Maxillofacial Trauma

6,655 views
6,296 views

Published on

Published in: Health & Medicine, Education
13 Comments
56 Likes
Statistics
Notes
No Downloads
Views
Total views
6,655
On SlideShare
0
From Embeds
0
Number of Embeds
193
Actions
Shares
0
Downloads
0
Comments
13
Likes
56
Embeds 0
No embeds

No notes for slide

Maxillofacial Trauma

  1. 1. Maxillofacial Trauma El-Hawary
  2. 2. Maxillofacial Trauma El-Hawary
  3. 3. Maxillofacial Trauma El-Hawary DEFINITION
  4. 4. Maxillofacial Trauma El-Hawary Trauma Serious injury or shock to the body as form of violence or accident Bone fracture A medical condition in which there is a break in the continuty of bone
  5. 5. Maxillofacial Trauma El-Hawary CLASSIFICATIONS
  6. 6. Maxillofacial Trauma El-Hawary • Soft tissue wounds • Soft tissue wounds and fracture bones • Bone fractures only
  7. 7. Maxillofacial Trauma El-Hawary WOUNDS • Type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound) • In pathology: it specifically refers to a sharp injury which damages the dermis of the skin
  8. 8. Maxillofacial Trauma El-Hawary
  9. 9. Maxillofacial Trauma El-Hawary Classifications of wounds wound According to the exposure to the outer environement According to level of risk of sepsis
  10. 10. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury
  11. 11. Maxillofacial Trauma El-Hawary Classification according to object causing wound wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury
  12. 12. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury
  13. 13. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury
  14. 14. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury
  15. 15. Maxillofacial Trauma El-Hawary wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury Classification according to object causing wound
  16. 16. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://woundbegone.blogdrive.com/
  17. 17. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://en.wikipedia.org/wiki/File:Knee_puncture.JPG
  18. 18. Maxillofacial Trauma El-Hawary Classification according to object causing wound wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://journal.nzma.org.nz/journal/120-1267/2867/
  19. 19. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://www.podiatrytoday.com/article/6303
  20. 20. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury
  21. 21. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://en.wikipedia.org/wiki/File:Bruises.jpg
  22. 22. Maxillofacial Trauma El-Hawary Classification according to the exposure to the outer environment wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://www.buzzle.com/articles/hematoma-treatment.html
  23. 23. Maxillofacial Trauma El-Hawary Classification according to object causing wound wound Open Incision Laceration Abrasion Puncture Penetration Gunshot Closed Contusion Hematoma Crush injury http://www.smrteam.com/na1_crushinjury.htm
  24. 24. Maxillofacial Trauma El-Hawary Classification According to level of risk of sepsis
  25. 25. Maxillofacial Trauma El-Hawary Classification According to level of risk of sepsis wound Clean wound Clean contaminated wounds Contaminated wounds Dirty wounds
  26. 26. Maxillofacial Trauma El-Hawary Classification According to level of risk of sepsis wound Clean wound Clean contaminated wounds Contaminated wounds Dirty wounds • No viscus entered • No septic area • No break in aseptic technique • Such wounds should never become infected; infection rates less than 3%
  27. 27. Maxillofacial Trauma El-Hawary Classification According to level of risk of sepsis wound Clean wound Clean contaminated wounds Contaminated wounds Dirty wounds • Operation enters a non-infected area but may encounter bacteria • Careful control of the area should result in minimal spillage of organisms • Examples of this include surgery on the upper gastrointestinal tract, biliary tree or respiratory tract • Infection rates for this type of surgery should be less than 10%
  28. 28. Maxillofacial Trauma El-Hawary Classification According to level of risk of sepsis wound Clean wound Clean contaminated wounds Contaminated wounds Dirty wounds • Gross spillage of organisms, where there is infection already present but without pus formation • There is a major break in aseptic technique • There is an open wound that has been exposed for less than 4 h (e.g. following major trauma) • In this type of wound, sepsis frequently exceeds 30%
  29. 29. Maxillofacial Trauma El-Hawary Classification According to level of risk of sepsis wound Clean wound Clean contaminated wounds Contaminated wounds Dirty wounds • This is an operation through an infected area (e.g. perforated viscus, abscess or traumatic wound) that has been exposed for over 4 h
  30. 30. Maxillofacial Trauma El-Hawary Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 month
  31. 31. Maxillofacial Trauma El-Hawary Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture
  32. 32. Maxillofacial Trauma El-Hawary Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture
  33. 33. Maxillofacial Trauma El-Hawary Differences between primary and secondary healing Feature Primary healing Secondary healing Cleanness Clean Unclean Infection Generally uninfected May be infected Margins Surgically clean Irregular Healing Scanty granulation tissue Granulation tissue fill the gap Healing period Short long Healing direction Direct healing From the bottom to the edge Outcome Neat linear scar Contracted irregular wound
  34. 34. Maxillofacial Trauma El-Hawary Normal sequence of wound healing
  35. 35. Maxillofacial Trauma El-Hawary Normal sequence of wound healing Phases of wound healing Days Weeks Months Hemostasis
  36. 36. Maxillofacial Trauma El-Hawary Normal sequence of wound healing Phases of wound healing Days Weeks Months Hemostasis Inflammation
  37. 37. Maxillofacial Trauma El-Hawary Normal sequence of wound healing Phases of wound healing Days Weeks Months Hemostasis Inflammation Proliferation
  38. 38. Maxillofacial Trauma El-Hawary Normal sequence of wound healing Phases of wound healing Days Weeks Months Hemostasis Inflammation Proliferation Maturation & Remodeling
  39. 39. Maxillofacial Trauma El-Hawary http://en.wikipedia.org/wiki/File:Wound_healing_phases.png
  40. 40. Maxillofacial Trauma El-Hawary Factors affecting healing Factors Local factors Wound sepsis Blood supply Wound tension Foreign bodies Previous irradiation Poor technique Systemic factors Nutritional deficiencies Systemic diseases Therapeutic agents Age
  41. 41. Maxillofacial Trauma El-Hawary Complications of wound healing
  42. 42. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures
  43. 43. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures • Treatment • Prophylactic antibiotics • Empirical antibiotic • Therapeutic /specific antibiotics • I&D • Antiseptic packs
  44. 44. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures • Definition: Total breakdown of all the layers of the surgical repair of a wound • Etiology / causes: • Suture breakage • Knot slippage • Cutting out of sutures • Excess tension on the suture line © 2009 Nucleus Medical Art, Inc. http://www.empowher.com/media/reference/wound-dehiscence
  45. 45. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures • Definition: Breakdown of the deeper layers of a wound in which the skin layer remains intact with protrusion of underlying structures through the deeper defect http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional_her nia/info-incisional-hernia-gen-1.htm
  46. 46. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures • Treatment: • Difficult • Further surgery should not be attempted for at least 6 months • Excision of the scar and re-suturing often has disappointing results, resulting in the same over healing • Radiotherapy used to be used but has now been abandoned • Some improvement can be achieved with local injection of corticosteroids directly into the scar, a process that might need repeating several times http://www.ehow.com/about_5422431 _natural-herbs-hypertrophic-scars.html
  47. 47. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures • Treatment: • Excision generally results in a larger recurrence • Although excision followed by compression bandaging can have slightly better results • Corticosteroid injections give some improvement
  48. 48. Maxillofacial Trauma El-Hawary Complications of wound healing complications Infection Dehiscence Incisional Hernia Hypertrophic scaring Keloid scarring Contractures • Wound Contractures can occur with any wounds • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement • Surgical treatment include • Skin grafting • local flaps • wound Z-plasty http://www.patient.co.uk/health/D upuytren%27s-Contracture.htm
  49. 49. Maxillofacial Trauma El-Hawary SKELETAL TRAUMA
  50. 50. Maxillofacial Trauma El-Hawary ETIOLOGY
  51. 51. Maxillofacial Trauma El-Hawary • Motor vehicle accidents (MVA) • War injuries • Civilian accidents • Falls, altercations • Animal bites or kicks (dogs, horses, camels) • Pathological • Iatrogenic
  52. 52. Maxillofacial Trauma El-Hawary EMERGENCY
  53. 53. Maxillofacial Trauma El-Hawary First Aid Treatment • Airway • Breathing • Circulation • Drugs
  54. 54. Maxillofacial Trauma El-Hawary First Aid Treatment Airway management
  55. 55. Maxillofacial Trauma El-Hawary DIAGNOSIS
  56. 56. Maxillofacial Trauma El-Hawary Clinical Examination Radiographic Evaluation Advanced diagnostic History Diagnosis
  57. 57. Maxillofacial Trauma El-Hawary Clinical Examination Inspection Palpation Auscultation
  58. 58. Maxillofacial Trauma El-Hawary Clinical Examination Inspection Palpation Bimanual Bidigital Auscultation
  59. 59. Maxillofacial Trauma El-Hawary Clinical Examination • Systemic examination: - Vital signs - Level of consciousness - CNS - CSF leakage
  60. 60. Maxillofacial Trauma El-Hawary Clinical Examination • Signs & Symptoms: - Ecchymosis - Edema - Soft tissue wounds - Malocclusion - Trismus - Segment mobility - Steps or deformities
  61. 61. Maxillofacial Trauma El-Hawary
  62. 62. Maxillofacial Trauma El-Hawary
  63. 63. Maxillofacial Trauma El-Hawary
  64. 64. Maxillofacial Trauma El-Hawary Radiographic evaluation Plain Radiography IntraOral Techniques ExtraOral Techniques Advanced Radiographic Techniques
  65. 65. Maxillofacial Trauma El-Hawary Techniques Plain Radiography IntraOral Techniques ExtraOral Techniques Advanced Radiographic Techniques 1. Periapical Radiograph 2. Occlusal Radiograph
  66. 66. Maxillofacial Trauma El-Hawary Techniques Plain Radiography IntraOral Techniques ExtraOral Techniques Advanced Radiographic Techniques 1. Panoramic Radiograph 2. PA Radiograph 3. Occlusal Radiograph 4. Lateral Radiograph 5. Lateral Oblique
  67. 67. Maxillofacial Trauma El-Hawary Techniques Plain Radiography Advanced Radiographic Techniques 1. CT Scanning 2. Dental CT scaning 3. Cone Beam CT Scanning
  68. 68. Maxillofacial Trauma El-Hawary Advanced Diagnostic Modalities 1. MRI 2. Ultrasonography 3. SPECT
  69. 69. Maxillofacial Trauma El-Hawary II. Radiographic Examination
  70. 70. Maxillofacial Trauma El-Hawary
  71. 71. Maxillofacial Trauma El-Hawary
  72. 72. Maxillofacial Trauma El-Hawary
  73. 73. Maxillofacial Trauma El-Hawary
  74. 74. Maxillofacial Trauma El-Hawary
  75. 75. Maxillofacial Trauma El-Hawary
  76. 76. Maxillofacial Trauma El-Hawary
  77. 77. Maxillofacial Trauma El-Hawary
  78. 78. Maxillofacial Trauma El-Hawary
  79. 79. Maxillofacial Trauma El-Hawary
  80. 80. Maxillofacial Trauma El-Hawary
  81. 81. Maxillofacial Trauma El-Hawary
  82. 82. Maxillofacial Trauma El-Hawary
  83. 83. Maxillofacial Trauma El-Hawary
  84. 84. Maxillofacial Trauma El-Hawary TYPES
  85. 85. Maxillofacial Trauma El-Hawary Dentoalveolar Fractures
  86. 86. Maxillofacial Trauma El-Hawary Dentoalveolar Fractures • Ellis Classification: I. Fx within enamel II. Fx of enamel & dentin III. Fx involving pulp IV. Root fx
  87. 87. Maxillofacial Trauma El-Hawary Dentoalveolar Fractures 1. Periodontal Injuries: i. Concussion ii. Displacement (Luxation) a. Subluxation b. Intrusive luxation c. Extrusive luxation d. Lateral luxation e. Avulsion 2. Fx of the Alveolar Process
  88. 88. Maxillofacial Trauma El-Hawary Mandibular Fractures
  89. 89. Maxillofacial Trauma El-Hawary Mandibular Fractures • Classification: I. According to Site: a. Symphyseal b. Parasymphyseal c. Body d. Angle e. Ramus f. Condyle g. Coronoid
  90. 90. Maxillofacial Trauma El-Hawary Mandibular Fractures • Classification: I. According to Site: a. Symphyseal b. Parasymphyseal c. Body d. Angle e. Ramus f. Condyle g. Coronoid
  91. 91. Maxillofacial Trauma El-Hawary Anatomical distribution and frequency of mandible fractures (Haug, Parather, Indresano, 1990)
  92. 92. Maxillofacial Trauma El-Hawary Mandibular Fractures • Classification: II. According to Side: a. Unilateral b. Bilateral III. According to number of lines: a. Single b. Multiple
  93. 93. Maxillofacial Trauma El-Hawary Mandibular Fractures • Classification: IV. According to nature of fracture: a. Green stick b. Simple c. Compound d. Comminuted
  94. 94. Maxillofacial Trauma El-Hawary Mandibular Fractures • Classification: V. According to degree of displacement: a. Favorable fractures b. Unfavorable fractures
  95. 95. Maxillofacial Trauma El-Hawary Factors affecting the displacement of fracture • Direction of the fracture line (favorable/unfavorable) • Direction of muscle pull (elevators/depressors) • Presence/absence of teeth • Direction and magnitude of the traumatizing force
  96. 96. Maxillofacial Trauma El-Hawary
  97. 97. Maxillofacial Trauma El-Hawary
  98. 98. Maxillofacial Trauma El-Hawary Champy’s principles
  99. 99. Maxillofacial Trauma El-Hawary Condylar Fractures
  100. 100. Maxillofacial Trauma El-Hawary Classification of the TMJ region injury 1. Contusion : - Damage to the capsular ligaments - May be accompanied by : Synovial effusion. (Rowe & Kelly,2nd ed,1970) Haemarthrosis. (Bosanquet et al., 1990, Jones et al., 1991) Tearing of the meniscus &/or displacement of the articular disk. (Faustia et al., 1990) 2. Dislocation : (Sullivan et al., 1995) - Irreducible displacement of the condoyle from the glenoid fossa. - Direction of displacement: Anterior, medial (usually). Lateral, posterior or central (rare). 3. Fracture: - Any fracture above the level of the segmoid notch. - It may be: intracapsular i.e. within the capsule involving the condylar head or neck. extracapsular i.e. outside the capsule in the subcondylar region.
  101. 101. Maxillofacial Trauma El-Hawary Classification of Condylar fracture (Lindahl, 1977) A. Classification according to the fracture level: 1. Condylar head (Intracapsular). 2. Condylar Neck. 3. Subcondylar (high or low). B. Classification according to the relation of condyle to Mandible: 1. Non displaced. 2. Deviated or angulated. 3. Displaced ( M or L/A or P overlap). 4. No bony contact. C. Classification according to the relation of condyle to the Glenoid Fossa: 1. Non Displaced. 2. Displaced-still related to fossa. 3. Dislocation-completely out of fossa.
  102. 102. Maxillofacial Trauma El-Hawary Mechanism of injury  Provide clues about the magnitude and direction of force delivered to the patient.  The more force delivered, the more severe the fracture.  The direction of force influence the fracture pattern. (Spina & Marciani, 2000) Forces resulting in Trauma to the TMJ: 1. Moving object striking a static individual. 2. Moving individual striking a static object. 3. Combination of forces.
  103. 103. Maxillofacial Trauma El-Hawary Maxillary Fractures
  104. 104. Maxillofacial Trauma El-Hawary Maxillary Fractures • Classification: – LeForte I (Transverse fracture): Transversely through maxilla above teeth level, lateral antral wall, lower pterygoid plates.
  105. 105. Maxillofacial Trauma El-Hawary Maxillary Fractures • Classification: – LeForte II (pyramidal fracture): Nasal bone, maxillary frontal process, lacrimal bone, inf. orbital rim, Zygomaticomaxillary suture, lat. maxillary wall, pterygoid plates, pterygomaxillary fossa.
  106. 106. Maxillofacial Trauma El-Hawary Maxillary Fractures • Classification: – LeForte III (craniofacial dysjunction): Zygomaticofrontal, maxillofrontal and nasofrontal sutures
  107. 107. Maxillofacial Trauma El-Hawary Zygomatic fractures
  108. 108. Maxillofacial Trauma El-Hawary
  109. 109. Maxillofacial Trauma El-Hawary TREATMENT
  110. 110. Maxillofacial Trauma El-Hawary • The aim of mandibular fracture treatment is – Reduction • Restoration of anatomical form • Restoration of function • Establish proper occlusion – Fixation Immobilization – Stabilization – Prevention of infection
  111. 111. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation
  112. 112. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed
  113. 113. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigidSemi-rigid
  114. 114. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Semi-rigid
  115. 115. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Semi-rigid Plates and osteosynthesis Screws osteosynthesis K-wires
  116. 116. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Semi-rigid
  117. 117. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Semi-rigid Mini-plates osteosynthesis
  118. 118. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Semi-rigid Wire osteosynthesis
  119. 119. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Semi-rigid Closed reduction Rigid fixation
  120. 120. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Semi-rigid Closed reduction Rigid fixation External pin fixation
  121. 121. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Closed reduction Semi-rigid fixation Semi-rigid Closed reduction Rigid fixation
  122. 122. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Closed reduction Semi-rigid fixation Semi-rigid Closed reduction Rigid fixation Lingual splint
  123. 123. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Closed reduction Semi-rigid fixation Semi-rigid Closed reduction Rigid fixation Closed reduction Non-rigid fixation
  124. 124. Maxillofacial Trauma El-Hawary Treatment Reduction Fixation Open Closed Rigid Non-rigid Open reduction Rigid fixation Open reduction Semi-Rigid fixation Open reduction Non-Rigid fixation Closed reduction Semi-rigid fixation Semi-rigid Closed reduction Rigid fixation Closed reduction Non-rigid fixation Wiring techniques MMF
  125. 125. Maxillofacial Trauma El-Hawary
  126. 126. Maxillofacial Trauma El-Hawary Rigid versus Non-rigid Fixation
  127. 127. Maxillofacial Trauma El-Hawary Advantages of Rigid Fixation 1. Pts with poor or inadequate dentition 2. Avoidance of debilitating weight loss 3. No interference with speech 4. Suitable for pts with seizures or alcoholism 5. Immediate return to work and normal life style 6. Risk of infection reduced
  128. 128. Maxillofacial Trauma El-Hawary Advantages of Rigid Fixation 7. Avoidance of TMJ disturbance especially in cases with condylar fracture 8. Fewer complications as non- or malunion (1ry rather than 2ry bone healing) 9. Safer airway and decreased risk of aspiration 10. Allows for proper oral hygiene 11. Ability to obtain and maintain precise anatomic reduction of fractured segments
  129. 129. Maxillofacial Trauma El-Hawary Effects of Intermaxillary Fixation • On the following tissues – Muscles – TMJ – Bone – Periarticular C.T.
  130. 130. Maxillofacial Trauma El-Hawary Factors affecting the selection of the Surgical approaches for open reduction 1. The level of the fracture. 2. The degree of displacement or dislocation. 3. The planned method of the fixation. 4. Langer’s lines
  131. 131. Maxillofacial Trauma El-Hawary http://www.beltina.org/health-dictionary/langers-lines-skin.html
  132. 132. Maxillofacial Trauma El-Hawary http://hi.baidu.com/hilygogo/blog/item/35cbe8f0db3a7baba50f5271.html
  133. 133. Maxillofacial Trauma El-Hawary Factors affecting the selection of the line of treatment 1. Factors related to the patient – Age of the patient. – Well – Systemic condition 2. Factors related to the fracture – Site, type and level of fracture. – Degree of displacement. – Condition of the post injury occlusion. 3. Factors related to the operator 1. Conditions 2. Skill 3. Armamentarium
  134. 134. Maxillofacial Trauma El-Hawary TREATMENT MODALITIES
  135. 135. Maxillofacial Trauma El-Hawary
  136. 136. Maxillofacial Trauma El-Hawary
  137. 137. Maxillofacial Trauma El-Hawary
  138. 138. Maxillofacial Trauma El-Hawary
  139. 139. Maxillofacial Trauma El-Hawary
  140. 140. Maxillofacial Trauma El-Hawary
  141. 141. Maxillofacial Trauma El-Hawary
  142. 142. Maxillofacial Trauma El-Hawary
  143. 143. Maxillofacial Trauma El-Hawary
  144. 144. Maxillofacial Trauma El-Hawary
  145. 145. Maxillofacial Trauma El-Hawary
  146. 146. Maxillofacial Trauma El-Hawary Fixation of Mandibular Fractures II. Open Reduction Techniques (direct fixation techniques) ORIF: 1. Non-rigid: (needs supplementary fixation, IMF) a. Transosseous (intraosseous) wiring
  147. 147. Maxillofacial Trauma El-Hawary Fixation of Mandibular Fractures II. Open Reduction Techniques (direct fixation techniques) ORIF: 2. Rigid: (sole fixation methods) a. Intramedullary Pinning: Kirchner wires, Steinmann pins. b. Metal Mesh plates: Titanium mesh c. Bone plates and screws: mono- or bicortical d. Lag Screws e. Biodegradable (resorbable) bone screws f. Bone Clamps
  148. 148. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF:
  149. 149. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF:
  150. 150. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone plates:
  151. 151. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone plates:
  152. 152. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone plates:
  153. 153. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone plates:
  154. 154. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone plates:
  155. 155. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone plates:
  156. 156. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Lag screws:
  157. 157. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Lag screws:
  158. 158. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Biodegradable plates:
  159. 159. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone clamps:
  160. 160. Maxillofacial Trauma El-Hawary Open Reduction Techniques (direct fixation techniques) ORIF: • Bone clamps:
  161. 161. Maxillofacial Trauma El-Hawary Treatment of Maxillary Fractures
  162. 162. Maxillofacial Trauma El-Hawary Treatment of Maxillary Fractures
  163. 163. Maxillofacial Trauma El-Hawary Treatment of Maxillary Fractures
  164. 164. Maxillofacial Trauma El-Hawary Treatment of Maxillary Fractures
  165. 165. Maxillofacial Trauma El-Hawary Treatment of Maxillary Fractures
  166. 166. Maxillofacial Trauma El-Hawary Condylar Fx Treatment modalities Treatment modalities Conservative treatment Open reduction Close Observation Closed reduction
  167. 167. Maxillofacial Trauma El-Hawary Observation Indications: - Well aligned segments (no displacement). - Repeatable occlusion without pain. - Children under 12 years of age, with minimal fracture displacement and normal occlusion. Technique: - Clinical observation. - Soft diet. - Active function. - Physiotherapy.
  168. 168. Maxillofacial Trauma El-Hawary Closed reduction Indications: - Correctable Malocclusion. - Deviation of the mandible with function. - Pain. Technique: - Immobilization (7-21 days) in the form of arch bars, Ivy loops or individual wiring followed by active mobilization and physiotherapy. - Period of immobilization depend on: Age of the patient. Level of fracture. Degree of displacement.
  169. 169. Maxillofacial Trauma El-Hawary Indications for open reduction (Zide & Kent, 1983) Absolute indications Relative indications 1. Bilateral condylar fracture with concomitant comminuted midfacial fracture. 2. Bilateral condylar fracture in an edentulous patient when splints are unavilable or imposible because of sever ridge atrophy. 3. Displaced condyle in an medically compromised patient where MMF is contraindicated. 1. Inability to obtain adequate occlusion with closed reduction. 2. Displacement of the condyle into the middle cranial fossa. 3. Lateral extracapsular displacement. 4. Foreign body in the joint capsule.
  170. 170. Maxillofacial Trauma El-Hawary Summary of treatment
  171. 171. Maxillofacial Trauma El-Hawary Management of condylar fractures in children According to the degree of displacement:  Undisplaced / minimally displaced condylar fractures: Conservative non immobilization with active function.  Severly displaced with malocclusion: 7:10 days immobilization followed up by acyive function and physiotherapy.
  172. 172. Maxillofacial Trauma El-Hawary Postoperative instructions /medications • Good oral hygiene – Teeth brushing – Rinse utilizing warm saline and mouth wash • Semi-solid feeding was ordered for the patients on the second postoperative day and until the end of MMF period. • Prophylactic Antibiotics-one week postoperatively • Anti-edemic • Analgesics
  173. 173. Maxillofacial Trauma El-Hawary THANK YOUTHANK YOU

×