Trauma 2011-curs
-
Upload
james-molina -
Category
Documents
-
view
222 -
download
0
Transcript of Trauma 2011-curs
![Page 1: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/1.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 1/181
2010-2011
RADIOLOGIC AND IMAGISTIC DIAGNOSIS INMAXILLO-FACIAL TRAUMA
![Page 2: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/2.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 2/181
RADIOLOGIC EXAMINATION CONTRIBUTION
Diagnosis
Therapeutic planning
post-therapeutic evaluation of the treatmentaccuracy
Bone healing evaluation
The appearance of any complication
![Page 3: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/3.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 3/181
MAXILLOFACIAL FRACTURE DIAGNOSIS – WHAT NEEDS TO
BE NOTED THROUGH RADIOLOGIC EXAMINATION?
The presence of a fracture
Localization
The path of fracture lineDisplacements
The presence and size of the bone
fragments Fracture’s complications
![Page 4: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/4.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 4/181
EVALUATING MFT
CT –examination of choiceCBCT
1,04% from MFT are accompanied bycervical spine fractures
Brain damageCarotid arteries
![Page 5: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/5.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 5/181
METHODS OF IMAGISTIC EXAMINATION
CT
CBCT
Conventional radiology Waters skull radiography (semiaxial)
PA skull radiography(Caldwell view)
lateral skull radiography
![Page 6: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/6.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 6/181
![Page 7: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/7.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 7/181
![Page 8: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/8.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 8/181
![Page 9: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/9.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 9/181
CLASIFFICATION OF THE FACIAL FRACTURES
Dento-alveolar fractures
Mandibular fractures
Midface fracturesCentral midface fr.
Lateral midface fr.
Frontal fr.
Nasal fr.
![Page 10: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/10.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 10/181
1.
DENTO-ALVEOLAR FARCTURES
![Page 11: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/11.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 11/181
DENTAL FRACTURES
Crown fractures
Penetrating in pulp
chamber Non- penetrating
Root fractures
1/3 cervical – CRD?
1/3 medium – extraction?
1/3 apical - apical
rezection
![Page 12: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/12.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 12/181
DENTAL LUXATIONS
Total dental Avulsion – x-ray – aspect of recent post-
extractional socket
Partial Intrusion – narrowed periodontal space, tooth
under the occlusion level plane
Extrusion –enlarged periodontal space, toothover the occlusion level plane
![Page 13: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/13.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 13/181
SUBLUXATIONSDENTAL FRACTURES
![Page 14: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/14.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 14/181
DENTAL FRACTURES
![Page 15: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/15.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 15/181
TRAUMA
Root fractures
Subluxation 1.1
![Page 16: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/16.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 16/181
2.
MANDIBLE FRACTURES
![Page 17: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/17.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 17/181
MANDIBLE FRACTURES
70-80% from all cranio-facial fractures; 4:1: mand/max.
man> women, age 20-30
causes: agression, car accidents, work , sports acc.,
falling, iatrogenic Mechanism of apperance
directly
Indirectly
flexion
pressure(direct)
Compaction (indirect)
avulsion Share (ascending ram of mandible)
![Page 18: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/18.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 18/181
CLASIFFICATION
Totally
Partially
Alveolar crest fracture
Fracture of the base partof the mandible
By number unique
double
triple multiple or cominutive
![Page 19: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/19.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 19/181
By the site of the fracture symphyseal (menton and
paramenton)
horizontal ramus angle
Ascending ramus
condyle
Subcondylar (high, low)
Open/close (close: condyle,coronoid p., ascendingramus)
![Page 20: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/20.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 20/181
FRACTURES ON A PATHOLOGICAL
BONE
TUMORS
GIANT BONE CYSTS
OSTEITIS/OSTHEOMYELITIS
OSTEORADIONECROSIS
![Page 21: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/21.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 21/181
RADIOLOGIC EXAMINATION
Radiographs in at least 2 perpendicular
projectionsComparative radiographs
PA rgr. of the mandible
Unilateral rgr of the mandible
OPTOccluzal radiography
![Page 22: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/22.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 22/181
RADIOGRAPHY UNILATERAL OF
THE MANDIBLE
![Page 23: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/23.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 23/181
![Page 24: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/24.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 24/181
![Page 25: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/25.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 25/181
![Page 26: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/26.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 26/181
MANDIBLE FRACTURES
Fracture lineDirection
fragmentsdisplacements
![Page 27: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/27.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 27/181
SYMPHYSEAL FRACTURES
MEDIAN – fracture in lambda
PARAMEDIAN
Usually withoutdisplacement
Displacements vertically-
occlusal and basal shifts horizontal plane
displacements – mentalarch foreshortening
![Page 28: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/28.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 28/181
RADIOLOGIC EXAMINATION
Occlusal radiography
Submental radiography
Periapical radiography
Symphyseal fractures can be missed on
OPT
Unilateral of the mandible rgr.
![Page 29: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/29.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 29/181
Can be obscured on rgr PA and OPT
![Page 30: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/30.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 30/181
FRACTURES OF THE HORIZONTAL
PART
DISLOCATION FREQUENT AND LARGE
Deviation of the menton to
the side of the lesion,foreshortening of themandible arch
![Page 31: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/31.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 31/181
FRACTURES OF THE HORIZONTAL PART =
LATERAL FRACTURES
Radiologic exam :• rgr unilateral of the mandible
• skull PA rg.
• OPT• occlusal film rg.
• Retroalveolar rgr.
![Page 32: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/32.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 32/181
![Page 33: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/33.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 33/181
![Page 34: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/34.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 34/181
FRACTURES
AT GONION
Frequent
M3
Fragmentsdisplacements –
relationship with themasseter and the
internal pterigoidianmuscle insertion
![Page 35: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/35.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 35/181
GONION FRACTURES (ANGLE OF THE MANDIBLE)
Radiologic exam :• rgr unilatreal of the mandible
• skull PA rg.
• OPT• periapicals rg.
![Page 36: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/36.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 36/181
Dg. differential – air in the pharinx
!!!
![Page 37: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/37.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 37/181
![Page 38: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/38.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 38/181
![Page 39: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/39.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 39/181
FRACTURES AT THE VERTICAL
RAMUS
![Page 40: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/40.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 40/181
Radiographic projections:OPT
Unilateral of the mandible –radiography
Skull PA rgr
![Page 41: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/41.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 41/181
![Page 42: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/42.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 42/181
FRCACTURES OF THE CORONOID
PROCESS Directly/avulsion
Usually withoutdisplacement
Isolated or associated with ATZ fracture
![Page 43: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/43.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 43/181
MULTIPLE FRACTURES
Low Subcondylar+paramedian on theopposite side
cominutive
![Page 44: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/44.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 44/181
![Page 45: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/45.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 45/181
![Page 46: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/46.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 46/181
CONDYLAR FRACTURES -
CLASIFFICATION
![Page 47: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/47.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 47/181
LOW SUBCONDYLAR FRACTURES
OPT
skull PA
CT/CBCT
Radiologic projections
![Page 48: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/48.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 48/181
INTRA-ARTICULAR CONDYLAR FRACTURES
OPTComparative radiography of TMJ
CBCT – it is always recommended whenthere are clinical signs of condylar fractureseven tough the OPT or PA radiography arenot showing any fracture – RISK OF TMJ
POSTRAUMATIC ANKYLOSISCT – in the absence of CBCT
![Page 49: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/49.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 49/181
![Page 50: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/50.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 50/181
RADIOLOGICA EXAMINATION OF THE
TMJ – SCHULLER TRANSCRANIAL PROJECTION
Mouth opened Mouth closed
![Page 51: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/51.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 51/181
HIGH CONDYLAR FRACTURES
![Page 52: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/52.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 52/181
HIGH CONDYLAR FRACTURES
kids, falling on menton
DD
![Page 53: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/53.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 53/181
![Page 54: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/54.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 54/181
CONDYLAR FRACTURE AND TMJ ANKYLOSIS
![Page 55: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/55.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 55/181
![Page 56: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/56.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 56/181
CONDYLAR FRACTURE AND TMJ ANKYLOSIS
![Page 57: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/57.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 57/181
6. TMJ ANKYLOSIS– CBCT
![Page 58: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/58.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 58/181
![Page 59: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/59.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 59/181
![Page 60: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/60.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 60/181
![Page 61: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/61.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 61/181
MID- FACIAL FARCTURES
![Page 62: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/62.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 62/181
MID- FACIAL FARCTURES
! 1,04% from facial fractures areaccompanied with cervical column fractures
! Brain damage
! CA
CT IS THE EXAMINATION OF
CHOISE
![Page 63: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/63.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 63/181
MID- FACIAL FARCTURES
CT - axial + coronal sections aremandatory
- 3D CT - proves better the relationship between bone
fragments
Reduced value for the temporal bone fracture
Simulation of the bone fragments manipulation
On 3 D CT templates – one pour skeletalreconstructive prostheses
![Page 64: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/64.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 64/181
MRI only for inflammatory complications
Meninges lesions
![Page 65: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/65.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 65/181
![Page 66: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/66.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 66/181
NASAL FRACTURES
![Page 67: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/67.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 67/181
NASAL FRACTURES
METHODES OFINVESTIGATION
ConventionalradiologyLateral radiography
for the nasal bones
Skull radiography –lateral projection
CT (CBCT)
![Page 68: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/68.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 68/181
NASAL FRACTURES
METHODES OFINVESTIGATION
ConventionalradiologyLateral radiography
for the nasal bones
Skull radiography –lateral projection
CT (CBCT)
![Page 69: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/69.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 69/181
NASAL FRACTURES
•Side blow
•Vertical blow
Ist place (50% from MFT)
- Side blow > frontal blow
![Page 70: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/70.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 70/181
NASAL FRACTURES
Laterala blow
- displacementlaterally of the nasal
bone +/- fracture of the
nasal septum
Frontal (vertical)
blow
Fracture of both nasalbones + nasalseptum
![Page 71: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/71.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 71/181
![Page 72: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/72.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 72/181
CONVENTIONAL RADIOLOGY
Nasal bone rgr.
![Page 73: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/73.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 73/181
CT - AXIAL AND CORONAL SECTIONS
nasal bonergr
CT axialCTcoronal
![Page 74: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/74.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 74/181
CT – SECTIUNI AXIALE SI CORONALE
CT – fracture of the nasalbone with displacement
![Page 75: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/75.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 75/181
CT - RECONSTRUCTIONS 3D
3D CT
![Page 76: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/76.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 76/181
CBCT – 3D VOLUME
3D CBCT
![Page 77: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/77.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 77/181
CBCT – 3D VOLUME
3D CBCT with soft tissue
reconstruction
![Page 78: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/78.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 78/181
CBCT – AXIAL AND CORONAL SECTIONS
CBCT axial
![Page 79: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/79.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 79/181
MID FACIAL CENTRAL FRACTURES
![Page 80: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/80.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 80/181
MID-FACIAL CENTRAL FRACTURES
CALSIFFICATION
Mid facial central fractures
NASAL-ORBITARYFRACTURES Fractures of the bone
hard palate / IZOLATEDOF THE MAXILLA
LE FORT I LE FORT II LE FORT III
CONTRAFORTURI
MID FACIAL CENTRAL FRACTURES
![Page 81: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/81.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 81/181
MID FACIAL CENTRAL FRACTURES
Methds of investigation
Rgr skull- semiaxial Rgr skull – lateral
CT (CBCT)
MID FACIAL CENTRAL FRACTURES
![Page 82: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/82.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 82/181
MID FACIAL CENTRAL FRACTURES
Methods ofinvestigation
Rgr skull-semiaxial
Rgr skull – lateral
CT (CBCT)
MID FACIAL CENTRAL FRACTURES
![Page 83: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/83.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 83/181
MID FACIAL CENTRAL FRACTURES
Methods ofinvestigation
CT (CBCT)Sections axial and
coronal aremandatory
3D CT (CBCT – 3D)
![Page 84: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/84.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 84/181
MID FACIAL CENTRAL FRACTURES
CLASIFFICATION
Mid facial central fractures
NASAL-ORBITARYFRACTURES Fractures of the bone
hard palate / IZOLATEDOF THE MAXILLA
LE FORT I LE FORT II LE FORT III
CONTRAFORTURI
![Page 85: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/85.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 85/181
NAZAL ORBITAL FRACTURES
Mechanism : posterior movementof the nasal pyramid => bonesnasal, fractures,of the frontal
proces of the maxillary bone,lacrimal bone, ethmoid bone,nasal septum, frontal sinus wall.
Clinic:hyperthelorism,Lesions of the lacrimal
apparatus
! Optic canal
!FCA dura mater adherent firmly tothe periosteum => accumulation of airintracranial => intracranial infections
![Page 86: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/86.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 86/181
NASAL-ORBITAL FRACTURES
Nasal bone lateralradiography
DOES NOT
EVIDENTIATE THE
DISPLACEMENT
OF FRAGMENTS
Does not show
FCA
![Page 87: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/87.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 87/181
CT –axial section
Medial orbital wall-Nasal septum-Optic canal
-FCA
![Page 88: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/88.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 88/181
CBCT – section axial
CBCT hi h l ti
![Page 89: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/89.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 89/181
CBCT – high resolutionmultiplan reconstruction
-Sagital sections in the orbit
axis- l orbital floor
- Optic nerve canal
- FCA
-- coronal sections
- Orbital floor- Medial orbital wall
- FCA
NASAL ORBITAL FRACTURES
![Page 90: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/90.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 90/181
NASAL-ORBITAL FRACTURES
MRI Inflammatory complications
HemosinusMeningeal damages
![Page 91: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/91.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 91/181
MID-FACIAL CENTRAL FRCATURES
CONTRAFORTS
Mid facial central fractures
NASAL-ORBITARY
FRACTURES Fractures of the bone hard
palate / IZOLATED OF THEMAXILLA
LE FORT I LE FORT II LE FORT III
Classification:
![Page 92: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/92.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 92/181
2.
FRACTURES OF THE HARD PALATE
Classification:
Sagital
Lateral
transversal cominutive
CBCT /CT
- Axial sections- - topography of the
fracture
- - bone fragments
-Cross section:
- - dental socketsinvolvement
Through direct action of a thin
![Page 93: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/93.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 93/181
3. ISOLATED MAXILLARY FRACTURES
Through direct action of a thinobject → ant./ lat. Wall of the
maxilla
Location:• anterior/lateral wall of the
maxillary sinus • Alveolar bone fractures
Radiography- skull semiaxial
• Sinus opacification• Discontinuity of the infraorbitarl
rim
CT/CBCT
![Page 94: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/94.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 94/181
3. ISOLATED MAXILLARY FRACTURES
CT/CBCT
Axial sections
- anterior wall
- lateral wall- Hemosinus
-Coronal sections
- - orbital floor
-Cross section- - dental alveolar
bone
![Page 95: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/95.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 95/181
MID-FACIAL CENTRAL FRCATURES
CONTRAFORTS
Mid facial central fractures
NASAL-ORBITARY
FRACTURES Fractures of the bone hard
palate / IZOLATED OF THEMAXILLA
LE FORT I LE FORT II LE FORT III
![Page 96: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/96.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 96/181
FRACTURI LE FORT I
Impaction at the level of
superior lipDetach of thesuperior alveolarprocess,inferior part of the nasalseptum,
inferior wall of MS,inferior part of pterygoidprocesses
–posterior displacement
Clinic: MalocclusionMaxillary hemosinusDento-alveolar
fractures
Methods of investigation:
![Page 97: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/97.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 97/181
LE FORT I FRACTURES
Methods of investigation:- lateral skull radiography
- PA skull radiography
CT/CBCT
![Page 98: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/98.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 98/181
LE FORT I FRACTURES
CT/CBCT
- cross section
- Relationship with dentalroots
- Sinusal floor
- Hemosinus/sinusal content
- alveolar crest ant-post
-Coronal section –lateraldisplacement of the crest
- Axial sections – lessdiagnostically importance
CT/CBCT
![Page 99: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/99.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 99/181
LE FORT I FRACTURES
CT/CBCT
- - 3D – path and
displacements
![Page 100: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/100.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 100/181
MID-FACIAL CENTRAL FRCATURES
CONTRAFORTS
Mid facial central fractures
NASAL-ORBITARY
FRACTURES Fractures of the bone hard
palate / IZOLATED OF THEMAXILLA
LE FORT I LE FORT II LE FORT III
Detach of a pyramidal
![Page 101: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/101.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 101/181
LE FORT II FRACTURES
Detach of a pyramidalshape fragment of acentre –facial part
Zygomatic bone remainsattach at the skull
Clinic:.• Facial deformation ;
• malocclusion ,
• anesthesia/paresthesiainfraorbital nerve territory
Skull semiaxial radiographyWATERS
![Page 102: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/102.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 102/181
LE FORT II FRACTURES
Infraorbital rim
zygomatico-alveolar
apophysis Sinus content
temporo-zygomatic achintact
fronto-ziyomatic suture
intact
CT/CBCT
![Page 103: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/103.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 103/181
LE FORT II FRACTURES
CT/CBCT
Axial sections Nasal bones
anterior sinus wall lateral sinus wall
posterior sinus wall
Pterygopalatin plates
Sinus content
ATZ temporo-zygomaticach intact
fronto-zygomatic sutureintact
sagital and coronal sections
CT/CBCT
![Page 104: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/104.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 104/181
LE FORT II FRACTURES
CT/CBCT
sagital and coronal sections
Orbital floor – involved
only infra-orbital rim Maxilary sinus content
CT/CBCT
![Page 105: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/105.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 105/181
LE FORT II FRACTURES
CT/CBCT
3D CT
Path and displacement
Associated fractures
![Page 106: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/106.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 106/181
MID-FACIAL CENTRAL FRCATURES
CONTRAFORTS
Mid facial central fractures
NASAL-ORBITARY
FRACTURES Fractures of the bone hard
palate / IZOLATED OF THEMAXILLA
LE FORT I LE FORT II LE FORT III
![Page 107: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/107.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 107/181
LE FORT III FRACTURES
bilateral
cranio-facial Disjunction
+ ATZ (temporo-zygomatic ach) fractures
Clinical-facial deformity-hemorrhage-CRF fistula-lesions of lachrymal apparatus
-malocclusion-n. Infraorbital →interested in 69% of
the cases
On skull semiaxial
![Page 108: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/108.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 108/181
radiography Waters Infraorbital rim
ATZ temporo-zygomaticach
Le Fort III fractures
CT/CBCT
![Page 109: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/109.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 109/181
LE FORT III FRACTURES
Axial sections
Nasal bones
fronto-zygomatic suture ATZ –temporo-zygomatic ach
Infraorbital canal
-Coronal and sagital sections for
the orbiteOrbital floor, orbital contentdisplacement inside themaxillary sinus
CT/CBCT
![Page 110: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/110.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 110/181
LE FORT III FRACTURES
Axial sections
Nasal bones
fronto-zygomatic suture ATZ temporo-zygomatic ach
Infraorbital canal
-Coronal and sagital sections for
the orbiteOrbital floor, orbital contentdisplacement inside themaxillary sinus
3D CT/CBCT
![Page 111: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/111.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 111/181
FRACTURES path
Movement direction
![Page 112: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/112.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 112/181
LATERAL MID-FACIAL FRACTURES
LATERAL MID-FACIAL FRACTURES
![Page 113: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/113.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 113/181
LATERAL MID FACIAL FRACTURES
1. ZYGOMATIC2. ZYGOMATIC-MAXILLARY
3. ZIGOMATIC-MANDIBLE
4. ATZ (temporo-zygomatic arch)5. ORBITAL FLOOR –Blow Out, Blow in
ZYGOMATIC BONE FRACTURES
![Page 114: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/114.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 114/181
ZYGOMATIC BONE FRACTURES
II-nd place Tripod fracture, unilateral
Clinic - infraorbital nerve in94,2% cases
ocular lesions 16% cases 3D CT – movement and
rotation direction of thefragments
ZYGOMATIC BONE FRACTURES
![Page 115: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/115.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 115/181
ZYGOMATIC BONE FRACTURES
Skull semiaxialradiography -Waters fronto-zygomatic suture
Infraorbital rim
pterygo-maxillaryapophysis
ATZ
Sinus opacification displacement, rotation
![Page 116: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/116.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 116/181
CT/CBCT
![Page 117: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/117.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 117/181
ZYGOMATIC FRACTURES
Coronal and sagitalsections
Orbital floor – displacement
Malar bone fragmentdiplacement
![Page 118: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/118.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 118/181
CBCT – reconstruction for theorbital floor
![Page 119: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/119.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 119/181
ZYGOMATIC FRACTURES
3D CT – fractures path and malar
fragment displacement
LATERAL MID-FACIAL FRACTURES
![Page 120: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/120.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 120/181
LATERAL MID FACIAL FRACTURES
1. ZYGOMATIC2. ZYGOMATIC-MAXILLARY
3. ZIGOMATIC-MANDIBLE
4. ATZ (temporo-zygomatic arch)5. ORBITAL FLOOR –Blow Out, Blow in
LATERAL MID-FACIAL FRACTURES
ATZ (TEMPORO-ZYGOMATIC ARCH ) FRACTURES
![Page 121: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/121.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 121/181
- - mechanism
- TRISMUS
ATZ radiography
![Page 122: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/122.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 122/181
ISOLATED ATZ FRACTURES
![Page 123: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/123.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 123/181
Semiaxial radiographyWaters
CT- if there is alsomalar bone disjunction
LATERAL MID-FACIAL FRACTURES
![Page 124: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/124.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 124/181
1. ZYGOMATIC2. ZYGOMATIC-MAXILLARY
3. ZIGOMATIC-MANDIBLE
4. ATZ (temporo-zygomatic arch)5. ORBITAL FLOOR –Blow Out, Blow in
![Page 125: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/125.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 125/181
ORBITAL FLOOR FRACTURES
Mechanism for orbital floorfractures
Blow in –bone fragment
from orbital floor herniateinside the orbit.
Blow out =trauma produced bylarge dimension object
- force absorbed by the orbitalwalls and transmitted to orbital
floor- the eye is pushed posteriorly- usual the infraorbital rim is not
affectedCl.: -transitory diplopia is due toedema and hemorrhage
LATERAL MID-FACIAL FRACTURES
ORBITAL FRACTURES
![Page 126: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/126.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 126/181
ORBITAL FRACTURES
Clinic:
- Diplopia 41%
- Enoftalmia 12%
- Blindness 2%
- Imaging identifying orbitalcontent collapse
- Intra-orbital emphysema
CT/CBCT
![Page 127: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/127.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 127/181
ORBITAL FRACTURES
- Coronal sections
mandatory foridentifying orbitalcontent collapse
![Page 128: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/128.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 128/181
Coronal sections !!!
![Page 129: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/129.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 129/181
![Page 130: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/130.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 130/181
![Page 131: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/131.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 131/181
intra-orbitar emphysema
![Page 132: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/132.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 132/181
CBCT MPR
![Page 133: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/133.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 133/181
ORBITAL FRACTURES
![Page 134: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/134.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 134/181
Sagital sections Coronal sections
FRONTAL FRACTURES
![Page 135: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/135.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 135/181
Investigations Semiaxial rgr Waters PA skull rgr CT
Anterior corticalbone 67%
Ant. and post.cortical 28%
Post. cortical 5%
![Page 136: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/136.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 136/181
FRONTAL FRACTURES
![Page 137: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/137.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 137/181
![Page 138: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/138.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 138/181
FRONTALE FRACTURES
Skull radiography
- LATERAL- PA
![Page 139: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/139.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 139/181
FRONTAL FRACTURES
CT/CBCT
POSTERIOR CORTICALINVOLVMENT – RISK FORMENINGEAL LESION
![Page 140: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/140.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 140/181
cases
![Page 141: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/141.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 141/181
![Page 142: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/142.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 142/181
![Page 143: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/143.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 143/181
![Page 144: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/144.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 144/181
![Page 145: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/145.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 145/181
![Page 146: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/146.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 146/181
POST-THERAPEUTIC RADIOLOGIC AND IMAGING
EXAMINATIONS
![Page 147: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/147.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 147/181
NORMAL BONE CONSOLIDATION EVOLUTION
![Page 148: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/148.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 148/181
6-8 days – fibrino - proteic callus (hemorrhagic -exudative phase) Demineralization of bone fragments, becoming more
radiotransparent Fracture line is more visible
8- 16 days – fibrous or chondroid callus (fibro-chondroid phase) Cartilage tissue, not visible radiological
From day 16 –several months - primitive bone callus (provisoryossification phase) Oval opacity, inhomogeneous, around the fracture fragments 6 months -1-2 years – definitive bone callus Intense opacity , net contour, reduced dimensions
Mandible fractures that are reduced and correctly immobilized consolidatesin 4-6 weeks
THE ROLE OF RADIOLOGIC EXAMINATION
![Page 149: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/149.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 149/181
Normal/pathological healing Fragments reduction
Complication appearance
FRACTURES COMPLICATIONS
![Page 150: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/150.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 150/181
Ê LATE FORMING CALLUS
Ê VICIOUS CALLUS
Ì PSEUDARTHROSISÍ OSTEITIS/OSTEOMYELITIS
Î POSTRAUMATIC ARTHRITIS/ANKYLOSIS
LATE CALLUS FORMATION
![Page 151: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/151.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 151/181
Ê 2 monthsÊ Fracture line persistency
Ê osteoporosis at fracture fragments end
Ê Clinic :mobility of the fragmentsÊ Causes:
Ê general:Ê age, avitaminosis, fosfo-calcic metab., hypofisar insuf.
Ê Local:Ê incorrect or late immobilization
Ê Soft tissue interposition
VICIOUS CALLUS
In large displacements of the fracture
![Page 152: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/152.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 152/181
In large displacements of the fracture
fragmentsMandible deformation, occlusion
disturbances
PSEUDARTHROSIS
![Page 153: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/153.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 153/181
at 6 months: persistentfracture line
Fractured bone edges arerounded, condensed
Clinic mobility of thefragments
Causes: loss of bonesubstance, large, cominutive
fractures, wrongimmobilization with soft tissueinterposition, importantdisplacements
PSEUDARTHROSIS
![Page 154: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/154.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 154/181
OSTEOMYELITIS
![Page 155: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/155.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 155/181
Osteoporosis Osteolysis - patchy aspect of the bone
Periostitis – lamellar
Bone Sequestrum
Endosteal osteosclerosis
Healing – bone sclerosis, thickened, deformed, bone
![Page 156: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/156.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 156/181
OSTEITIS/OSTEOMYELITIS
Mixed image,
inhomogeneous, withradio- transparencies andopacities
Bone sequestrum
![Page 157: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/157.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 157/181
Osteomyelitis of thecallus
CHRONIC OSTEOMYELITIS
![Page 158: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/158.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 158/181
OSTEOMYELITIS
![Page 159: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/159.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 159/181
Brodie Abscess
![Page 160: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/160.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 160/181
SUBMANDIBULAR ABSCESS
![Page 161: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/161.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 161/181
SUBMANDIBULAR ABSCESS
![Page 162: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/162.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 162/181
SUBMANDIBULAR ABSCESS
![Page 163: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/163.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 163/181
SUBMANDIBULAR ABSCESS
![Page 164: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/164.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 164/181
SUBMANDIBULAR ABSCESS
![Page 165: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/165.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 165/181
GARRE OSTEOMYELITIS
![Page 166: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/166.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 166/181
GARRE OSTEOMYELITIS
![Page 167: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/167.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 167/181
![Page 168: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/168.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 168/181
NON-SPECIFIC OSTEOMYELITIS
![Page 169: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/169.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 169/181
NON-SPECIFIC OSTEOMYELITIS
![Page 170: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/170.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 170/181
NON-SPECIFIC OSTEOMYELITIS
![Page 171: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/171.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 171/181
POSTTRAUMATIC ARTHRITIS/ANKYLOSIS
![Page 172: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/172.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 172/181
In intra-articular TMJ fractures
OSTEONECROSIS
![Page 173: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/173.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 173/181
ASEPTIC
SEPTIC:SEQUESTRUM
OSTEORADIONECROSIS
![Page 174: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/174.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 174/181
OSTEORADIONECROSIS
![Page 175: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/175.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 175/181
OSTEORADIONECROSIS
![Page 176: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/176.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 176/181
OSTEOMYELITIS
![Page 177: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/177.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 177/181
OSTEOMYLEITIS
![Page 178: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/178.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 178/181
OSTEOMYELITIS
![Page 179: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/179.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 179/181
OSTEOMYELITIS
![Page 180: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/180.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 180/181
![Page 181: Trauma 2011-curs](https://reader030.fdocuments.us/reader030/viewer/2022021318/577cc0ce1a28aba711912fbe/html5/thumbnails/181.jpg)
8/10/2019 Trauma 2011-curs
http://slidepdf.com/reader/full/trauma-2011-curs 181/181