INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
• SMELL
• EAT
• SIGHT
• HEAR
• TALK
• BREATHE
www.indiandentalacademy.com

GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Control of infe...
MAXILLOFACIAL INJURIES
TRAUMA: PHYSICAL FORCE RESULTS IN INJURY
2

F = mv

ETIOLOGY
• ASSAULTS
• FALL
• INDUSTRIAL ACCIDEN...
MAXILLOFACIAL INJURIES
SERIOUS TRAUMA :DEATH
TRIMODAL DISTRIBUTION
SECONDS TO MINUTES
MINUTES TO HOURS
(GOLDEN HOUR)
AFTER...
MAXILLOFACIAL INJURIES
GOLDEN HOUR
COMPLICATIONS
UNRECOGNIZED SERIOUS
AIRWAY,HEMMORHAGE
CERVICAL SPINE
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MAXILLOFACIAL INJURIES
GOLDEN HOUR

AIRWAY
BREATHING
CIRCULATION
DEFORMITY
EXPOSURE
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GK / MAXF...
MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
SUCTION
CHIN LIFT JAW THRUST
AIRWAYS
CRICO/TRACHY
OXYGEN
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MAXILLOFACIAL INJURIES
GOLDEN HOUR

BREATHING
CHEST INJURY
Pneumothorax
Cardiac tamponade
Ruptured diaphram
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MAXILLOFACIAL INJURIES
GOLDEN HOUR

CIRCULATION
I.V ACCESS
TRANSFUSION
Hypovolemia-

SHOCK

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G...
MAXILLOFACIAL INJURIES
GOLDEN HOUR: CIRCULATION

Hypovolemic shock
Tachycardia, hypotension
cold clamy skin, loss of perip...
MAXILLOFACIAL INJURIES
GOLDEN HOUR

DISABILITY
patient’s response ‘AVPU’
Awake
Verbal stimuli
Painful stimuli
Unconcious

...
MAXILLOFACIAL INJURIES
Secondary survey
ABDOMEN
Occult blood sequestration
Tenderness / acute abdomen
Gastric decompressio...
MAXILLOFACIAL INJURIES
Secondary survey
EXTREMITIES
Reduced perfusion
Traumatic amputation
Compartmental syndrome
Site for...
MAXILLOFACIAL INJURIES
DIAGNOSIS & TREATMENT PLAN
Eye witness report
Clinical diagnosis (ABCDE)
Neurological examination

...
MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION

Inspection
•
•
•
•
•

Swelling
Hematoma,
Skin lacerations/defects,
Facial ne...
MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION

Palpation
•

Tenderness

•

Crepitation

•

Contour irregularities (step)

•...
MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION

Ear
• Hematoma
• Laceration
• CSF ottohorea
• Tympanic membrane
• Obstructio...
MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION

Eye
• Visual acquity, perception of light
• Position of eye: pupil levels
en...
MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION

Nose

• Swelling
• Septal deviation
• Mobility and crackling
• Mucosal lacer...
MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION

Soft tissues
(contusion

tissue loss)

Foreign bodies
Nerves
Ducts
Blood ves...
MAXILLOFACIAL INJURIES
INTRAORAL EXAMINATION

Inspection
• Asymmetry, Swelling
• Bleeding, Hematoma
• Occlusal plane / Ste...
MAXILLOFACIAL INJURIES
INTRAORAL EXAMINATION

Palpation
• Bimanual
• Tenderness
• # line / Step deformity
• Crepitation
• ...
MAXILLOFACIAL INJURIES
INTRAORAL EXAMINATION

Salivary glands
duct
orifice

Tongue

ventral surface
dorsal surface
movemen...
MAXILLOFACIAL INJURIES
RADIOGRAPHIC EXAMINATION
Based on clinical examination

Plain radiographs
Location & Severity of fr...
MAXILLOFACIAL INJURIES
Classification of fractures
1)Relation to overlying soft tissues
Closed / Simple
Open / Compound
Co...
MAXILLOFACIAL INJURIES
Classification of fractures
3)Type of fracture
Green stick
Single or Multiple
Comminuted

( oblique...
MAXILLOFACIAL INJURIES
Classification of fractures
4) Anatomic site of fracture
Midface
• Frontal bone / sinus
• Zygomatic...
MAXILLOFACIAL INJURIES
Management
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Cont...
MAXILLOFACIAL INJURIES
Classification of fractures
4) Anatomical site of Fracture
Mandible
symphysis
body
ramus
condylar
i...
MAXILLOFACIAL INJURIES
Surgical management
Pan facial trauma 3d reconstruction
AP dimension zygomatic arch
Horizontal dime...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
• Classification
• Applied surgical anatomy
• Clinical features
• Radiological...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
anatomical site

• symphysis
• parasymphysis
• body
• angle
• r...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Displacement of fractured site
favourable / unfavourable
horizo...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Surgical anatomy
Areas of weakness
• teeth
• foramen
• alveolar bone
• angle
•...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Clinical features - Inspection
• Haemorrhage
• Pain
• Swelling
• Altered occlu...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Clinical features - palpation
• Confirm inspectory findings
• Tenderness
• Fra...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Radiographic features
OPG / Lateral oblique
P A mandible
Intra oral occlusal v...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management objectives
RESTORE FORM & FUNCTION
Remember A B C D E
Precise diagn...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

REDUCTION Closed
Advantages
No need for a G.A
Can be used in commi...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

REDUCTION Open
Exposure of fracture skin / mucosa
Direct reduction...
MAXILLOFACIAL INJURIES
Applied anatomy
Muscle attachments:
Depressors
Digastric
geniohyoid
Elevators
temporalis
masseter
m...
MAXILLOFACIAL INJURIES
Mandibular fractures
Classification
Classification
Kazanzian & Converse
Kazanzian & Converse
Class ...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
central support to cheek
buttress of lateral mid 3rd face
Artic...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Processes
Temporal - arch
Orbital - sphenoid
Frontal – external...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY

Arch

Temporal
Zygoma
Maxilla

Muscle attachments
Zygomaticus ...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Mechanism of Injury
Direct & Indirect
Inbending area of impact
Out bend...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Classification
Based on
1 Direction of dislocation
- rotation in severa...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures

Classification

Knight & North (1961)
Group 1
Group 2
Group 3
Group 4
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures

Classification

Rowe & Killey (1968)

Type 1 no significant displaceme...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures

Classification
Rowe & Killey (1968)

Type 5 displacement en bloc
media...
MAXILLOFACIAL INJURIES
ZYGOMATIC COMPLEX FRACTURES
Classification
Applied surgical anatomy
Clinical features
Radiological ...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Flattening of cheeck
Peri orbital edema/echymosis
Sub...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures

Classification

stable fractures:

arch fractures
latreal rotation aro...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features: DIPLOPIA
Downward displacement
Expansion of floor of...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
DIPLOPIA
Whitnall’s tubercle (7mm below FZ suture)
La...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
diplopia
Soft tissue ligaments(Leo Koorneff)
(Connect periosteum & inte...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Enopthalmos
Inferior posterior displacement
Expansion...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Occiputomental view (PNS view, Waters positon)...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management

www.indiandentalacademy.com

GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Mandibular Fractures
Applied anatomy
Curved bone
Thickness of cortices
Neurovascular bundle
Dentiti...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

CLOSED REDUCTION
AIM:Immobilization (IMF)
Direct wiring
Ivy Eylet ...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

Open REDUCTION
Plate & Screw Osteosynthesis
Titanium/Stainless ste...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

Open REDUCTION
Dynamic Compression Plates
Extraoral approach
Bicor...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

Open REDUCTION
Miniplate Osteosynthesis (Champy)
# displacement du...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

Open REDUCTION
Miniplate Osteosynthesis (Champy)
Small malleable p...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

Open REDUCTION
Miniplate Osteosynthesis (Champy)
Based on
Mathemat...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

Open REDUCTION
Miniplate Osteosynthesis (Champy)
Ideal line of ost...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management

OPEN REDUCTION
Miniplate Osteosynthesis (Champy)
Requirements of m...
MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management
OPEN REDUCTION Miniplate Osteosynthesis

Clinical applications
Sym...
MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management
OPEN REDUCTION Miniplate Osteosynthesis

Clinical applications
Cur...
MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management
OPEN REDUCTION Miniplate Osteosynthesis

Clinical applications
Pre...
MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management
OPEN REDUCTION Lag Screw Fixation

Principle
Axial tensile stress ...
MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management
OPEN REDUCTION Lag Screw Fixation
Indiactions : # symphysis / body...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Angle of mandible
Extraoral:Gonion
Intraoral: Junction of alveolar bone and r...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Fracture of angle mandible
Change in direction of grains
Impacted / partially...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Fracture of angle mandible
Displacement of Ramus
(post edentulous fragment)
F...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Fracture of angle mandible
Displacement of Ramus: muscular pull
Elevators: up...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Edentulous mandibles
Mostly simple #s
Usually heals with out complications
Dis...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Edentulous mandibles Treatment Methods
Closed Reduction & Fixation
Intra oral...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Edentulous mandibles Treatment Methods
Open reduction & fixation
Intraosseous...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Condylar Fractures
Always located behind & above lingula
Difficult to diagnos...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Condylar Fractures
mecanism of fracture simplifies diagnosis
2/3rds associate...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Condylar Fractures
Classification
Clinical features
Radiolodical investigatio...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Theraputic & Prognostic indicators
Height
Direction of frac...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES

Condylar Fractures
Classification
Base Intracapsular
Extracapsular(sub condyl...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinial Diagnosis
Height of fracture
Degree of dislocation ...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features
Intracapsular fractures(above lateral pte...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features

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GK / MAXFAC...
www.indiandentalacademy.com

GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Classification :Anatomical site
Etiology

Force >>> Injury
Force=Kinetic energy (K) K=MV2

www.indi...
Thank you
For more details please visit
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Maxillofacial injuries /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Transcript of "Maxillofacial injuries /certified fixed orthodontic courses by Indian dental academy "

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. MAXILLOFACIAL INJURIES • SMELL • EAT • SIGHT • HEAR • TALK • BREATHE www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  3. 3. MAXILLOFACIAL INJURIES Primary management (ABCDE) Neurological assessment (GCS) Control of pain analgesics Control of infection antibiotics Surgical planning GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  4. 4. MAXILLOFACIAL INJURIES TRAUMA: PHYSICAL FORCE RESULTS IN INJURY 2 F = mv ETIOLOGY • ASSAULTS • FALL • INDUSTRIAL ACCIDENTS • RTA • SPORTS INJURIES • WAR INJURIES www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  5. 5. MAXILLOFACIAL INJURIES SERIOUS TRAUMA :DEATH TRIMODAL DISTRIBUTION SECONDS TO MINUTES MINUTES TO HOURS (GOLDEN HOUR) AFTER DAYS www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  6. 6. MAXILLOFACIAL INJURIES GOLDEN HOUR COMPLICATIONS UNRECOGNIZED SERIOUS AIRWAY,HEMMORHAGE CERVICAL SPINE www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  7. 7. MAXILLOFACIAL INJURIES GOLDEN HOUR AIRWAY BREATHING CIRCULATION DEFORMITY EXPOSURE www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  8. 8. MAXILLOFACIAL INJURIES GOLDEN HOUR AIRWAY SUCTION CHIN LIFT JAW THRUST AIRWAYS CRICO/TRACHY OXYGEN www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  9. 9. MAXILLOFACIAL INJURIES GOLDEN HOUR BREATHING CHEST INJURY Pneumothorax Cardiac tamponade Ruptured diaphram www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  10. 10. MAXILLOFACIAL INJURIES GOLDEN HOUR CIRCULATION I.V ACCESS TRANSFUSION Hypovolemia- SHOCK www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  11. 11. MAXILLOFACIAL INJURIES GOLDEN HOUR: CIRCULATION Hypovolemic shock Tachycardia, hypotension cold clamy skin, loss of peripheral pulse, falling urinary output Confusion & disorientation www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  12. 12. MAXILLOFACIAL INJURIES GOLDEN HOUR DISABILITY patient’s response ‘AVPU’ Awake Verbal stimuli Painful stimuli Unconcious www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  13. 13. MAXILLOFACIAL INJURIES Secondary survey ABDOMEN Occult blood sequestration Tenderness / acute abdomen Gastric decompression(N.G tube) Direct peritoneal lavage www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  14. 14. MAXILLOFACIAL INJURIES Secondary survey EXTREMITIES Reduced perfusion Traumatic amputation Compartmental syndrome Site for major blood loss (1-6 units) www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  15. 15. MAXILLOFACIAL INJURIES DIAGNOSIS & TREATMENT PLAN Eye witness report Clinical diagnosis (ABCDE) Neurological examination - G.C.S - Cranial Nerves www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  16. 16. MAXILLOFACIAL INJURIES EXTRAORAL EXAMINATION Inspection • • • • • Swelling Hematoma, Skin lacerations/defects, Facial nerve Mouth opening www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  17. 17. MAXILLOFACIAL INJURIES EXTRAORAL EXAMINATION Palpation • Tenderness • Crepitation • Contour irregularities (step) • Depressed / Penetrating bone www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  18. 18. MAXILLOFACIAL INJURIES EXTRAORAL EXAMINATION Ear • Hematoma • Laceration • CSF ottohorea • Tympanic membrane • Obstruction • Laceration • Haematoma www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  19. 19. MAXILLOFACIAL INJURIES EXTRAORAL EXAMINATION Eye • Visual acquity, perception of light • Position of eye: pupil levels enophthalmos proptosis • Diplopia • Restricted movements www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  20. 20. MAXILLOFACIAL INJURIES EXTRAORAL EXAMINATION Nose • Swelling • Septal deviation • Mobility and crackling • Mucosal lacerations • Epistaxis • CSF Rhinorrhoea • Anosmia? www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  21. 21. MAXILLOFACIAL INJURIES EXTRAORAL EXAMINATION Soft tissues (contusion tissue loss) Foreign bodies Nerves Ducts Blood vessels (remember tetanus) www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  22. 22. MAXILLOFACIAL INJURIES INTRAORAL EXAMINATION Inspection • Asymmetry, Swelling • Bleeding, Hematoma • Occlusal plane / Step deformity • Mucosal lacerations • Teeth: fracture avulsion dislocation www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  23. 23. MAXILLOFACIAL INJURIES INTRAORAL EXAMINATION Palpation • Bimanual • Tenderness • # line / Step deformity • Crepitation • Teeth movement, Number • Missing parts • Sensory distribution of V1V2V3 www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  24. 24. MAXILLOFACIAL INJURIES INTRAORAL EXAMINATION Salivary glands duct orifice Tongue ventral surface dorsal surface movements Hard/Soft palate www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  25. 25. MAXILLOFACIAL INJURIES RADIOGRAPHIC EXAMINATION Based on clinical examination Plain radiographs Location & Severity of fractures Radio-opaque foreign bodies CT scans Intracranial injuries Orbital & naso-ethmoidal injuries www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  26. 26. MAXILLOFACIAL INJURIES Classification of fractures 1)Relation to overlying soft tissues Closed / Simple Open / Compound Complicated 2)Type of fracture Green stick Single Multiple Comminuted www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  27. 27. MAXILLOFACIAL INJURIES Classification of fractures 3)Type of fracture Green stick Single or Multiple Comminuted ( oblique / transverse / sagital & degree of dislocation ) Additional features Pathologic Atrophic Impacted Direct / indirect (contra-coup) Blow out / in www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  28. 28. MAXILLOFACIAL INJURIES Classification of fractures 4) Anatomic site of fracture Midface • Frontal bone / sinus • Zygomatic arch • Zygomatic complex / malar • Orbit • Nose • Naso ethmoidal • Maxilla www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  29. 29. MAXILLOFACIAL INJURIES Management Primary management (ABCDE) Neurological assessment (GCS) Control of pain analgesics Control of infection antibiotics Surgical planning www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  30. 30. MAXILLOFACIAL INJURIES Classification of fractures 4) Anatomical site of Fracture Mandible symphysis body ramus condylar intracapsular parasymphysis angle coronoid (dento) alveolar www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  31. 31. MAXILLOFACIAL INJURIES Surgical management Pan facial trauma 3d reconstruction AP dimension zygomatic arch Horizontal dimension zygoma to FZ suture Anterior vertical dimension frontal bar and NE# Posterior vertical dimension condylar fractures Restore occlusion I.M.F Stabilize mandibular fractures Maxilla at Lefort 1 (teeth bearing) Soft tissue repositioning www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  32. 32. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES • Classification • Applied surgical anatomy • Clinical features • Radiological features • Management immediate definitive • Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  33. 33. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification anatomical site • symphysis • parasymphysis • body • angle • ramus • condyle • coronoid www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  34. 34. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Displacement of fractured site favourable / unfavourable horizontal - vertical # with reference to dentition Dentulous jaw adult / child Edentulous jaw Dentulous jaw with posterior edentulous fragment www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  35. 35. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Surgical anatomy Areas of weakness • teeth • foramen • alveolar bone • angle • ramus • condyle Blood supply Nerve supply www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  36. 36. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Clinical features - Inspection • Haemorrhage • Pain • Swelling • Altered occlusion • Sublingual haemorrhage • Disturbed function • Halitosis • Paresthesia www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  37. 37. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Clinical features - palpation • Confirm inspectory findings • Tenderness • Fracture line/step • Crepitation • Paresthesia • Abnormal mobility www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  38. 38. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Radiographic features OPG / Lateral oblique P A mandible Intra oral occlusal view Confirms Site and severity of # Direction & displacement of # Condition of teeth in line of # Presence of bony pathology www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  39. 39. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management objectives RESTORE FORM & FUNCTION Remember A B C D E Precise diagnosis Early reduction Adequate fixation and immobilization Rehabilitation /restoration of functionGK / MAXFAC www.indiandentalacademy.com SDM DHARWAD
  40. 40. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Closed Advantages No need for a G.A Can be used in comminuted # Continuity defects ( missile injuries) Disadvantages Accuracy of reduction ambiguous Poor fracture allignment Innadequate reduction www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  41. 41. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Open Exposure of fracture skin / mucosa Direct reduction and fixation Transoseous Wiring Plate & Screw Osteosynthesis www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  42. 42. MAXILLOFACIAL INJURIES Applied anatomy Muscle attachments: Depressors Digastric geniohyoid Elevators temporalis masseter medial pterygoid www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  43. 43. MAXILLOFACIAL INJURIES Mandibular fractures Classification Classification Kazanzian & Converse Kazanzian & Converse Class II Teeth on both segments Class Teeth on both segments Class II teeth on onw segment Class II teeth on onw segment Class III Edentulous Class III Edentulous Rowe & Lilley Rowe & Lilley #s involving the basal bone #s involving the basal bone #s not involving the basal bone #s not involving the basal bone favourable // unfavourable favourable unfavourable www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  44. 44. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY central support to cheek buttress of lateral mid 3rd face Articulations Zygomatico frontal Infra orbital rim Zygomatico maxillary Zygomatico temporal (arch) Zygomatico sphenoid(orbital floor) www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  45. 45. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Processes Temporal - arch Orbital - sphenoid Frontal – external angular process Maxillary - infra orbital rim lateral wall and floor orbit roof and lateral wall maxillary sinus www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  46. 46. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Arch Temporal Zygoma Maxilla Muscle attachments Zygomaticus major/minor: malar eminenece Levator labi superioris:infraorbital rim Masseter : arch & Tuberosity www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  47. 47. MAXILLOFACIAL INJURIES Zygomatic complex fractures Mechanism of Injury Direct & Indirect Inbending area of impact Out bending of weak areas (distant) # always includes floor discontinuity Dislocation posterior inferior medial lateral www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  48. 48. MAXILLOFACIAL INJURIES Zygomatic complex fractures Classification Based on 1 Direction of dislocation - rotation in several planes 2 Success of reduction - intact buttress - stability Rotation: vertical & longitudinal Displacement : medial , lateral posterior, inferior www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  49. 49. MAXILLOFACIAL INJURIES Zygomatic complex fractures Classification Knight & North (1961) Group 1 Group 2 Group 3 Group 4 Group 5 Group 6 no significant displacement arch fractures unrotated body fractures medial rotation lateral rotation complex fractures www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  50. 50. MAXILLOFACIAL INJURIES Zygomatic complex fractures Classification Rowe & Killey (1968) Type 1 no significant displacement Type 2 arch fractures Type 3 rotation vertical axis: internal external Type 4 rotation longitudinal axis: medial www.indiandentalacademy.com lateral GK / MAXFAC SDM DHARWAD
  51. 51. MAXILLOFACIAL INJURIES Zygomatic complex fractures Classification Rowe & Killey (1968) Type 5 displacement en bloc medial inferior lateral Type 6 depression in orbito-antral portion inferior superior Type 7 orbital rim segment Type 8 complex www.indiandentalacademy.com # comminuted GK / MAXFAC SDM DHARWAD
  52. 52. MAXILLOFACIAL INJURIES ZYGOMATIC COMPLEX FRACTURES Classification Applied surgical anatomy Clinical features Radiological features Management immediate defnitive Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  53. 53. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Flattening of cheeck Peri orbital edema/echymosis Subconjunctival haemorrhage Epistaxis Paresthesia (V2) Trismus Tenderness/step deformity DIPLOPIA www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  54. 54. MAXILLOFACIAL INJURIES Zygomatic complex fractures Classification stable fractures: arch fractures latreal rotation around vertical axis posterior displacement unstable fractures: medial rotation around longitudinal axis medial, lateral or inferior displacement complex fractures www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  55. 55. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features: DIPLOPIA Downward displacement Expansion of floor of orbit Contusion of extra occular muscles / fat Haematoma / edema in orbital soft tissue Floor /Medial wall incarceration ‘Blow out Fractures of orbit’ www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  56. 56. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features DIPLOPIA Whitnall’s tubercle (7mm below FZ suture) Lateral canthal ligament Lockwoods suspensory ligament Lateral horn of levator Downward displacement Expansion of floor of orbit www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  57. 57. MAXILLOFACIAL INJURIES Zygomatic complex fractures diplopia Soft tissue ligaments(Leo Koorneff) (Connect periosteum & interlace soft tissue to muscle and globe) Incarceration to # fragments Impaired extra occular muscle motion www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  58. 58. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Enopthalmos Inferior posterior displacement Expansion of globe Migration of soft tissue (medial inferior & lateral) Exopthalmos Medial dislocations www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  59. 59. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Occiputomental view (PNS view, Waters positon) Fronto zygomatic suture zygomatico maxillary buttress infrior orbital rim Submeto-vertex view (jug handle view) Zygomatic arch Posterior displacement C.T Scans axial coronal www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  60. 60. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  61. 61. MAXILLOFACIAL INJURIES Mandibular Fractures Applied anatomy Curved bone Thickness of cortices Neurovascular bundle Dentition Attachment of Muscles www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  62. 62. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management CLOSED REDUCTION AIM:Immobilization (IMF) Direct wiring Ivy Eylet wiring Arch Bar Wiring Extra oral pin fixation www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  63. 63. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Plate & Screw Osteosynthesis Titanium/Stainless steel Compression plates Mini plates Lag Screw www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  64. 64. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Dynamic Compression Plates Extraoral approach Bicortical Screws Excentric/neutral holes Gap at upper border – tension band Direct healing no callus www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  65. 65. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Miniplate Osteosynthesis (Champy) # displacement due to muscles Biomechanical solution neutralization of unfavourable forces Mechanical charecteristics Contain forces of muscles GK / MAXFAC SDM DHARWAD Adequately rigid www.indiandentalacademy.com
  66. 66. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Miniplate Osteosynthesis (Champy) Small malleable plate Trans oral approach Monocortical fixation Defined osteosynthesis line Physiological tension zone GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com No post op IMF
  67. 67. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Miniplate Osteosynthesis (Champy) Based on Mathematical model of mandible Reactive bite forces Strains created by muscular activity Flexion - upper part of mandible GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com Torsion - canine
  68. 68. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Miniplate Osteosynthesis (Champy) Ideal line of osteosynthesis Anatomy of mandilbe Location of teeth apices Cortical thickness Line of tension at base of alveolus www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  69. 69. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis (Champy) Requirements of miniplate Neutralize Induced tension / torsion forces Behind mental foramen 1 plate subapically Anterior to mental foramen 2 plates Higher torsion forces www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  70. 70. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis Clinical applications Symphysis/Parasymphysis/body/angle G.A - Nasal Intubation Eylets / Archbars Temp IMF Intraoral Approach Exposure of fracture site(s) www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  71. 71. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis Clinical applications Curretage (haematoma) Reduction of Fracture Temporary Imobilization (IMF) Mini plate application & fixation Debridiment & removal of IMF Recheck occlusion & Clossure www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  72. 72. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis Clinical applications Precautions Protect mental nerve and soft tissues Position plates below apices of teeth Longer plates for comminuted #s Release IMF & recheck occlusion www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  73. 73. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Lag Screw Fixation Principle Axial tensile stress of screw transformed to Compressive stress on fracture site Near Fragment supported by screw head Distant fragment pulled by screw thread Axial compression of # site www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  74. 74. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Lag Screw Fixation Indiactions : # symphysis / body / angle Requirements: reliable cortical anchoring strong cortical surface Limitations: # localization soft tissue & nerves www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  75. 75. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Angle of mandible Extraoral:Gonion Intraoral: Junction of alveolar bone and ramus In fracture of angle mandible Greater fragment :teeth bearing segment Lesser fragment: ramus www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  76. 76. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Fracture of angle mandible Change in direction of grains Impacted / partially errupted 3rd molars Pterygo masseteric sling “Direction of fracture line determines degree of displacement of ramus” www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  77. 77. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Fracture of angle mandible Displacement of Ramus (post edentulous fragment) Favourable: Minimal displacement Unfavourable: Gross displacement Viewed from side: Horizontal Viewed from above: Vertical www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  78. 78. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Fracture of angle mandible Displacement of Ramus: muscular pull Elevators: upward forward medial Deprsessors: downwards backwards Masseter / Medial pterygoid Temporalis / mylohyoid www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  79. 79. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Edentulous mandibles Mostly simple #s Usually heals with out complications Displacement of # fragments variable Classification(Luhr et al) according to height of bone Class 1 : 16 - 20mm Class2 : 11- 15mm Class3 : less than 10mm www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  80. 80. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Edentulous mandibles Treatment Methods Closed Reduction & Fixation Intra oral apliances: gunning splints dentures trimmed & relined (stabilized with Circumfrential wiring) Extraoral pin fixation Immobilization period 4-6 weeks www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  81. 81. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Edentulous mandibles Treatment Methods Open reduction & fixation Intraosseous wiring Primary rib grafting Reconstruction plate In bilateral body #s ( bucket handle # ) Precautions Avoid excessive periosteal stripping www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  82. 82. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Always located behind & above lingula Difficult to diagnose Treatment Methods differ - access - growth centre www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  83. 83. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures mecanism of fracture simplifies diagnosis 2/3rds associated with other fractures Indirect injury - chin Direct injury - Zygoma www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  84. 84. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Clinical features Radiolodical investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  85. 85. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Theraputic & Prognostic indicators Height Direction of fracture line Degree of displacement Classification (height) Intracapsular Extracapsular(sub condylar): High Low Base www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  86. 86. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Base Intracapsular Extracapsular(sub condylar): High, Low, Base www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  87. 87. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinial Diagnosis Height of fracture Degree of dislocation of fragment Fracture gap at attachment of Lateral Pterygoid www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  88. 88. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features Intracapsular fractures(above lateral pterygoid) Tenderness in articular region Painful limitation in mouth opening Occlusal derangement – posturing and deviation to healthy side (due to edema & pain) www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  89. 89. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  90. 90. www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  91. 91. MAXILLOFACIAL INJURIES Classification :Anatomical site Etiology Force >>> Injury Force=Kinetic energy (K) K=MV2 www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  92. 92. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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