Fractures of the Middle Third of the Face
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Transcript of Fractures of the Middle Third of the Face
04/20/23 Professor Sameer Bafaqeeh 1
Fractures of the Middle Thirdof the Face
Fractures of the Middle Thirdof the Face
Maxillary Fracture
Can compromise the airway Commonly transverse Direct trauma to the face
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Le Fort Fractures SystemLe Fort Fractures System
• Le Fort 1: The upper alveolus is detached
• Le Fort 2: the entire upper jaw is detached
• Le Fort 3: the F.S. is separated from the S.B.
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Fractures of the Middle Thirdof the Face
• High-speed injuries (Motor vehicle accidents)• Seatbelt Laws
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Fractures of the Middle Thirdof the Face• Careful history &examination• Palpation around the facial
structures• Jaw movements &mobility• Eye & eye movements
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Types of Central Middle Third Fracture(Le Fort Classes I )
Types of Central Middle Third Fracture(Le Fort Classes I )
Maxillary FractureClinical presentation*Le Fort Class I – Low max. horizontal fractures – # the upper alveolus – Abnormal occlusion – Hematoma or fracture of the antral wall
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Types of Central Middle Third Fracture(Le Fort Classes II )
Types of Central Middle Third Fracture(Le Fort Classes II )
Maxillary FractureClinical presentation*Le Fort Class II – Pyramid fractures – # the upper jaw – The fracture passes – Dislocation and depression – Ethmoids, orbital, lacrimal involvement – Hypertelorism
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Types of Central Middle Third Fracture(Le Fort Classes III )
Types of Central Middle Third Fracture(Le Fort Classes III )
*Le Fort Class III – F. Sk. and SB are separated – The fracture line: zygomaticofrontal, maxillofrontal, and nasofrontal sutures – All the structures of the central part of the facial skeleton are involved – Massive depression of the middle third of the face – Multiple fractures of the bones (dish face) – Typical symptoms (shock, concussion, cerebral contusion)
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PathogenesisCentral Middle-third Fractures
# High-speed injuries
• Traffic accidents
• Occupational injuries
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Trauma of the Middle Third of the FaceDiagnosis
* History: Type, direction and force
* Inspection: – Skeletal (fracture, dislocations,depression) – Symmetry of middle and frontal areas – The nose – The orbit (hematoma, movement, & vision)
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Trauma of the Middle Third of the FaceDiagnosis (cont.)
Trauma of the Middle Third of the FaceDiagnosis (cont.)
* Palpation: Tenderness, upper jaw, facial contour, bony skeleton, orbital rim, trismus, nose root, mandible, occlusion, teeth.
* Sensory or motor innervation
* CSF Rhinorrhea* Brain tissue
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Trauma of the Middle Third of the FaceDiagnosis (cont.)
* Radiography: – Skull radiography (Radiopaque F.B.) – Angiography – C.T. scan – Olfactometry* Maxillofacial surgeon, an ophthalmologist a neurologist, a neurosurgeon, general and orthopedic surgeon are consulted.
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NOTE:
Rapid soft tissue swelling. Bloody effusion.
Soft tissue injuries.
Skeletal assymetryor deformity
Life-threateningskeletal injuries
concealed
concealed
}
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Treatment ofMiddle Third Injuries
Traumatologic ABC
A = Airway (the airway is secured and aspiration is prevented)
B = Bleeding (must be controlled)
C = Circulation (shock must be treated)
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Fracture Middle 1/3 Face
• Hospitalization: Traumatologic center
• Admission: Extent and type of the skull, thorax, abdomen & extremities
• Patient head injury: Special traumatologic teams
(A neurosurgeon, a rhinosurgeon, a maxillo- facial surgeon and an ophthalmic surgeon)
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Definitive Surgery ofMiddle Third Fractures
• Reconstitution (anatomy and function) - Debridement - Ventilation - Drainage• Rhinologic surgeon: I - Soft tissue injury, nose and sinuses II - Assessment of the base skull III- Correction of the F.Sk. and the B.O.• D.S. should be carried out quickly
Fracture Formationof callus
Rapidly heal in wrong position
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Fractures of the MandibleFractures of the Mandible
• Maintain the airway• Stop hemorrhage• Intracranial or other injury• Mouth deformity& malocclusion • Inferior dental nerve• Orthopantamogram [OPG]
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Mandible Fractures TreatmentMandible Fractures Treatment
• Undisplaced fractures: Analgesia & antibiotics .A simple fracture: Intermaxillary
fixation [eyelet wiring] .An irreducible fracture: Open reduction&fixation Wires or an AO Plate.
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Key Points:Key Points:
• 1.In orbital trauma, check the eye movements, palpate the bony orbital rim, and record visual acuity.
• 2.In patients with facial injury, always check the full range of jaw mov. &determine whether or not the upper jaw is mobile. fractures of the cheek bone [ zygoma ] are often overlooked.
• 3.Wear eye protection while playing racquet sports.
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Isolated Blowout Fracture Isolated Blowout Fracture
– Localized violence --> Orbital contents
– A blow (a fist, a tennis ball, a sq. ball,
a champagn bottle cork, etc )
– Fractures of the orbital bony floor
– Trapping of the orbital contents
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Blowout Fracture SymptomsBlowout Fracture Symptoms
– Enophthalmos
– Double vision
– Limitation of eye movement
– Infraorbital nerve sensation disorders
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Blowout FractureDiagnosis
Blowout FractureDiagnosis
• Radiographs “tear drop”
• Tomograms
• Ophthalmologic examination
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Blowout FractureTreatment
Blowout FractureTreatment
• The antral cavity must be explored: - The bony fragments are exposed - The prolapsed part is replaced - Bridging or stabilization (Lyophilized dura, cartilage or plastic prop)
• Alternative or supplementary measures: - Orbital access - Lyophilized dura, silicone sheet, or teflon - Autologous implant to correct enophthalmos
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Nasal trauma in ChildhoodNasal trauma in Childhood
• Child’s nose - less promineent
-more cartilaginous.Nonaccidental injury -[grotesque].# growth centers N.deformity.Surgical correction :conservative delay.Cart. : repositioned not resected
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Mucosal injuries of the MOUTH & Pharynx [ F.B. &
Trauma ]
• Good healing properties
• Mucosal suture in extensive injuries
• Antibiotic cover
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Penetrating soft tissue injuries of the Mouth and Pharynx
Penetrating soft tissue injuries of the Mouth and Pharynx
• Bullet, stab, and traffic accidents wounds.
• Mouth and Pharynx must be assessed with related soft and bony tissues
• Structures shoud be debrided, repositioned, fixed, and sutured in layers
• Antibiotic • Surgical emphysema
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Impalement injuries of the Palate and posterior
Pharyngeal wall• Children falling on pointed objects.• Expert examination• Suture of the wound
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Tongue Bites Heal spontaneously Penetrating bite require
suture Completely divided
tongue reimplanted :
-the time of reconstruction
-the condition of the wound
-the blood supply
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Insect Bites
• Swallowing a living insect [bees, etc.] .
• Edema of the pharynx respiratory obstruction
• I.V. high-dose steroids• Ice packs • Calcium &
tracheotomy