Question 2 Flashcards
(12 cards)
zygomatico-orbital fractures
- signs and symptoms
▪ Numbness – damage to infraorbital nerve (skin lateral to nose, cheek
and under eye)
▪ Facial asymmetry
▪ Pain, bruising, swelling – subconjunctival haemorrhage, peri-orbital
ecchymosis
▪ Eye paralysis or restricted movement – damage to CN III, IV or VI.
Entrapment may result in diplopia/double vision
▪ Limited mouth opening – displacement of fractured zygoma imposing
on coronoid process
▪ Epistaxis (nose bleed) – bleeding inside maxillary sinus builds up and
runs out middle meatus in nose. Sinus may appear radiopaque on x-
ray
▪ Step deformity of bones – temporal bone to zygomatic bone
(zygomatic arch)
zygomatico-orbital fractures
- E/O exam
▪ Gentle bilateral palpation of supra- and infraorbital ridges, zygomatic
bone/arch and maxilla
▪ Examine for epistaxis
▪ Check range of mandibular opening – may be limited
▪ Examine eyes – check eye and surrounding area for bleeding or
bruising, check range of movements to 9 segments, check vision and
for double vision
▪ Examine sensation to infra-orbital region – lateral inferior of nose,
lower eyelid, cheek and upper lip
zygomatico-orbital fractures
I/O exam
▪ Tenderness of zygomatic buttress
▪ Check for bleeding, bruising, swelling
▪ Check for occlusal derangement
▪ Check for anaesthesia/paraesthesia of teeth in upper quadrant
zygomatico-orbital fractures
- special investigations
Occipito-mental view, CBCT or CT – check for fracture lines and
radiopacity of maxillary sinus
zygomatico-orbital fractures
- management
▪ Urgent referral to OMFS
▪ Advise to avoid nose blowing and consider prophylactic antibiotics
▪ Surgical management – Open reduction, internal fixation (ORIF)
Mandibular fractures:
o Signs and symptoms
▪ Pain, swelling and limited function – unable to bite properly
▪ Occlusal derangement – step deformity
▪ Numbness of lower lip
▪ Loose or mobile teeth
▪ Bleeding – teeth, ear, FoM
▪ Anterior open bite – bilateral subcondylar fracture
▪ Facial asymmetry
▪ Deviation of mandible to opposite side
Mandibular fractures:
o E/O exam
▪ Pain, bleeding, bruising, swelling
▪ Facial asymmetry
▪ Palpation of mandible bilaterally
▪ Limitation of mandibular opening
▪ Mandibular deviation on opening
▪ Sensation to lower lip and chin – mental nerve
Mandibular fractures:
o I/O exam
▪ Bleeding, bruising, swelling
▪ Occlusal derangement and step deformities
▪ Mobile or broken teeth
▪ Anaesthesia/paraesthesia of teeth in quadrant
▪ Anterior open bite
Mandibular fractures:
o Special investigation
▪ Two radiographs at right angles – OPT and PA mandible
▪ CBCT, occlusal, lateral oblique
● 3 radiographic features
o Step deformity of occlusion
o Radiolucent fracture line
o Loss of continuity of inferior border
Mandibular fractures:
o Classification
▪ Involvement of surrounding tissues – simple, compound or comminuted
▪ No. of fractures – single, double or multiple
▪ Side of fracture – unilateral (right or left) or bilateral
▪ Site of fracture – angle, subcondylar, parasymphyseal, body, ramus,
coronoid, condylar, alveolar process
▪ Direction of fracture line – favourable or unfavourable
▪ Displacement of fracture- displaced or undisplaced
▪ Specific fractures – greenstick (children with soft bendy bone), pathological
(osteoporosis, cysts, tumours…)
Mandibular fractures:
o Factors influencing displacement
▪ Direction of fracture line
▪ Opposing occlusion
▪ Magnitude of force
▪ Mechanism of injury
Mandibular fractures:
o Management
▪ Urgent referral to OMFS
▪ Control of pain and infection – antibiotics if compound
▪ Undisplaced fracture – no treatment
▪ Displaced fracture - ORIF
