Maxillofacial Trauma Dr. Fuad AbulJadayel BDS, DPH, MSc, Jord. Board.e Maxillofacial Specialist.
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Maxillofacial TraumaDr. Fuad AbulJadayel BDS, DPH, MSc, Jord. Board.e Maxillofacial Specialist AetiologyInterpersonal violence tends to be the most common aetiology in the UK.Road traffic accidents. Falls. Sports injuries.Industrial injuries.Surgical AnatomyThe upper facial skeleton (The Frontal Bone).The middle facial skeleton (MFS).The lower facial skeleton (The mandible).
Surgical Anatomy of MFSBoundary: zygomaticofrontal suture Zygomaticofrontal suture occlusal plane of the upper teeth.The MFS is made up of the Following Bones:Two maxillae.Two zygomatic bones.Two zygomatic processes of the temporal bones.Two palatine bones.Two Nasal bonesTwo lacrimal bonesThe vomerThe Ethmoid and its attached conchaeTwo inferior conchaeThe pterygoid plates of the sphenoid.6Death from trauma has a trimodal distributionThe 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 peakMinutes 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 TraumaInitial Assessment: -Primary Survey (A,B,C,D,E). -Secondary Survey (GCS). Eye opening. Motor response. Verbal response.Definitive care phase. Glasgow Coma ScaleEye openingSpontaneously 4To speech 3To pain 2None 1
Motor responseObeys 6Localizes pain 5Withdraws from pain 4Flexion to pain 3Extension to pain 2None 1
Verbal responseOriented 5Confused 4Inappropriate 3Incomprehensible 2None 1
Patients score determines category of neurologic impairment:15 = normal; 13 or 14 = mild injury; 912 = moderate injury; 38 = severe injury.
Management of Trauma3 mandatory radiographs:C1-T1Chest x-rayPelvic x-rayFacial examinationInspect from the front, profile, and also from above by standing behind, look for deformity, contours, asymmetry, flattening, depression, raccoons eyes, battles 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 examinationNose: 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.
ContExaminationPalpate bones to elicit tenderness, crepitus or depressionFeel 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.
DiplopiaNeurologic (II,III,IV,VI,V sensory and VII motor)
Radiographic evaluation of the mandibleTwo or more of the following:panoramic view open-mouth Towne's viewposteroanterior viewlateral oblique views
Radiographic Evaluation of midface fracturesWaters' viewLateral skull view Posteroanterior skull viewSubmental vertex viewCT
Goals of treatment Rapid bone healingReturn of normal appearanceMasticatory and nasal functionRestoration of speechMinimal complications
Basic surgical principlesReduction of the fractureFixation of the bony segmentStabilization of the bony segmentImmobilization of segmentsPreoperative occlusion must be restored