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My BDS4 > OMFS - Trauma > Flashcards

OMFS - Trauma Flashcards

1
Q

What is the relevance of the muscles of mastication in relation to mandibular fracture?

A

These muscles can cause displacement of the fracture
(Displacement dictates management)

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2
Q

What are the signs and symptoms of mandibular fracture? (11)

A
  • Pain
  • Swelling
  • Limited function (opening and lateral movements)
  • occlusal derangement = Can’t bite as normal into ICP
  • Numbness lower lip
  • Mobility of teeth/loose teeth
  • Bleeding limited to area of fracture
  • AOB
  • Facial asymmetry
  • deviation of mandible towards opposite side to fracture
  • bleeding in FOM
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3
Q

What is a specific symptom of a condylar mandibular fracture?

A

Bleeding of the ear

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4
Q

How do we classify a mandibular fracture? (7+)

A
  1. Involvement of the surrounding soft tissue;
    * Simple: surrounding soft tissue intact
    * Compound: fracture exposed to the surrounding environment (soft tissue breached)
    Need AB’s
    * Comminuted: multiple small fragments e.g. from gunshot
  2. No of fractures
    * Single
    * Double
    * Multiple
  3. side of fracture
    * Unilateral
    * Bilateral
  4. Site of fracture
    * Angle
    * Below condyle (subcondyle)
    * Parasymphyseal (in the middle)
    * Body
    * Ramus
    * Coronoid
    * Condylar fracture (intra/extra caspular)
    * Alveolar process
  5. Direction of fracture line
    * Favourable:
    * Unfavourable
  6. Specific fractures
    * Green stick fracture: soft bone (children) very unlikely to completely fracture = still attachment in one of the cortices
    * Pathological: fracture caused by pathology
  7. Displacement of the fracture
    * Displaced
    * Undisplaced
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5
Q

What is the difference between a simple and compound fracture?

A
  • Simple: surrounding soft tissue intact
  • Compound: fracture exposed to the surrounding environment (soft tissue breached)
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6
Q

What is required if there is a compound fracture?

A

antibiotics

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7
Q

If a fracture breaches the tooth bearing area of the mandible what is it automatically classified as and why?

A

compound fracture

as it is In direct communication with the PDL (Gingival crevice) = surrounding environment

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8
Q

What is a comminuted fracture?
what is it commonly caused by?

A

multiple small fragments of fracture

gunshot

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9
Q

What makes a fracture favourable?

A

direction of fracture line limits the displacement of the fracture by the action of the surrounding muscles

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10
Q

What makes a fracture unfavourable?

A

direction of fracture line encourages the displacement of the fracture

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11
Q

What conditions can cause a pathological fracture to the mandible? (5)

A

osteoporosis, osteomyelitis, Padgets, expanding cystic lesion

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12
Q

What factors cause displacement of the mandibular fracture? (6)

A
  • Direction of fracture line
  • Opposing occlusion: prevents fracture being displaced
  • Magnitude of force
  • Mechanism of injury
  • Intact soft tissue: intact tissue = displacement unlikely
  • Other associated fractures: > 1 fracture = higher chance of displacement
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13
Q

What radiographic views do we use for assessing/locating mandibular fractures? (6)

A

2 Plain views at 90 degree angles to each other;
OPT + posteroanterior mandible

Other radiographs:
Most common now = CT scan or CBCT

  • Occlusal
  • Lateral oblique
  • Towns view
  • SMV
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14
Q

How do we treat mandibular fractures? (3)

A

Control pain and infection via NSAIDS & AB’s

Reduction

Fixation

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15
Q

What are the 2 basic principles of treating a mandibular fracture?
Describe.

A
  • Reduction: to reduce the displaced fragment back to its normal anatomical orientation
  • Fixation: to fix the fractured segment in place using plates and screws (internal fixation)
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16
Q

What is usually the tx option of choice for an undisplaced mandibular fracture?

A

No tx

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17
Q

What is usually the tx option of choice for a displaced/mobile mandibular fracture?

What is the other option?

A

ORIF
open reduction internal fixation

Closed reduction +/- fixation

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18
Q

Describe closed reduction.

A

reduce the fractured segments to their normal anatomical orientation without exposing the fracture line
= No periosteal exposure of the fracture segment

19
Q

In closed reduction how do we ensure that the displaced mandibular fragment has been reduced to its original/desired site if we cannot directly see the fracture line?

A

Intermaxillary fixation = if teeth go into ICP

20
Q

In a closed reduction approach how to we ensure fixation of the mandibular segments?

A

Intermaxillary fixation

= teeth go into ICP & wire teeth together

21
Q

What is the contraindication of intermaxillary fixation of the mandible?

A

Epilepsy

22
Q

What are the risks associated with ORIF of the mandible? (2)

A

All surgical risks

Damage to vital structures e.g. nerves

23
Q

What must be considered before carrying out a ORIF approach in the mandible? How do we combat this?

A

Thin mandibular bone in px’s with disease of the bone (osteoporosis)

= requires rib bone graft before plates placed for ORIF

24
Q

What specific type of mandibular fracture causes AOB?

Describe how this causes AOB.

A

Subcondylar (bilateral)

Causes shortening In vertical height of ramus
(posterior teeth meet prematurely)

25
Q

List 3 radiographic signs of mandibular fracture.

A
  1. Loss in continuity of the inferior mandibular border
  2. Step deformity in occlusion
  3. Radiolucent line
26
Q

List the classifications of maxillofacial fractures. (4)

A
  1. Nasoethmoidal fractures
  2. Lateral middle third (zygoma)
  3. Central middle third
  4. Mandibular fractures
27
Q

List the classifications of central middle 1/3rd facial fractures. (5)

A
  • Nasal bone
  • Unilateral maxillary fracture
  • Le fort 1 fracture
  • Le frot 2 fracture
  • Le fort 3 fracture
    Various combinations
28
Q

Which structures can be damaged after an anterior wall orbital naso-ethmoidal injury? (3)

A
  • Eyelids
  • Cornea
  • Sclera
29
Q

Which structures can be damaged after a medial wall orbital naso-ethmoidal injury? (6)

A
  • Medical rectus muscles (action affected)
  • Nose
  • Lacriminal duct and sac
  • Medial canthal ligament
  • Ethmoid sinus
  • Cribriform plate
30
Q

Which structures can be damaged after a superior orbital fissure orbital naso-ethmoidal injury? (5)

A
  • Oculomotor nerve: function = supply all muscles of the eye
    (except lateral rectus and superior oblique)
  • Trochlear nerve (4)
  • Abducent nerve (6)
  • Branches of the Ophthalmic nerve
  • Ophthalmic veins
31
Q

Which structures can be damaged after an inferior orbital fissure orbital naso-ethmoidal injury? (3)

A
  • Infraorbital nerve
    supplies = lateral side of nose, cheek, skin underneath the eye (3 branches from the foramen)
  • Infraorbital vein
  • Infraorbital artery
32
Q

What does the infraorbital nerve supply? (4)

A

lateral side of nose
cheek
skin below eye
top lio

33
Q

What are the signs and symptoms of a zygomatico-orbital fracture? (8)

A
  • Numbness (below the eye)
  • Facial asymmetry
  • Pain
  • Bruising
  • Swelling
  • Flatness of the face
  • Difficulty/paralysis of the eye
  • Restricted eye movement and diplopia (double vision)
34
Q

Why does the patient complain of not being able to move the eye after a ZO fracture?

A

damage to the oculomotor nerve which supplies mostly all of the muscles of the eye

= superior orbital fissure syndrome/damage

35
Q

Why does the patient complain of double vision after a ZO fracture?

A

from entrapment of the recti muscle

36
Q

How do we examine the bones of the maxillofacial region after trauma? (3)

A

Palpate the;
- superior orbital ridge

  • infrorbital ridge & prominence of the zygoma
    (does the cheekbone appear flat?)
  • intra-oral palpation to assess for maxillary mobility
37
Q

How do we examine the muscles and nerves of the eye after maxillofacial trauma?

A

Movements of eyes;
- Centre
- Upwards to the right, centre, left
- Downwards to the right, centre, left

38
Q

How do we examine the soft tissues after maxillofacial trauma? (3)

A

Assess for Subconjunctival haemorrhage

Circum/periorbital ecchymosis (bruising)

Subcutaneous emphysema

39
Q

What other signs do we look for after maxillofacial trauma? (2)

Explain why these can present.

A

Epistaxis = Bleeding from the nose: bleeding in maxillary sinus, maxillary sinus connected to nose via middle meatus

Limited mouth opening: damage to the zygoma interferes with the coronoid process

40
Q

Describe two ways in which ZO complex fractures can present radiographically.

A

radiopaque sinus

reduced length of zygoma

41
Q

Whats involved in the inital stage of ZO fracture treatment? (3)

A
  • Exclude ocular injury
  • Prophylactic AB’s
  • Avoid nose blowing
42
Q

When do we review a patient with a ZO complex fracture?
What is carried out at this visit? (2)

A

Review once swelling subsided

  • Further radiographs (+/- CT)
  • Informed consent
43
Q

What are the definitve tx options for a ZO complex fracture?

A
  • Closed reduction +/- fixation
  • Open reduction + internal fixation
  • Most corrections have ORIF

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