduction
  • UNFAVORABLE: OPEN reduction
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19
Q

Principle for the definitive management for mandibular fractures. Enumerate how it’s done.

A

Determine and restore the pre-injury occlusion by interdental wiring and intermaxillary fixation

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20
Q

What is the conventional xray ordered for zygoma and orbital floor fractures? What will you look for?

A

Upright water’ view, look for Tear Drop sign

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21
Q

Type of test done in zygoma and orbital floor fractures to check for extraocular muscle entrapment

A

Forced Duction test

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22
Q

Describe Le fort I

A
  • low transverse fracture of maxilla involving the palate only
  • mobility or displacement of maxillary dental arch and palate;
  • dental malocclusion is usually present
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23
Q

Describe Le fort II

A
  • pyramidal fracture involves fracture en bloc of the palate and middle third of the face, including the nose
  • mobility of palate
  • nose en bloc
  • significant epistaxis
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24
Q

Describe Le Fort III

A
  • involves complete disruption of attachments of facial skeleton to the cranium
  • entire zygomaticomaxillary complex may be mobile and displaced
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25
Q

Most serious condition among facial fractures

A

Midface fractures

26
Q

AKA Zygomaticomaxillary complex fracture

A

tripod/trimalar fracture

27
Q

Diagnose the type of fracture- telecanthus, (+) bow string test, epistaxis, periorbital swelling

A

Naso-Orbitoethmoidal (NOE) fractures

28
Q

Differentiate NOE I and NOE II

A

NOE I-Medial canthan tendon is intact and connected to a single large fracture fragment

NOE II: comminuted of NOE complex, but with intact medial canthal attachments

29
Q

Enumerate at least 3 sequelae of maxillofacial fractures

A 
infection
malunion
non-union
impairment of loss of function (TMJ ankylosis)
cosmetic deformity
30
Q

Type of le Fort that results in floating palate

A

Le Fort I Low palate or Guerin Fracture 20-30%

31
Q

Type of Le Fort resulting to floating maxilla

A

Le Fort II Pyramidal fracture 35-55%

32
Q

type of Le Fort resulting to dishpan deformity

A

Le Fort III Craniofacial dysjunction 5-15%

33
Q

What is the P.E. finding in midface fractures that if absent could indicate that fractures are locked on each other?

A

Drawer Sign

34
Q

When a fracture involved the frontal recess, what is necessary management to prevent mucocele formation?

A

Fractures involving the frontal recess- should include cannulation of the frontal recess (not keeping it patent can lead to the complication-> mucocele

35
Q

What is the least common type of maxillofacial fracture?

A

Frontal sinus fracture because tremendous force is needed to fracture this

36
Q

3 areas involved in frontal sinus fracture?

A

anterior table, posterior table, frontal recess that opens to the middle meatus

37
Q

Complication of an untreated or improper treatment of frontal sinus fracture

A

mucocele

38
Q

gold standard for diagnosis CSF rhinorrhea

A

CT scan contrast

39
Q

When is CSF rhinorrhea (+) in Filter paper test

A

(+) halo sign

40
Q

Other maneuvers to detect CSF rhinorrhea

A
  • unilateral
  • affected by head position (Head Bow)
  • increasing the jugular vein compression
41
Q

Type of fracture that results from blunt eye trauma with prolapsing of the intraocular contents into the maxillary sinus

A

“Blow-out fractures”- isolated fractures involving the orbital floor with sparing of the orbital rims

42
Q

benefits of using arch bars in managing mandibular fractures

A

Like arch bars, parang braces. When you wire the jaw shut you

  1. Reestablish alignment
  2. Restore occlusion
  3. Immobilize the mandible
  4. Reduce the fracture
    * *Without interdental and intermaxillary you may be reducing the fracture without correcting the occlusion.
43
Q

Enumerate the type of mandibular fractures from the most common to the least common

A

1st Condyle, 2nd Body, 3rd Angle

remember CBA

44
Q

Common fractures you see in children

A

greenstick/incomplete fractures

45
Q

What are the 2 conditions wherein you do immediate reduction of the fracture?

A

We only do immediate reduction of the fracture if

  1. If it will control the bleeding
  2. If it is interrupting the airway
46
Q

if the coronoid is the only fracture, what is your management?

A

None. Leave it alone.

47
Q

What is your management for coronoid fracture with trismus?

A

coronoidectomy

48
Q

Oral hygiene in mandibular fracture patients is best done with what?

A

pulsed water jet device (water pik)

49
Q

What is the sequelae for untreated zygoma and orbital floor fractures?

A

flattened cheek, ocular complications

50
Q

Fractures of the orbital floor may only be manifested by this finding. Explain the mechanism behind it.

A

restricted upward gaze d/t entrapment of the inferior rectus muscle

51
Q

What is the nerve damaged if there is hyperthesia of the cheek in zygoma and orbital floor fractures? be specific

A

maxillary division of the trigeminal nerve.

52
Q

Imaging helpful for orbital fractures

A

planigraphic or CT

53
Q

When the neck is palpated and free air and crepitation was noted what injury do you suspect?

A

rupture of tracheobronchial tree, and laryngeal fracture

54
Q

For how long can reduction and fixation of facial fractures be postponed?

A

4th to 6th day

55
Q

Facial fractures should be reduced within what time period to avoid malunion or nonunion?

A

within 1st 2 weeks

56
Q

Best radiograph to request for nasal fracture?

A

lateral radiograph

57
Q

What is the best radiograph requested for fractures of the middle 3rd of the face and paranasal sinuses?

A

Waters projection (Boies)

58
Q

best radiograph for mandibular fractures

A

panoramic radiograph

59
Q

Principle for treating facial injuries

A

” if in doubt, preserve tissue”

60
Q

Most common type of nasal fracture

A

depression of one nasal bone with contralateral displacement of nasal pyramid

ENT (1 decks)

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