Treatment Planning & Seminar Updated2
Transcript of Treatment Planning & Seminar Updated2
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Treatment Planning & Seminar
Karam Bassam 200910300
Amrou Mohamed 200910538
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The Case
Gender : Male Age : 32
PMH: Healthy
Patient is presented with BLOW to cheek
C/F: 1.Bruises
2.Blurred Vision
3. Diplopia
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Differential Diagnosis
Possible causes of diplopia due to trauma
include:
Zygomatic Complex Fracture
Blowout Injury/Orbital Floor Fracture
1. Orbital contusion with associated edema,
hemorrhage, and muscle contusion2. Orbital fracture with/without entrapment
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Zygomatic Complex fracture
Associated
Ocular Complications :
1-Retinal detachment.2-Dislocation of the lens.
3-Injuries to the globe.
4-Orbital floor fractures.
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Orbital floor Fracture
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Overview:
Strong TRAUMA
PAIN and BLOWOUTof orbital floor
1- BRUSIS.
2- DIPLOPIA.
3- EDEMA of EYELID.4- ENOPHTHALMOUS.
5- EPISTAXIS.
6- NAUSEA.
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Clinical examination
Ocular examination for vision acuity.
Palpation of the orbit for creptius.
External examinationfor edema.
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Investigations
Radiographs to confirm the diagnosis :
1. MRIfor examining the optic nerve
2. CT scan for the facial bones3. Occipitomental view
4. Submentovertex view for the zygomatic arch
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Final Diagnosis
Zygomatic complex fracture
Reasons:
1. Blow to the cheek2. Ophthalmic nerve
3. Infraorbital nerve and artery
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Treatment Plan
Aims
1-To correct diplopia and restore normal vision
2-To restore orbital volume when walls and floorare fractured
3-To restore the normal contour of the face for
cosmetic reasons.
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Treatment of diplopia
Includes observation and surgical repair
Timing of surgery: As soon as initial edema or
hematoma subsides (5-7 days)
Considerations: presence or absence of
entrapment, prescence of
diplopia,enophtalmous
Transconjuctival approach preferred.
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Treatment of possible zygomatic
fracture
Treatment objective: To place fragments in
normal position and to fix them during the
course of healing
Same period of time before the start of
surgery
Open reduction and intraosseous wire fixation
indicated.