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DEN4SKE > Oral surgery - Trauma > Flashcards

Oral surgery - Trauma Flashcards

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1
Q

List the 7 bones of the orbit

A

Maxillary, Facial, Zygomatic, Ethmoid, Lacrimal, Sphenoid, Palatal

Many Friendly Zebras Enjoy Lazy Summer Picnis

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2
Q

What makes up the upper facial skeleton?

A

Frontal bone and orbital cavity

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3
Q

What are 3 potential consequences of fracture of the facial skeleton on the brain?

A

Direct brain injury
secondary injury due to bleeding at fracture site
tear of dura

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4
Q

What structures travel through the Optic canal?

A

optic nerve
opthalmic artery

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5
Q

What structures travel through the superior orbital fissure?

A

CNIV, CNIII, CNVI
superior opthalmic vein

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6
Q

What structures travel through the inferior orbital fissure?

A

Zygomatic br of CNV2
Inferior Opthalmic artery

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7
Q

Why does fracture of mid-facial skeleton affect cranial base? What is the sequelae of this in the case of a mid-face fracture?

A

Mid facial skeleton articulates with the cranial base
Fracture may cause displacement of cranial base
Signs: Anterior open bite cuasing premature occlusion of posterior teeth
Soft palate pushed down to occlude airway

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8
Q

What is a life threatening sequelae of a mandibular fracture?

A

Bleeding at FoM causing elevation of tongue and airway occlusion
May cause injury to the cervical spine

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9
Q

List the areas of high impact in the facial skeleton

A

supraorbital rim
symphysis of mandible
Glabella - frontal
angle of mandible

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10
Q

List the areas of low impact in the facial skeleton

A

Zygoma
nasal bone

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11
Q

What 4 conditions necessitate emergency medical care after a facial fracture?

A
  1. Airway involvement
  2. Massive haemorrhage
  3. cervical spine innjury
  4. orbital fracture with inferior rectis muscle entrapment
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12
Q

By which mechanism can mass haemorrhage occur with facial fracture

A

A maxillary fracture that involves the pterygoid plexus or internal maxillary artery

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13
Q

After checking airways/haemorrhage, what is the next area to check?

A

Peri-orbital

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14
Q

What does the peri-orbital exam involve?

A

Visual acuity
Pupils - size, reaction
Lacterations
Occular muscle movement (CN III,IV,VI)
Orbital palpation - step off, sensation

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15
Q

If the patient has a penetration of the globe what should you do?

A

Refer to opthalmologist

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16
Q

What is CSF Rhiborrhea?

A

Cervical Spinal Fluid leakage from nose

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17
Q

What is CSF Rhinorrhea a sign of?

A

skull base fracture

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18
Q

What are the 3 signs of scull base fracture?

A

Battle’s sign
Racoon Eyes
CSF Rhinorrhea

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19
Q

What is Battle’s sign?

A

ecchymosis behind ears

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20
Q

What are racoon eyes?

A

Bilateral periorbital ecchymosis

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21
Q

Deviation of the mandible on opening is a sign of what?

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A

Condylar fracture

22
Q

What are the 3 most common facial bones to fracture?

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A

Mandible
Zygomatic
Orbital floor

23
Q

Which parts of the orbital wall most commonly fracture and why?

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A

Floor or medial wall
Thin bone

24
Q

What is the hydrolytic theory?

Study These Flashcards
A

A sudden blow to the orbit will result in sudden expansion within the orbit causing increased pressure, which may cause fracture of orbit.

AKA blow-out fracture

25
What are the symptoms of an orbital wall fracture?
Enopthalmus Anaestehsia of infra-orbital area Diplopia Infra-orbital step off subcutaneous emphysema decreased visual acuity
26
What is enopthalmus?
orbital content herniates into maxillary sinus causing one eye to appear sunken
27
What is diplopia?
Double vision when patient looks up caused by herniation of inferior rectis muscle into fracture
28
What is the management for orbital floor fracture?
Immediate surgery if inferior rectus muscle entrapment or retrobulbal haemorrhage OMFD + Opthalmologist referral nasal decongestants (avoid blowing nose) CT scan
29
Retro-bulbal haemorrhage is a risk of what surgery?
orbital floor surgery
30
Symptoms of retro-bulbal haemorrhage
Proptosis (bulging) loss of vision severe pain non-reactive pupil muscle palsy blindness
31
Describe LeFort I fracture
horizontal fracture invovling low level maxilla, and pterygoid plate Causes separation of maxilla from mid-face at the base of the nasal cavity
32
Describe LeFort II fracture
pyrimidal fracture from pterygoid plate, high level maxilla, low level zygomatic bone, infra-orbital foramen
33
Describe LeFort III fracture
fracture causing craniofacial dislocation from cranial base zygomatic frontal suture involved orbital floor ethmoid sinus and bone
34
How to you differentiate between LeFort fractures on a CT scan?
I - anterolateral margin of nasal fossa fractured II - inferior orbital rim fractured III- zygomatic arch fractured
35
Repair of a LeFort I fracture involves incision where?
Buccal vestibule
36
What is used to reduce a LeFort fracture?
miniplates and screws
37
What are the two types of zygomatic fractures?
Tripod fracture - fractures from 3 suture points Arch fracture - limited to zygomatic arch
38
what does ORIF stand for?
Open reduction and internal fixation
39
Which 4 bones does the zygomatic bone articulate with?
superior : frontal Medial: maxillary Posterior: temporal Lateral: sphenoid
40
Which bony structure will a zygomatic fracture commonly involve?
orbital floor zygomatic bone forms part of orbital floor
41
What important structure do you need to check in a zygomatic fracture?
orbit check for orbital floor fracture
42
# 7 What are the signs of a zygomatic fracture?
asymmetry depression of zygomatic prominence step-off paraesthesia ecchymosis subconjunctival haemorrhage decreased range of mtoion of mandbile (if impinging on coronoid process)
43
What is a common surgical technique for management of a simple zygomatic fracture?
Gilies incision at hairline pass instrument along temporal facial to zygomatic bone elevate fracture portion of zygomatic bone
44
What are the signs of a mandibular fracture?
Malocclusion Intra-oral lacerations sublingual ecchymosis nerve injury
45
Why do mandibular fractures often present as multiple fractures, not just one?
U shape of mandible = force transmitted to contralateral side of initial site of impact
46
What are the 8 classification of mandibular fractures?
Dentoalveolar condylar coronoid ramus angle body parasymphysis symphysis
47
Which 3 areas of the mandible are most commonly fractured?
body angle condyle
48
If a mandibular fracture is open, what do you need to do?
prescribe antibiotics
49
What is IMF
inter-maxillary fixation
50
In which cases is IMF still used?
comminuted fractures condylar fractures (surgery impossible here)

DEN4SKE (8 decks)

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