Treatment principles of maxillofacial trauma

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Treatment principles of maxillofacial trauma Reporter : Ho-Tai Wu

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Treatment principles of maxillofacial trauma. Reporter : Ho-Tai Wu. Evaluation of p’t with facial trauma Classification of facial fractures Treatment of facial fractures. Maxillofacial Injuries. Treatment divided into following phases Emergency or initial care Early care Definitive care. - PowerPoint PPT Presentation

Transcript of Treatment principles of maxillofacial trauma

  • Treatment principles of maxillofacial traumaReporter : Ho-Tai Wu

  • Evaluation of pt with facial traumaClassification of facial fracturesTreatment of facial fractures

  • Maxillofacial InjuriesTreatment divided into following phasesEmergency or initial care

    Early careDefinitive care


  • Emergency CarePreserve the airwayControl of hemorrhagePrevent or control shockC-Spine stabilizationControl of life-threatening injurieshead injuries, chest injuries, compound limb fractures, intra-abdominal bleeding

  • Emergency CarePreserve the airwayExistence & identification of obstructionManually clear of fractured teeth, blood clots, denturesEndotracheal intubation & packing of oronasal airway

  • Emergency CareControl of hemorrhageExtensive vascularity of head & neck may lead to massive blood lossMonitor vital signs closelyIntravenous infusionPenetrating injuries need to be exploredArteriogramEsophagram

  • Emergency CarePrevent or control shockHemorrhage most common cause of shock after injuryMultiple injury patients have hypovolemiaGoal is to restore organ perfusion

  • Emergency CareC-Spine stabilizationAvoid any movement of spinal columnUntil rule out C-spine FxLateral C-spine radiographsCT of C-spineNeurologic exam

  • Early CareEmergency care has stabilized patientInitial stabilization of fracturesDebridement & dressing of soft tissuesElective tracheostomyPhysical exam & historyLaboratory testsComplete head & neck examinationDiagnosis of maxillofacial injuries

  • HistoryPatient, witness or family memberHow did the accident occur ?When did the accident occur ?What are the specifics of the injury ?Was there a loss of consciousness ?What symptoms are now ?

  • Physical examinationInspection

    HemorrhageOtorrheaRhinorrheaContour deformityEcchymosisEdemaContinuity defectsMalocclusion

  • Physical examinationPALPATIONStep DefectCrepitusBony segmentsSubcutaneous emphysemaMobility

  • Physical examinationNeurological examination Visual or pupillary changes (CN II III IV VI)Abnormalities of ocular movements (neurologic, orbital area fractures )Motor function of the facial muscle (CN VII)Muscles of mastication (CN V)Sensation the facial area (CN V)

  • Maxilla Mobility of the maxilla either as an isolated zygoma or nasal bones

    Palpated for step deformites in forehead, orbital rim, nasal or zygoma areas

    Evaluation of the nose, nasal spetum and paranasal structures

    Intercanthal distance (naso-orbital ethmoid injures)Mandible TMJOcclusion planeLaceration of oral cavityMobility and missing of the teeth

  • DIAGNOSTIC IMAGINGMandible fractures : PA viewLateral oblique view Townes view Panoramic viewOcclusal viewCT

  • DIAGNOSTIC IMAGINGMidface fractures Waters viewLateral skull viewPA skull view Submental vertex viewCT scans3-D reconstruction

  • 3D CT

  • Evaluation of pt with facial traumaClassification of facial fracturesTreatment of facial fractures

  • Mandibular Fractures

    50% of mandibular fractures are multipleExamine patient and radiographs closely and suspect additional fractures

  • Mandibular FracturesCondylar AngleBodySymphysealAlveolarRamusCoronoid precess

  • Mandibular Fractures


  • Mandibular FracturesHorizontally favorable Horizontally unfavorableVertically favorableVertically unfavorable

  • Mandibular Fractures Radiographic evaluation

  • Midface FracturesThree buttresses allow face to absorb forceNasomaxillary (medial) buttressZymaticomaxillary (lateral) buttressPyterigomaxillary (posterior) buttress

  • Midface FracturesLeFort I Transverse MaxillaryLefort II PyramidalLefort III Craniofacial DysjunctionZygomatic ComplexNaso-orbital/Ethmoid Occlusion involved

  • Lefort I FractureTransverse Maxillary

    Lefort II FracturePyramidalLefort III FractureCraniofacial Dysjunctionabove the level of teethat level of nasal bonesat orbital level(Rene Lefort, 1901)

  • Naso-orbital/EthmoidZygomatic Complex

  • Evaluation of pt with facial traumaClassification of facial fracturesTreatment of facial fractures

  • Goals of the treatments Rapid bone healingReturn of normal appearanceMasticatory and nasal functionRestoration of speechAcceptable esthetic

  • Basic surgical principleReduction of the fractureFixation of the bony segmentStabilization of the bony segmentImmobilization of segmentsPreoperative occlusion must be restoredInfection in the area must be eradicated

  • Basic surgical procedure1. Place the teeth in the proper occlusion2. Appropriated reduction of bony fractures3. Bony repair should also precede soft tissue repair4. Fractures treated as soon as the pt condition permits5. Rigid fixation begins in the area where fractures can e most easily stabilized .

  • Principle of mandibular fractureClosed reduction 1. IMF ( Prefabricated arch bar )2. Ivy loop wiring3. Continuous loop wiring4. Heavy elastic traction (pull the bony segments)5. Circummandibular wiring (edentulous pt)6. Lingual or occlusal splint (children)

  • Principle of mandibular fracture Open reductionContinued displacement of the bony segments Unfavorable fracture (angle fracture)Intraosseous wiring + IMF (3 to 8 weeks)Rigid internal fixation these method use bone plates, bone screws or both to fix the fracture.Proper occlusal established before reduction stabilization and fixation of the bony segment

  • Advantages of rigid fixation

    IMF is eliminated or reducedImproved postoperative nutritionImproved postoperative hygieneExternal skeletal fixation

    Appearance and inconvenienceFunctional movementComminuted fracture

  • Principle of midface fractureZygomaticomaxillary buttressZygomaticofrontal area Orbital rim area

  • Principle of midface fractureOcclusion related (Le fort fractures)Rehabilitation of occlusion relationshipReduction of bone segmentStablization of fractured segments

  • Principle of midface fractureStablization of fractured segments Direct Intraosseous wiring Suspension wiring techniqueBone plate & screws

  • Principle of midface fractureZygomatic Complex & Naso-orbital- Ethmoid fractureRepair functions of eye, nose & mastication.Acceptable estheticPrevent interfere to coronoid process (Zygomatic arch)

  • Goals of the treatments Rapid bone healingReturn of normal appearanceMasticatory and nasal functionRestoration of speechAcceptable estheticConclusion

  • Thanks for your attention !!!END