Definitive treatment of midfacial fractures

Dr. Mohamed Rahil ((Maxillofacial surgeon))

Tikrit dentistry college 2015 – 2016

Priority to saving patient life (ABC)

Principle of treatment

Reduction

Fixation

Immobilization

Follow up and rehabilitation

Dentoalveolar fracture

I. Fracture of teeth

a. Fracture of teeth without pulp exposure

b. Fracture of teeth with pulp epxosure

c. Subluxation

d. Avultion

II. Fracture of alveolus and maxillary tuberosity

Zygomatic complex fracture

Indications for reduction

• Diplopia

• Restriction of mandibular movement

• Restore orbit skeleton

• Restore normal contour of face

Reduction

• Time

• Appraoches

Gillies approach

Keen approach

Quinn approach

Percutaneous approach

fixation

• Trans-osseous wiring

plating

Fixation with pack in the maxillary sinus

• Comminuted fracture of zygoma

• Comminuted fracture of orbital floor

• Ballon or back can be used

Pin fixation

• Excessively mobile zygoma

• Following surgical refractur of badly displaced zygomatic bone which has been healed

Fracture of zygomatic arch

• Reduction through Gillies approach

• Fixation un necessary in recent fracture

Fracture of orbital floor

Indications for treatment

• Diplopia not resolved after 10 days after injury

• Large herniation of tissue to the antrum

• Restriction of eye globe movment

• Enophthalmus greater than 3 mm

Nasal complex fracture

• Reduction

Walsham’s forceps Asche’s forceps

fixation

• POP

• Lead plate splint

• Open reduction

LeFort fractures

Le Fort I fracture

Rowe’s disimpaction forceps

Lefort II

Lefort III

Usually multiple fractures

Priority of treatment ;

Reduction of zygomatic bone fracture

Teeth bearing portion

Naso-ethmoidal fracture

And finally nasal complex immobilization

Immobilization of lefort fractures

• Extra-oral immobilization

• Immobilization within the tissue

Extra oral immobilization

• 1. cranio-mandibular • A. box frame • B. halo frame • C. pop headcap • 2. craniomaxillary • a. supra – orbital pins • B. zygomatic pins • C. halo fram • 3. suspension

Immobilization within the tissues

1. Direct fixation

• A.Transosseous wiring

• B. K-wire

• C. plating

2. internal wire suscpension

3.support

Type of plating

• Minplate

• Compression plate

• Reconstruction plate

Rigid fixation VS non rigid fixation

Complications of fractures

• Complication from head injury

• Complications from fracture it self

• Complications associated with lacrimal system

• Ophthalmic complication

• Complications from neural damage

• Non - union

Thank you for listening

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