Trauma Flashcards
(39 cards)
Why might someone with a fractured mandible present with an anterior open bite
The ramus has shouted due to bi-lateral subcondylar fracture the mandible
What clincal signs and symptoms might someone with a mandibular fracture present with?
Name 5
Pain, swelling and limitation of function
Occlusal derangement
Numbness of the lower lip
Loose of mobile teeth
Bleeding
Facial asymmetry
Deviation of mandible
Sublingual haematoma
What are the three classifications of a fracture with regards to the surrounding tissues
Simple - fracture in bone but the soft tissues are intact
Compound - soft tissues damaged/lacerated exposing the soft tissue
Comminuted ;bone broken into mutiple pieces
Any fracture involving the teeth bearing area is classified as what kind of fracture and why
This is a compound fracture as it is in direct communication with the PDL
Direction of the fracture line - relates to the displacement
What are the two kinds of fracture line
Favourable - in the direction that minimises displacement
Unfavourable - encourages displacement
What is a green stick fracture
This is a fracture that happens in children because of the organic content of the bone - the bones are soft so fracture may not cause complete separation
Name 6 factors which can cause displacement of mandibular fractures
- Direction of the fracture line ; favourable or unfavourable
- Opposing occlusion ; if they have a good opposing occlusion the displacement will be minimised as the opposing occlusion will act as a stop for displacing the mandible
- Magnitude of the force
- Mechanism of injury
- Intact soft tissues - displacement unlikely
- Other associated fractures
What two radiographs would you want to assess a mandibuar fracture
OPT
PA mandible
- postero anterior mandible radiograph
What kind of mandibular fracture is most likely to get infected and therefore requires antibiotics
Compound
What are the two basic principles of treatment of a mandibular fracture
Reduction ; put the fracture segments into the right anatomical alingment
Fixation ; fix in postion
What are the two treatment options for displaced or mobile fractures
- Closed reduction and fixation
- do not open the fracture ( i.e dont raise a flap), you depend on the patients occlusion to guide the reduction process - Open reduction and internal fixation
- expose the bony edges surgically and reduce them directly with vision and fix in place with screws
When doing closed reduction with fixation - the patients occlusion is used to guide reduction, what else is needed to do this
Inter-maxillary fixation
Teeth are wired together
What group of people is intermaxillary fixation contraindicated in
Epileptics - if they are sick they will die
If a patient is edentulous and closed fixation is being used what kind of split is used
A gunning splint - dentures are utilised
What treamtent option do majority of patients now have for displaced or mobile mandibular fractures
Open reduction and internal fixation
What is a possible complication of ORIF
Damage to IAN
While most children’s injury’s are innocent we need to be able to spot signs of non accidental injury in children. What are some signs of this ?
Injuries sustained that are non Consistent with the history provided by the parent
Delayed presentation
Apparent lack of concern or apparently over anxious parents
Clinical or radiographic evidence of multiple injuries - especially if of different ages
Withdrawn or frightened child
Name 5 disadvantages of Intermaxillary fixation
The airway is partially compromised and is at increased risk in the event of postoperative swelling, regurgitation or swelling
Patients are unable to take a solid diet
It is difficult to maintain good oral hygiene
Poor patient tolerance
Post treatment stiffness of the TMJ and risk of ankylosis
When may be open reduction with internal fixation be contraindicated
Significant comminution or infection
In children where unerupted teeth are still present in the jaws
What are the signs and symptoms of a maxillary fracture
Pain
Asymmetry
Diplopia
Altersed sensation
Mobility
Swelling
Nose bleed
What are the three le fort classifications
1 - tooth bearing area detached
2 - fracture involving nasal IO rims
3- whole maxilla detached from the base of the skill
What radiographs would you request for a maxillary fracture o
Occipitomeatal at 15 and 30 degrees
6 signs of zygomatic-orbital fracture
Numbness of cheek
Diplopia
Asymmetry
Subconjunctival haemorrhage
Flattening of zygoma
Pain on eye movement
Decreased visual activity
What are three treatment options for fractures
- Conservative management ; monitor and analgesia
2, open reduction and internal fixation - Closed reduction and intermaxillary fixation
