ORAL SURG midface fractures

Question 1

what is the terminology for midface fractures?

Answer 1

middle 1/3rd
Le Fort type(s)
Panfacial
Complex
Major Facial Trauma

Question 2

what are the potentially serious outcomes and associations with midthird fractures?

Answer 2

airway
haemorrhage
head injury
orbital/ eye injury
other trauma

Question 3

define the superior anatomy of the mid third facial skeleton?

Answer 3

frontozygomatic
frontonasal
frontomaxillary

Question 4

define the inferior anatomy of the mid third facial skeleton?

Answer 4

occlusal plane upper teeth
alveolar ridge

Question 5

define the posterior anatomy of the mid third facial skeleton?

Answer 5

pterygoid plates sphenoid

Question 6

how is stability gained in the mid third facial skeleton?

Answer 6

paired buttressing system:
- vertical
- horizontal
- sagittal

Question 7

how does the mid third facial skeleton protect the brain?

Answer 7

mid face collapse so energy absorption

Question 8

what are the horizontal buttresses of the mid third face?

Answer 8

superior orbital rim
inferior orbital rim
maxillary alveolus
palate
serrated edges greater wings of sphenoid
zygomatic arches

Question 9

what are the vertical buttresses of the mid third face?

Answer 9

nasomaxillary
zygomaticomaxillary
pterygomaxillary

Question 10

what is the primary role of the vertical buttresses of the mid third face?

Answer 10

transmit masticatory forces to the skull base

Question 11

what are the sagittal buttresses of the mid third face?

Answer 11

zygomatic arches
palate
floor of orbit

Question 12

what are the weakest bones of the face?

Answer 12

nasal bones
zygomatic arch
maxillae

Question 13

what are results of trauma to the mid third facial skeleton?

Answer 13

anterior open bite
facial lengthening
soft palate obstruct airway (extreme)
nares blood clot conscious
coincident head injury
dish face deformity (severe)

Question 14

describe La Fort fracture I?

Answer 14

‘floating palate’
horizontal maxillary fracture, separating teeth from upper face
fracture line passes through alveolar ridge, lateral nose and inferior wall of maxillary sinus

Question 15

describe a La Fort fracture II?

Answer 15

‘floating maxilla’
pyramidal fracture with teeth at the base of the pyramid, and nasofrontal suture at the apex
fracture passes through posterior alveolar ridge, lateral walls of maxillary sinus, inferior orbital rim and nasal bones

Question 16

describe a La Fort fracture III?

Answer 16

‘floating face’
craniofacial disjunction
transverse fracture passes through nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch

Question 17

what is the initial management of midface fractures?

Answer 17

airway
haemorrhage
head injury

Question 18

how may an airway be affected following midface fracture?

Answer 18

anatomy changes
swelling
bleeding
foreign body

Question 19

how may a haemorrhage come about following mid third face fracture?

Answer 19

maxillary artery rupture
nasal wall bleed
retrobulbar haemorrhage
septal haematoma

Question 20

how can a haemorrhage of the mid third face be managed?

Answer 20

nasal packing/ tamponade

Question 21

how is head injury assessed?

Answer 21

Glasgow coma scale

Question 22

explain the glasgow coma scale?

Answer 22

measurement of head injury using 3 parameters: eye opening, verbal response, motor response

3 being the worst
15 being the best

motor response is the predominant factor

Question 23

what is the secondary survey of mid third fracture?

Answer 23

assessing the head and neck extra and intra orally

Question 24

in the extraoral assessment following a midthird fracture, where do you palpate?

Answer 24

frontal bones
supraorbital rims
frontonasal suture
lateral orbital rims
zygoma
zygomatic arch

Question 25

what do you assess head and neck for extraorally following mid third fracture?

Answer 25

asymmetry laceration ecchymosis discharge nose/ ears systematic/ bilateral palpation of bones

Question 26

what do you assess head and neck for intraorally following mid third fracture?

Answer 26

max incisal opening maxillary vestibule zygomaticomaxillary buttress palate occlusal steps malocclusions mobility of maxillary

Question 27

what is the presentation and clinical findings of a le fort I fracture?

Answer 27

mobility of tooth-bearing segment of the upper jaw crepitus in buccal sulcus 'cracked-pot' percussion note from upper teeth (dull) intra-oral haematoma in buccal sulcus fractured teeth cusps bruising of the upper lip and lower mid-face occlusal discrepancy anterior open bite tendency dentures not fitting

Question 28

what are the presentations and clinical findings of le fort II/III fractures?

Answer 28

bilateral peri-orbital bruising subconjunctival haemorrhage lengthening of face malocclusion gross oedema of face nasal deformity CSF rhinorrhoea diplopia and other visual problems mobility of upper jaw palatal haematoma concurrent mandibular fractures nasal septal haematoma palatal split

Question 29

what are the mandatory fracture lines which must be present in order to diagnose le fort I fractures?

Answer 29

lateral piriform aperture

Question 30

what are the mandatory fracture lines which must be present in order to diagnose le fort II fractures?

Answer 30

Inferior orbital rim and zygomatic buttress

Question 31

what are the mandatory fracture lines which must be present in order to diagnose le fort III fractures?

Answer 31

lateral orbital wall and zygomatic arch

Question 32

what are the mandatory fracture lines which must be present in order to diagnose all le fort fractures?

Answer 32

pterygoid plates

Question 33

what are the aims of management of mid third facial fractures?

Answer 33

restoration of normal function (ocular, nasal, oral, dental) and aesthetics

Question 34

what is the technique of management of mid third facial fractures?

Answer 34

ORIF *reduction may be open or closed however

Question 35

when reconstructing the face where do you start?

Answer 35

with the most reliable structures with the least comminution

Question 36

what instrument is used for reduction and disimpaction?

Answer 36

rowes disimpaction forceps

Question 37

how are rowes forceps used?

Answer 37

introduced into the nose and palate - provides leverage to fracture in order to manipulate the lower face

Question 38

what buttresses are generally fixated in le fort fracture I?

Answer 38

nasomaxillary zygomaticomaxillary

Question 39

what buttresses are generally fixated in le fort fracture II?

Answer 39

infra orbital naso frontal zygomaticomaxillary

Question 40

what buttresses are generally fixated in le fort fracture III?

Answer 40

frontozygomatic naso frontal zygomatic arches

Question 41

what types of incisions are cut for midface access?

Answer 41

bicoronal flap intra oral vestibular zygomatic/ orbital direct lacerations

Question 42

symptoms of a le fort I #?

Answer 42

bilateral bruising of buccal sulcus disturbed occlusion

Question 43

symptoms of le fort II and III#?

Answer 43

gross oedema of soft tissues bilateral black eyes subconjunctival haemorrhage mobile mid face extensive bruising of soft palate

Question 44

what is a unique symptom of le fort II #?

Answer 44

infra-orbital nerve paraesthesia step deformity in orbital rim

Question 44

what are symptoms of le fort III#?

Answer 44

tenderness and separation of the frontozygomatic suture deformity of zygomatic arches mobility of entire facial skeleton