Maxillofacial Trauma

Dr. Fuad AbulJadayel

BDS, DPH, MSc, Jord. Board.e

Maxillofacial Specialist

Aetiology

Interpersonal violence tends to be the most common aetiology in the UK.

Road traffic accidents.

Falls.

Sports injuries.

Industrial injuries.

Surgical Anatomy

The upper facial skeleton (The Frontal Bone).

The middle facial skeleton (MFS).

The lower facial skeleton (The mandible).

Surgical Anatomy of MFS- Boundary: zygomaticofrontal suture Zygomaticofrontal

suture occlusal plane of the upper teeth.

The MFS is made up of the Following Bones:

1. Two maxillae.

2. Two zygomatic bones.

3. Two zygomatic processes of the temporal bones.

4. Two palatine bones.

5. Two Nasal bones

6. Two lacrimal bones

7. The vomer

8. The Ethmoid and its attached conchae

9. Two inferior conchae

10.The pterygoid plates of the sphenoid.

Death from trauma has a trimodal distribution

The first peak

Within seconds or minutes of the injury, due major damage to brain, spinal cord, heart, aorta, or other large vessels.

The second death peak

Minutes to hours after injury “golden hour.”

Death is usually due to subdural haematoma, ruptured spleen, pelvic #.

The third death peak

Days to weeks after injury.

Death due to sepsis and organ failure.

Management of Trauma

Initial Assessment:

-Primary Survey (A,B,C,D,E).

-Secondary Survey (GCS).

Eye opening.

Motor response.

Verbal response.

Definitive care phase.

Glasgow Coma Scale

Eye opening

Spontaneously 4

To speech 3

To pain 2

None 1

Motor response

Obeys 6

Localizes pain 5

Withdraws from pain 4

Flexion to pain 3

Extension to pain 2

None 1

Verbal response

Oriented 5

Confused 4

Inappropriate 3

Incomprehensible 2

None 1

Patient’s score determines category of neurologic impairment:

15 = normal;

13 or 14 = mild injury;

9–12 = moderate injury;

3–8 = severe injury.

Management of Trauma

3 mandatory radiographs:

C1-T1

Chest x-ray

Pelvic x-ray

Facial examination

Inspect from the front, profile, and also from above by standing behind, look for deformity, contours, asymmetry, flattening, depression, raccoon’s eyes, battle’s sign, dish face, telecanthus.

Eyes: pupils (reflexes , symmetry), subconjunctival haemorrhage (from direct trauma to globe, or fracture zygoma & orbital wall fracture), epiphora, enophthalmus, proptosis.

Facial examination

Nose: deformity, swelling, obstruction, bleeding and CSF leak, septal hematoma.

Ears: bleeding and CSF leak, hemotympanum.

Mouth: teeth, haematoma (especially sublingual haematoma), intra-oral lacerations, and malocclusion.

Midface fractures

Zygomatic fractures

Cont…Examination

Palpate bones to elicit tenderness, crepitus or depression

Feel for step defects, all butresses

Maxillary mobility, range of mandibular motion, deviation on opening, palpate condyles during motion, test for nondisplaced#

Surgical emphysema.

Visual aquity, visual fields, ocular motility, canthal integrity, eyelid and lacrimal integrity.

Diplopia

Neurologic (II,III,IV,VI,V sensory and VII motor)

Radiographic evaluation of the mandible

Two or more of the following:

panoramic view

open-mouth Towne's view

posteroanterior view

lateral oblique views

Radiographic Evaluation of midface fractures

Waters' view

Lateral skull view

Posteroanterior skull view

Submental vertex view

CT

Goals of treatment

Rapid bone healing Return of normal appearance Masticatory and nasal function Restoration of speech Minimal complications

Basic surgical principles

Reduction of the fracture Fixation of the bony segment Stabilization of the bony segment Immobilization of segments Preoperative occlusion must be

restored

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