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    Maxillofacail Injury

    Uploaded by

    Farhan Ali
    1. Maxillofacial trauma involves injuries to the upper third, middle third, and lower third of the face, including the frontal bones, zygomas, orbits, maxillae, nasal bones, and mandible. 2. Evaluation and diagnosis involves assessing the airway, performing a physical exam of the scalp and facial bones, and using CT imaging to diagnose fractures. 3. Management includes securing the airway, administering antibiotics and analgesics, cleaning and dressing wounds, and monitoring for complications such as infections. Surgical fixation may be needed for displaced or unstable fractures.

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    Maxillofacail Injury

    Uploaded by

    Farhan Ali
    105 views37 pages
    1. Maxillofacial trauma involves injuries to the upper third, middle third, and lower third of the face, including the frontal bones, zygomas, orbits, maxillae, nasal bones, and mandible. 2. Evaluation and diagnosis involves assessing the airway, performing a physical exam of the scalp and facial bones, and using CT imaging to diagnose fractures. 3. Management includes securing the airway, administering antibiotics and analgesics, cleaning and dressing wounds, and monitoring for complications such as infections. Surgical fixation may be needed for displaced or unstable fractures.

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    1. Maxillofacial trauma involves injuries to the upper third, middle third, and lower third of the face, including the frontal bones, zygomas, orbits, maxillae, nasal bones, and mandible. 2. Evaluation and diagnosis involves assessing the airway, performing a physical exam of the scalp and facial bones, and using CT imaging to diagnose fractures. 3. Management includes securing the airway, administering antibiotics and analgesics, cleaning and dressing wounds, and monitoring for complications such as infections. Surgical fixation may be needed for displaced or unstable fractures.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    105 views37 pages

    Maxillofacail Injury

    Uploaded by

    Farhan Ali
    1. Maxillofacial trauma involves injuries to the upper third, middle third, and lower third of the face, including the frontal bones, zygomas, orbits, maxillae, nasal bones, and mandible. 2. Evaluation and diagnosis involves assessing the airway, performing a physical exam of the scalp and facial bones, and using CT imaging to diagnose fractures. 3. Management includes securing the airway, administering antibiotics and analgesics, cleaning and dressing wounds, and monitoring for complications such as infections. Surgical fixation may be needed for displaced or unstable fractures.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    Maxillofacial Trauma

    Dr gurey
    Anatomy
    • Upper Third
    – Frontal bones
    • Middle Third
    – Zygomas, orbits, maxillae, nasal bones
    • Lower Third
    – Mandible
    Evaluation and Diagnosis
    • ABCs
    – Airway
    – High rate of c-spine fractures if facial trauma
    • PE
    – scalp, forehead
    – Orbits/vision, zygomas, nasal bones, septum, maxillae
    – Teeth, mandible, occlusion
    – Sensation, facial nerve function
    • CT is golden diagnosis
    Airway Management
    • Posture
    • Chin lift or jaw thrust
    • Oral airway
    • Nasopharangeal
    • Intubate
    • Surgical
    Tracheostomy
    • tracheostomy is an opening surgically created
    through the neck into the trachea (windpipe)
    to allow direct access to the breathing tube
    Secondary Survey
    • History
    Head to toe
    Clean up
    Good records
    Re-evaluate
    Clinical Signs and Symptoms
    of Fractures
    • Pain
    • Swelling and bruising
    • Deformity
    • Loss of function
    • Abnormal mobility
    • Neurovascular disturbance
    • Deranged occlusion
    Assessment
    • Soft Tissue Injury
    • Bone Injury
    • Soft Tissue Loss
    • Bone Loss
    • Teeth
    Initial Management
    • Antibiotics
    • Analgesia
    • Tetanus
    • Clean and dress wounds
    • Maintain airway
    • Monitor
    Gibbons’ Rules
    • Systematic examination
    • Midface trauma check eyes and nose
    • CT head and neck
    • Clean soft tissues.
    Early management of soft
    tissue injury
    • Debride
    • Preserve tissue
    • Primary closure
    • Delayed primary closure
    Frontal Sinus
    • Anterior/posterior table, comminution,
    thickness
    • the more central and the more severe the
    fracture, more likely csf leakage
    Frontal Sinus Repair
    • Is exploration necessary? Is obliteration
    necessary?
    • Anterior wall for cosmesis
    • Posterior wall to protect anterior cranial fossa
    • If nasofrontal ducts involved may lead to
    infection
    • Obliteration via cranialization if posterior wall
    severely comminuted
    posterior table bone
    • Severe injuries which result in disruption of
    greater than 25% of the posterior table should
    be considered for cranialization.
    • This involves exposure of the entire sinus,
    meticulous removal of all sinus mucosa, and
    removal of the posterior table bone.
    Midface fractures
    • Midface fractures are common sequelae of motor
    vehicle accidents, falls, assaults, and other blunt
    trauma.
    • Types of midface fracture or Le Fort classification
    Le Fort classification
    • Le Fort I or type 1
    – Horizontal floating plate
    • Le Fort II / type 2
    – Pyramidal floating maxillery
    • Le Fort III/ type 3
    – Complete craniofacial separation floating face which
    is transverse
    Le Fort classification
    hear no evil
    speak no evil see no evil
    Midface
    Midface Repair
    Fractures of the midface are
    treated surgically if they
    cause
    malocclusion, enophthalmos,
    diplopia, infraorbital nerve
    anesthesia, or
    unacceptable cosmetic
    deformity. Surgical treatment
    usually consists of
    internal stabilization using fine
    screws and plates.
    Nasal fracture
    Nasal bone fractures classified :

    Type I)
    Simple without displacement;
    Type II)
    Simple with displacement
    Type III)
    Comminuted with depression.
    NOE repair
    • Difficult, esp if comminuted
    • Ensure positioning and fixation of canthal ligament to prevent
    telecanthus
    • If medial canthal ligaments attached to central bone– stablize
    bone to surrouding skeleton
    • If comminuted expose ligament and fix to frontal bone
    Mandible
    • Symphyseal, parasymphyseal,
    body, angle, ramus, condyle,
    coronoid

    • Favorable vs unfavorable:
    favorable when muscles tend
    to draw bony fragments
    together.

    unfavorable when bony


    fragments are displaced by
    muscle forces.
    1. Horizontally favorable fractures: The fracture
    line starts at the alveolar margin and extends
    forward or anteriorly and downwards till the
    lower border of mandible. The Elevator and
    Depressor Muscles act against each other and
    help in keeping the bones on either sides of the
    fracture line to be kept in position which helps in
    preventing unnecessary movements and
    decreases time of healing
    • Horizontally unfavorable fractures: The fracture line
    starts at the alveolar margin and extends
    downwards and backwards till the lowest border of
    mandible is reached. The Elevator and Depressor
    Muscles act in the same direction and this causes
    the bones on either sides of the fracture line to
    move away from each other which causes
    unnecessary movements and increases time of
    healing.
    • Vertical fractures are seen from the top of the
    mandible or from the occlusal surface.
    • Vertically favorable fractures: Fracture line starts at
    the buccal or outer border of the mandible and it
    extends obliquely backwards towards the lingual
    margin of mandible. The Elevator and Depressor
    Muscles act against each other and help in keeping
    the bones on either sides of the fracture line to be
    kept in position which helps in preventing
    unnecessary movements and decreases time of
    healing.
    • vertical unfavorable fracture of mandible
    • Vertical unfavorable fractures: Fracture line
    starts at the lingual or inner border of the
    mandible extending obliquely backwards
    towards the buccal margin of the mandible.
    The Elevator and Depressor Muscles act in the
    same direction and this causes the bones on
    either sides of the fracture line to move away
    from each other which causes unnecessary
    movements and increases time of healing.
    Mandible Repair

    • Plating if displaced, comminuted, unfavorable


    • Subcondylar fxs are controversial
    – MMF
    – Open reduction if condylar displacement into
    middle fossa, inability to obtain reduction, lateral
    extacapsular displacement of condyle, invasion by
    foreign body
    • Teeth in fracture line: pull if infected
    Facial Defects soft tissue
    Nasal repair soft injury
    • Small defects with adjacent nasal skin
    • Full thickness skin graft for shallow defects
    • Interpolated paramedian forehead flap or
    melolabial flap for deeper defect
    • Full thickness requires replacement of internal
    lining, structural support with cartilage or
    bone, external coverage with interpolated
    cheek or forehead flap
    nasal flaps
    Lip reconstruction
    • Less than one half with primary wound
    closure or local flap
    • ½ to 2/3 require full thickness flap from
    opposite lip or cheek
    • Full thickness >2/3 need regional flap or
    vascularized microsurgical flap
    Complications
    • Complications of facial flaps include those of
    tension-related.
    • ischemic .
    • hematologic.
    • infectious.
    •END

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