Term
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Definition
• Skull and face make up the most complex area of skeletal estate of our body
• Important to know normal anatomy and fracture patterns
• Although facial fractures represent serious injuries therapy often delayed until more pressing problems resolved: airway, hemodynamic stabilization and eval. of head/chest and abdomen |
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Term
| Primary Survey of Trauma Patients |
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Definition
• A-Airway maintenance with cervical spine protection
• B-Breathing with ventilation
• C-Circulation with hemorrhage control
• D-Disability: neurological status
• E-Exposure; completely undress pt., but prevent hypothermia |
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Term
| Secondary Survey of Trauma Patients |
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Definition
• It starts after PRIMARY survey completed, resuscitation efforts are well established, and patient is in stable condition.
• Complete history, including mechanism of injury High velocity vs Low, preexisting medical condition, current meds., allergies, last time patient ate.
• Complete exam, including Glasgow Coma Scale
• Images obtained, basic labs and urinalysis
• Head and spinal injuries need cervical spine clearance
• Assessment of blunt or penetrating trauma
• MAXILLOFACIAL TRAUMA not associated with airway obstruction or major bleeding is treated after pt. is stabilized and life- threatening injuries have been managed. |
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Term
| Epidemiology of Facial Trauma |
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Definition
• Males:Females is 4:1
• Young males in the 20-30s
• Causes - MVA- Fights- Falls, elderly
• Most common: nasal bone, tripod fx, LeFort and blow out fx of the orbit |
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Term
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Definition
• Horizontal and vertical buttresses
• Vertical-nasomaxillary, ZYGOMATICOMAXILLARY, pterygomaxillary and mandible condyle/ramus
• Horizontal-Frontal bar, inferior orbital rim, zygomatic processes of temp. bone, palate and mandible body/symphysis |
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Term
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Definition
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Term
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Definition
• The cornerstone of the buttress system.
• Provides the aesthetically important malar
prominence.
• Vertical arch defines the course of the zygomaticomaxillary buttress
• Horizontal arch runs from the lacrimal fossa around the zygoma to the zygomatic process of the temporal bone |
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Term
| Management of Facial Fractures |
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Definition
• Considered contaminated and Abx as PCN, Cephalosporins or Clindamycin
• Timing of surgery based on severity and complexity, but generally early intervention
• Airway, general trauma management, secure airway before swelling !!! |
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Term
| Physical Exam for facial fructures |
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Definition
• Accurate history, mechanism of injury, energy and direction of impact
• INSPECTION :edema, laceration, ecchymosis, hematomas, asymmetry
• manual PALPATION: steps, stability, para- anaesthesia, malocclusion, crepitation.
• Proceed in orderly fashion: top to bottom and medial to lateral
• Systematic bimanual exam-premaxilla should be grasped for midfacial stability
• Complete neurological exam, level of consciousness and cranial nerves, CN V. and CN VII.
• Opthalmological exam, optic nerve injury?, visual acuity, diplopia, EOM, pupillary reflexes
• Ear canal exam, hematotympanon, anterior rhinoscopy, CSF rhinorrhea |
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Term
| physical exam for facial fractures, soft tissue |
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Definition
• Swelling
• Ecchymosis
• Lacerations
• Crepitus
• Globe Position |
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Term
| physical exam for facial fractures, skeleton |
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Definition
• Forehead/Calvarium • Orbital Rims
• Malar Eminence
• Zygomatic Arch
• TMJ
• Midface
• Mandible |
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Term
| Physical Exam for facial fractures, nerves, eyes, teeth |
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Definition
• Nerves- CN 5,7
• Opthalmology exam-pupillary function, EOM, hyphema( pooling of blood inside ant. chamber)- ?s, consult ophtalmo
• Dentition-occlusion, avulsed teeth, • consult max-facial |
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Term
| Hemorrhage in facial fractures |
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Definition
• Direct pressure
• Ant./Post packing-Foley
• Embolization by interventional radiology
• Surgical control by endoscopic sphenopalatine artery ligation and anterior ethmoid artery ligation if needed
• Avoid blind clamping in wounds |
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Term
| Radiological Studies for facial fracxtures |
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Definition
• CT axial and coronal, if impossible have axial and reformatted coronal, 3D reconstruction for planning the surgery
• Panorex for mandible fracture, but CT is better to evaluate condylar head injury
• Orbital blow out fracture needs eval. with thin cuts CT(1mm), 2cmx1cm floor of orbit disruption will cause enophtalmus |
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Term
| types of facial fractures |
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Definition
• Frontal/sinus
• Naso-orbital-ethmoid • Orbital, blow-out
• ZMC
• Maxilla, LeForts
• Mandible
• Dentoalveolar |
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Term
| impact resistance of bones on face |
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Definition
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Term
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Definition
• Uncommon, high energy impact with blunt trauma-MVA, motorcycle accidents
• High incidence of intracranial injury
• Ant. Vs Posterior table fx
• CSF leak?
• Dural tears? |
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Term
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Definition
| anterior wall frontal sinus fracture |
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Term
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Definition
| posterior wall frontal sinus fracxture |
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Term
| Frontal Sinus Fracture details |
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Definition
• Contour deformity with ecchymosis
• V1 anaesthesia
• CSF rhinorrhea
• Orbital deformities
• Intracranial bleeding and post table fx, needs neurosurg. Consult
• Post table displaced fx needs repair to prevent mucocele formation, it will get trapped in the fx line |
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Term
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Definition
• Most commonly fractured
• Nondisplaced vs displaced-evaluate with imaging if needed
• Ask: history of previous fx, how does it look to you, do you have difficulty breathing
• Do not require CT scan, Xray if needed, deformity seen on exam |
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Term
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Definition
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Term
| Nasal Bone fracture steps |
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Definition
• Control epistaxis
• Exam intranasally for septal hematomas, mucosal injury
• Refer to ENT if any doubt |
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Term
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Definition
Naso-Orbital-Ethmoid fx
• Low force, direct blow to midface • MVA, usullay steering wheel
• CSF?
• Nasolacrimal duct injury-epiphora
• Crepitus from ethmoid fx
• Subconjunctival hemorrhage
• Epistaxis |
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Term
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Definition
• Blow in fx-Exopthalmus
• Blow out fx-Enopthalmus
• Periorbital ecchymosis, subconjuctival hemorrhage
• Diplopia and restriction with gazes if muscle entrapment
• Retrobulbar hematoma- needs CT |
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Term
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Definition
| orbital blow out fracture |
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Term
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Definition
• Zygomaticomaxillary complex fx is composed of ant-post-lat wall of maxilla,floor of orbit and zygomatic arch/body
• V2 para/anesthesia
• Antimongoloid slant as the body of zygoma moves down, asymmetry of zygomatic arch
• Diplopia? Trismus? |
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Term
| 4 types of tripod or ZMC fractures |
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Definition
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Term
| 3 types of le fort fractures |
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Definition
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Term
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Definition
horizontal maxillary fr. Above the level of maxillary dentition, separating the alveoli and teeth from the face above, via the septum, post, maxillary walls and pterygoid plates.
• Traverses the lateral antral and nasal wall, lower part of septum and pterygoid plates
-transvere |
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Term
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Definition
or pyramidal fr. Extends across the maxilla, infraorbital rim and floor, up to medial wall of orbit, across nasal root area
• Extends from nasofrontal suture, through nasal bones to the ZM suture. Includes the medial inf. Third of the orbit. Continues through the pterygoid plate |
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Term
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Definition
• It is a true craniofacial separation.
• Includes fr. of zygomatic arches and frontozygomatic areas, than crosses the lateral, inferior and medial orbits and completed across the nasal root. |
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Term
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Definition
Symphysis, body, angle, ramus, coronoid process and condyle and alveolus.
• Favorable or unfavorable depending on how the muscles are drawing the fragments toward each other or when fragments are distracted.
• Panorex is the best, but CT of facial bones usually done as well for eval of other facial bones |
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Term
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Definition
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Term
| Mandible Fractures Diagnosis |
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Definition
• Malocclusion
• Fragment mobility
• Trismus(40mm is normal)
• Open bite contralateral to side of fractured condyle
• Possible laceration of attached gingiva overlying fracture site |
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Term
| Surgical Management for mandible fractures |
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Definition
• Goal is to reestablish the proper occlusional, pretrauma relationship of the toothbearing maxillary surface and mandible.
• Stabilization of the midfacial buttress system.
• MMF and ORIF(open reduction and internal fixation), key is the occlusal plane. |
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Term
| Surgical Management of Facial Fractures |
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Definition
• Approaches to upper third is coronal incision(frontal and supraorbital rim)
• Middle third:Gillie’s incision, lateral lid or lateral brow incision for frontozygomatic area
• Orbital floor:transconjuctival through lower lid, or transcutaneous through lower lid
• Lower third;transcut. or transmucosally |
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Term
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Definition
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