Maxillofacial Trauma mo

8/20/2019 Maxillofacial Trauma mo

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PG TUTORIAL

AXILLOFACIAL TRAU A

DR. AHMED AL-ARFAJ

Asst. Professor / Consultant

ORL Department, KAUH


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Epidemiology

Incidence 50/100000

M:F

Causes

Paediatrics


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General Consideration

H&N

ABCDs

Soft tissues


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History & Physical

examination


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Face & Facial Skeleton

Insection

Palation

Assess function


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H!AD & N!C"

#ADI$%$GICA% !A'S


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Facial Plain Films

Largely been replaced by computer tomography

e!cept "or the mandible#

Plain Film Mandible $eries and Panore!

Computed %omography C%#

Most in"ormati&e radiographic e!am "ro head and nec'

%rauma (!ial and coronal "acial C% )ith bone and so"t tissue

)indo)* +,- mm sections


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Secial #adiolo(ic !xams

An(io(rahy

'a(netic #esonance Ima(in(

'odified Barium S)allo) and !soha(ram


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'ANDIB*%A# F#AC+*#!S


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Introduction

'ost common in youn( males ,a(es -./012

Causes3 assault 4 motor 5ehicle

accidents4 sorts and (unshots )ounds

'ost common Fractures Sites

#isks3 imacted teeth4 osteoorosis4 edentulous areas4

atholo(ic4 lytic lesions


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Classification 6y Site Symhyseal 7 Parasymhyseal

Body

#amus

Coronoid Process

Condyle

Al5eolus

An(le


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Classification 6y Fa5ora6ility

Fa5ora6le

*nfa5ora6le


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Anterior 'uscles 8eaker force

'ylohyoid4 (eniohyoid4 (enio(lossus4

latysma4 anterior di(astric muscles

'uscle action deresses and retracts

,oen mandi6le2


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Posterior 'uscles3

Stron(er force

+emoralis 'uscle

'asseter 'uscle

'edial Ptery(oid 'uscles

%ateral Ptery(oid 'uscles


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Classification 6y +ye of Fracture

$en 5ersus Closed

Fracture Pattern3 Communited4 o6li9ue4

trans5erse4 siral4 (reenstick

Patholo(ic3 fractures secondary to 6one disease

,e(4 osteo(enic tumors4 osteoorosis2


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Dental Classification

Class I

Class II

Class III


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An(les Classification

Class I

Class II

Class III


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'ANAG!'!N+


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'ana(ement Concets

Goals3 restore occlusion4 esta6lish 6ony union& a5oid

+': atholo(y

#eair )ithin first )eek

In (eneral fa5ora6le fractures may only need closed

reduction

Postoerati5e Care


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'axillo/'andi6ular Fixation ,''F2 /

Closed #eduction

Indications

'ethods

#e9uires an intact maxilla

+yically ''F may 6e remo5ed

after ;/. )eeks

Comlications


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$en #eduction &Internal Fixation

,$#IF2

Indications

Aroaches3

-< +ransoral

;< !xternal


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'ana(ement 6y +ye

Coronoid4 Greenstick4 *nilateral Nondislaced

Fractures3 o6ser5ation )ith soft diet4 anal(esics4

oral anti6iotics and close follo)/u4 hysio/theray

exercises for 0 months ,may consider ''F forse5erely dislaced coronoid fractures2

Fa5ora6le4 'inimally Dislaced Noncondylar Fractures 3

may consider closed reduction and =/> )eeks of ''F


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Dislaced Fractures

Symhyseal and Parasymhyseal fractures3 tend to 6e

5ertically unfa5ora6le Body Fractures 3 almost al)ays unfa5ora6le An(le fractures in (eneral ha5e the hi(hest comlication

rate

#amus Fractures3 isolated ramus fractures are rare ,rotected 6y masseter muscle2


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Sur(ical Comlications

Chin and %i Hyesthesis $steomyelitis 'alunion Nonunion

Plate !xosure 'ar(inal 'andi6ular Ner5e In?ury Necrosis of Condylar Head

,Asetic Necrosis2 +': Ankylosis

Dental In?ury


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'AI%%A#@ F#AC+*#!S


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Introduction

Causes

+he matrix of the maxilla a6sor6s

ener(y )ith imact

Sinusitis is a otential comlication


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Classification

Buttress System

ertical Buttressess

-< Naso/'axillary ,N'2 ;< y(omatico/'axillary ,'2

0< Ptery(o/'axillary ,P'2

=< Nasal Setum


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Horiontal Beams

-< Frontal Bar

;< Inferior $r6ital #ims

0< 'axillary Al5eolus and Palate =< y(omatic Process

< Greater 8in( of the Shenoid

>< 'edial and %ateral Ptery(oid Plates

E< 'andi6le


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%e Fort Classification

Based on atterns of fractures ,lines of minimal

resistance2 classified accordin( to the hi(hest le5el of

In?ury In many cases %e Fort classification is incomlete for

maxillary fractures %e Fort fractures may resent in many com6inations or

on one side ,hemi/%e Fort2


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%e Fort I ,%o) 'axillary2 +rans5erse maxillary fracture

In5ol5es anterolateral maxillary )all4 medial maxillary )all4 tery(oid lates4 setum at

floor of nose


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%e Fort II ,Pyramidal 2 Caused tyically from a sueriorly directed force

a(ainst the maxilla< In5ol5es nasofrontal suture4 or6ital foramen4 rim4

and floor frontal rocess of lacrimal 6one4

y(omaxillary suture4 lamina ayracea of

ethmoid tery(oid late and hi(h setum


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%e Fort III ,Craniofacial Dys?unction2

Searates facial skeleton from 6ase of skull4 tyically

caused 6y hi(h 5elocity imacts<

In5ol5es nasofrontal suture4 y(oma and y(omatic arch tery(oid lates and nasal setum


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'ana(ement

Princiles

Goals of #econstruction !xosure7Aroaches +imin( Postoerati5e Care


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Cont3 'ana(ement

+echni9ues

Plate Fixation ,'inilates2 Interosseous 8ire Fixation Bone Grafts


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'ana(ement 6y %e Fort Classification

%e Fort I3 reduced di(itally4 ''F4 fixation of '

%e Fort II3 sta6iliation of the ' 6uttress4 ''F 4 nasofrontal

rocess and inferior or6ital rim<

%e Fort III3 usually re9uires coronal fla for ade9uate

exosure for exloration and minilate fixation


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Sur(ical comlications 'alunion4 Nonunion4 Plate !xosure

Pala6le or $6ser5a6le Plates

Forehead or Cheek Hyesthesi

$steomyelitis

Dental In?ury


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@G$'A+IC$'AI%%A#@& $#BI+A% F#AC+*#!S

y(omaticomaxillary Comlex

,+rimalar2 Fractures


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Introduction

Symtom3 . Su6con?uncti5al & erior6ital ecchymosis. !yelid edema. !istaxis. Cheek hyesthesia

. Diloia

. Hyohthalmos

. !nohthalmos

. +rismus

y(omaticomaxillary Comlex

,+rimalar2 Fractures


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Four sutures in5ol5ed in

y(omaticomaxillary

Comlex Fractures

-< y(omaticonfrontal Suture

;< y(omaticomaxillary Suture

0< y(omaticotemoral Suture

=< y(omaticoshenoid Suture


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'ana(ement

Sta6iliin( the y(omatic arch

'inimum of ;oints fixation

Closed #eduction

$en #eduction


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Common Aroaches

to y(oma

Incisions

Intraoral aroach ,"een2

Coronal4 Hemicoronal or !xtended

Pretra(al Aroaches

%ateral Bro) Aroach


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$#BI+A% F#AC+*#!S


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IN+#$D*C+I$N

$r6ital Bones $tic Canal& $r6ital Fissures Contents

Si(n& Symtoms


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+@P!S

Pure

Imure


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'ana(ement

Indication for Sur(ical Inter5ention

Contraindications for Sur(ical Inter5ention3 hyhema4

retinal tear4 (lo6e erforation4 only seein( eye sinusitis4

froen (lo6e

$hthalmolo(ical !5aluation

+imin( 3-)eek

+echni9ue


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APP#$ACH!S

Su6ciliary Incision ,Infraciliary2

+ranscon?ucti5al Incision

%ynch Incision ,Frontoethmoidal2

Bro) Incision

Su6tarsal Incision

Cald)ell/%uc ,+ransantral2 Aroach


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Sur(ical Comlication

Postoerati5e Blindness CSF %eak Persistent !nohthalmos and Diloia !ctroion

!ntroion Cheek Hyesthesia !xtrusion of Grafts 'alunion4 nonunion4Plate!xosure$steomyelitis Pala6le or $6ser5a6le Plates


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F#$N+A% SIN*S F#AC+*#!


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F#$N+A% SIN*S F#AC+*#!

. Si(n& Symtoms

. #isk


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'ANAG!'!N+


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Anterior +a6le Fractures

%inear4 'inimally Dislaced

Deressed Fractures

Comminuted or *nsta6le Fractures


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Posterior +a6le Fractures

Isolated Nondislaced Psoterior +a6le Fracture

Dislaced Posterior +a6le Fracture

Comminuted4 Contaminated or throu(h and

+hrou(h Fractures//Cranialiation


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Sur(ical Comlications

'ucocele4 'ucoyoceles Sinusitis Forehead Contour Deformity

Intracranial Infections $steomyelitis CSF leak Forehead Hyesthesia Forehead Paralysis


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NAS$/$#BI+$!+H'$ID ,N$!2F#AC+*#!S


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Introduction

N$!3 frontal rocess of maxilla4 nasal 6ones4

and or6ital sace Si(n& Symtoms

Pseudohyertelorism ,+raumatic +elecanthus2


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Anatomy

'edial Canthal %i(ament ,'C%2 %acrimal Collectin( System

Puncta Canaliculi

%acrimal Sac

%acrimal Duct


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'ana(ement

First reconstruct medial or6ital )all rior to

reair of the 'C%

'ust consider associated in?uries

'ay attemt closed reduction if 'C% and

lacrimal system is intact

+elescoin( Nasal Bones and Frontal Process

of the 'axilla


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N l F t


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Nasal Fractures

Introduction 'ost common Anterior imacts %ateral imacts Dislocated 9uadran(ular cartila(e inferiorly or C/shaed

Children usually ha5e dislocated or (reen stick fractures and ha5e a hi(her risk of

setal hematomas2 Comminutions are more common in adults Si(n& Symtoms Dia(nosis


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'ana(ement

Initial 'ana(ement

Preoerati5e hoto(rahs7x/ray may 6e

considered for medicole(al documentation

Setal hematomas

$en fractures must 6e cleaned then (i5en

anti6iotics

Cont 3 'ana(ement


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Sur(ical 'ana(ement

Generally nasal 6one deressed or de5iation

may under(o closed reduction

$en #eduction )ith Internal Fixation

,Setorhinolasty2

Pediatric Nasal Fractures3 (enerally should 6e

treated conser5ati5ely


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C t ' t


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Cont 3 'ana(ement

Sur(ical Comlications & Associated In?uries

Persistent Deformity

Nasal $6struction

Setal Hematoma

Setal Perforation and De5iations

Cri6riform Plate Fracture


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+hank you

&

Good luck to your examination

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