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Facial Fractures

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Contains foramens for the passage of nerves and blood vessels ... Maxilla & Zygoma. Frontal & Orbital Floor. Best View. Lateral Oblique. Waters. Reverse Townes ... – PowerPoint PPT presentation

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Title: Facial Fractures


1
Facial Fractures
  • Lisa Publicover
  • August 2005

2
Outline of Lecture
  • Introduction
  • Skeletal Anatomy
  • Fracture Patterns
  • Nasal
  • Zygomatic
  • Maxilla
  • Blowout
  • Frontal Sinus and Nasoethmoidal
  • Mandibular
  • Approach to a Suspected Facial Fracture

3
Anatomy
  • The face is composed of 14 bones
  • Mandible (1)
  • Vomer (1)
  • Maxilla (2)
  • Zygomata (2)
  • Nasal (2)
  • Lacrimals (2)
  • Palatines (2)
  • Inferior Nasal Conchae (2)

4
Image from http//face-and-emotion.com/dataface/ph
ysiognomy/cranium.jsp
5
The Mandible
  • Lower jawbone
  • Strongest facial bone
  • Articulates with the temporal bone
  • Contains foramens for the passage of nerves and
    blood vessels to the face

6
The Volmer
  • A small, narrow bone
  • Forms the inferior part of the nasal septum

7
The Maxilla
  • Paired
  • Form the upper jawbone
  • Articulates will every other facial bone except
    the mandible
  • Contains the maxillary sinuses
  • Forms the inferior floor of the orbits
  • Contains a foramen to allow passage of the
    maxillary/infraorbital nerve

8
The Zygomata
  • Paired
  • Form the cheekbones
  • Articulate with the temporal, frontal, and
    maxillary bones
  • Their prominent position and shape renders them
    susceptible to injury

9
The Nasal Bones
  • Paired
  • Join in the midline to form the nasal bridge
  • They articulate with the frontal, maxillary, and
    ethmoid bones.

10
The Lacrimal Bones
  • Paired
  • Small Fragile
  • Located in the
  • medial wall of each orbit
  • Contains a small fossa,
  • which houses the lacrimal
  • apparatus

11
The Palatine Bones
  • Paired
  • Located posterior to the maxilla
  • Form the posterior part of the lateral wall of
    the nasal cavity

12
The Inferior Nasal Conchae
  • Paired
  • Located within the nasal cavity
  • Project medially from the lateral walls of the
    nasal cavity

13
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

14
Nasal Fractures ILateral Blow
  • Cause Lateral force
  • Signs Symptoms
  • Pain
  • Swelling
  • Epistaxis
  • Lacerations
  • Respiratory Obstruction
  • Treatment Emergency care, reduction referral
    if presentation is delayed.

15
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

16
Nasal Fractures IIOther
  • Cause Anterior force
  • Signs Symptoms Similar to lateral blow
    fractures
  • Treatment Require referral for treatment.
    Treatment involves adequate reduction, packing
    (24-48h), and fixation with a plaster cast or
    splint.

17
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

18
Zygomatic Fractures
  • Cause Blunt Force
  • Signs Symptoms
  • Pain
  • Numbness of the cheek, infraorbital region
    upper teeth on injured side
  • Eyelid swelling
  • Inability to close mouth properly
  • Swelling, Edema, Ecchymoses
  • Flattened cheekbone
  • Palpable depression at fracture site
  • Treatment Reduction fixation

19
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

20
Maxillary Fractures
  • Complex, Bilateral fracture that have an unstable
    floating fragment.
  • Classified as LeFort I, II, or III based on the
    plane of the fracture.
  • LeFort I Transmaxillary
  • LeFort II Pyramidal/Subzygomatic
  • LeFort III Craniofacial

Image from http//www.rad.washington.edu/mskbook/f
acialfx.html
21
LeFort I Transmaxillary
  • The fracture occurs along the nasal and maxillary
    floor
  • Almost always involves the pterygoid process of
    the sphenoid bone
  • May involve the maxillary sinuses
  • The resultant floating component is the lower
    part of the maxilla and its teeth

22
LeFort II Pyramidal/Subzygomatic
  • Result from a downward force on the nose
  • The fracture runs from the peak of the nasal bone
    laterally beneath the orbits.

23
LeFort III Craniofacial
  • Most severe
  • Often associated with extensive soft tissue
    injury
  • Large force is necessary to cause this type of
    fracture
  • The resultant floating component is virtually
    the entire face

24
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

25
Blowout Fracture
  • Downward displacement of the orbital floor with
    protrusion of orbital contents into the maxillary
    sinus.
  • Caused by a force applied to the eye, which
    causes an increased intraorbital pressure.
  • The elevated intraorbital pressure causes a
    fracture at the weakest point (posterior medial
    floor)
  • Treatment involves surgical repair of the defect
    in the orbital floor

26
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

27
Frontal Sinus Nasoethmoid
  • Caused by a force applied to the anterior aspect
    of the face
  • Potentially dangerous (sharp edges can penetrate
    dura resulting in leakage of CSF)
  • Treatment is surgical reduction, fixation, and
    repair of any damaged ligaments.

28
Fracture Patterns
  • Nasal
  • Lateral Blow
  • Other
  • Zygomatic
  • Maxilla
  • LeFort I
  • LeFort II
  • LeFort III
  • Blowout
  • Frontal Sinus Nasoethmoid
  • Mandibular

29
Mandibular Fractures (1)
  • Involved in 2/3 of all facial fractures
  • Fractures are classified as open or closed
  • Open With a break in the skin or mucosa
  • Closed No break in the skin or mucosa
  • Described as
  • Oblique
  • Transverse
  • Comminuted
  • Greenstick

30
Mandibular Fractures (2)
  • Signs Symptoms
  • Pain
  • Malocclusion
  • Excessive salivation
  • Dysphagia
  • Swelling
  • Crepitation
  • Discoloration
  • Deformity

31
Approach to a Suspected Fracture
  • History
  • Symptoms
  • Physical Examination
  • Imaging

32
History
  • Cause of Fracture
  • Degree of Force
  • Specific Symptoms
  • Time since injury
  • Allergies
  • Medications
  • Etc.

33
Physical Examination
  • Symmetry/Deformity
  • Lacerations/Abrasions/Ecchymoses
  • Palpable step deformities
  • Orbital rims
  • Zygomatic arches
  • Nose
  • Frontal Bones
  • Mandibular borders
  • Movement of dental arches
  • Fractured/Avulsed/Mobile teeth
  • Visual disturbances
  • Diplopia
  • Reflexes
  • Extraocular muscle function
  • Acuity
  • Fields
  • Intranasal Inspection
  • Hematoma
  • Airway Obstruction
  • CSF rhinorrhea
  • Facial movement (including jaw excursions)
  • Facial sensation

34
Radiographic Examination
  • Structure
  • Mandible
  • Condyle/Coronoid
  • Ramus/Body
  • Condyle Neck
  • Symphysis
  • Symphysis/Body/Ramus
  • Maxilla Zygoma
  • Frontal Orbital Floor
  • Best View
  • Lateral Oblique
  • Waters
  • Reverse Townes
  • Occlusal
  • Panoramic
  • Waters
  • Lateral
  • Caldwell
  • Waters

35
References
  • Grabb, W. Smith,J. (1979). Plastic Surgery (3rd
    Ed.). Little, Brown and Company Boston, MA
  • University of Washington School of
    Medicinehttp//www.rad.washington.edu/mskbook/fac
    ialfx.html
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