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Maxillofacial Trauma Readiness
Briefing
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacadem...
Maxillofacial Trauma
Readiness Training
for
Dental Officers

www.indiandentalacademy.com
Maxillofacial Trauma
Evaluation and Management

www.indiandentalacademy.com
Maxillofacial Injuries
• Treatment divided into following
phases
Emergency or initial care
Early care
Definitive care
...
Emergency Care
•
•
•
•
•

Preserve the airway
Control of hemorrhage
Prevent or control shock
C-Spine stabilization
Control...
Emergency Care
• Evaluate the airway
Existence & identification of obstruction
Manually clear of fractured teeth, blood
...
Emergency Care
• Airway Management
Maintain an intact airway
Protect airway in jeopardy
Provide an airway

• C-Spine in...
Airway Management
• Chin lift to open intact
airway
• Intubation
Oral: C-spine injury
absent on X ray
Nasotracheal intub...
Emergency Care
• Extensive vascularity of head & neck
may lead to massive blood loss
Monitor vital signs closely
Intrave...
Treatment of Blood Loss & Shock
• Hemorrhage most common cause of
shock after injury
• Multiple injury patients
have hypov...
Treatment of Blood Loss & Shock
• External bleeding controlled by
direct pressure over bleeding site
• Gain prompt access ...
Stabilization of associated injuries
• C-spine injury is primary concern
with all maxillofacial trauma victims
Any patien...
Stabilization of associated injuries
• C-spine injury suspected
 Avoid any movement of
spinal column
 Establish & mainta...
Head/Neck/C-Spine Stabilization

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Lateral C-Spine Film

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C-spine CTs

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Early Care
Emergency care has stabilized patient
Initial stabilization of fractures
Debridement & dressing of soft tiss...
Diagnosis of Maxillofacial Injuries
• Inspection
• Palpation
• Diagnostic Imaging
Plain films
CT
Stereolithography (whe...
Diagnosis of Maxillofacial Injuries
• INSPECTION
Hemorrhage
Otorrhea
Rhinorrhea
Contour deformity
Ecchymosis
Edema
...
Inspection

Sublingual ecchymosis

Step defects, ridge
discontinuity, malocclusion

www.indiandentalacademy.com
Diagnosis of Maxillofacial Injuries
• PALPATION
“Step” Defect
Crepitus
Bony segments
Subcutaneous
emphysema
Mobility
...
Diagnosis of Maxillofacial Injuries
• DIAGNOSTIC IMAGING
Panorex
Plain films
CT
Stereolithography

www.indiandentalaca...
www.indiandentalacademy.com
CT Scans

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3D CT

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Stereolithography

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Definitive Care
• Soft Tissue Injuries
Contusions
Abrasions
Lacerations

www.indiandentalacademy.com
Soft tissue injury
Facial lacerations not complicated by
associated injury can be managed in an
ER setting
Large extensi...
Soft tissue injury
• Hemostasis
• Debridement
• Approximate wound edges
Sutures
Steristrips

• Dressings
• Antibiotics/T...
Facial lacerations

www.indiandentalacademy.com
Associated Soft Tissue Injury
• Lacrimal System
• Parotid Duct
• Facial Nerve
Surgical repair if posterior to vertical
li...
Associated Soft Tissue Injury

Remember to think in 3D
for there are always
other structures involved!
www.indiandentalaca...
Mandibular Fractures
• Mandible is second
most common
fractured facial bone
• 50% of mandibular
fractures are multiple
 E...
Mandibular Fractures
• Clinical Signs and
Symptoms
 Tenderness & pain
 Malocclusion
 Ecchymosis in floor of
mouth
 Muc...
Mandibular Fractures
• Treatment depends on fracture site
and amount of segment
displacement
• Closed reduction
Applicati...
Closed Reduction with IMF

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Open Reduction

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Open Reduction

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Midface Fractures
•
•
•
•
•
•
•

LeFort I Transverse Maxillary
Lefort II Pyramidal
Lefort III Craniofacial Dysjunction
Zyg...
Midface Fractures
• Three buttresses
allow face to absorb
force
 Nasomaxillary
(medial) buttress
 Zymaticomaxillary
(lat...
Lefort Classification
• Weakest areas of midfacial complex
when assaulted from a frontal
direction at different levels (Re...
Lefort Classification
Provides uniform method to describe
the level of major fracture lines
Allows references regarding ...
Lefort I Fracture
Transverse Maxillary

www.indiandentalacademy.com
Lefort II Fracture
Pyramidal

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Lefort III Fracture
Craniofacial Dysjunction

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Facial Examination
• Evaluate for laceration
• Obvious depression in
skull
• Asymmetry
• Discharge from nose or
ear
 Assu...
Facial Examination
• Evaluate mandibular
opening
• Palpation of buccal
vestibule
Crepitus of lateral antral wall

• Occlus...
Facial Examination
• Orbits evaluated
 Periorbital edema and
ecchymosis
 Gross visual acuity
determined
 Diplopia
 Pup...
Facial Examination
• Orbits evaluated
 Lid lacerations
 Attachment of medial
canthal tendon
Rounding of lacrimal
lake
...
Facial Examination
Orbits Evaluated

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Facial Examination
Palpation of Midface/bridge of nose

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Radiographic Evaluation
• Plain Films
Lateral Skull
Waters View
Posteroanterior view of skull
Submental vertex

• CT S...
Radiographic Evaluation

Lateral skull

Water’s View

www.indiandentalacademy.com
Radiographic Evaluation

CT Scan

3D CT

www.indiandentalacademy.com
Radiographic Evaluation

Stereolithography
allows actual model
of defect. A nice
reconstruction tool
to use if available
w...
Treatment of Midface Fractures
• Once patient’s condition
stabilized, no need to
rush to surgery
 Address rapidly
develop...
Diagnosis of Lefort I Fractures
• Direction of force
• Maxilla displaced
posteriorly and inferiorly
 Open bite deformity
...
Treatment of Lefort I Fractures
 Direct exposure of all
involved fractures
 Reduction and anatomic
realignment of the
ma...
Treatment of Lefort I Fractures

www.indiandentalacademy.com
Diagnosis of Lefort II and III
• Clinical evaluation provides only a
rough impression since swelling
hides the underlying ...
Diagnosis Lefort II and III
• Bilateral periorbital
edema & ecchymosis
• Step deformity
palpated infraorbital &
nasofronta...
Treatment of Lefort II and III
• Fractures should be treated as early
as the general condition of the
patient allows
• Tea...
Treatment of Lefort II and III
• Intubation must not interfere with ability
to use IMF
• Exposure & visualization of all f...
Fractures
Teeth and occlusion
are the key to
reconstruction and
provide the
foundation upon
which other facial
structures ...
Treatment of Lefort II and III
Severely comminuted fractures
preliminary approximation may be
performed with wire
Establ...
Treatment of Lefort II and III
Reestablishment of the correct
intercanthal distance
Infraorbital rim fixated
Orbit is r...
Lefort II & III Reconstruction

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Lefort II & III
Reconstruction

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Nasal-Orbital-Ethmoid (NOE)
Fractures
 Usually not isolated event
 Frequently associated with
multiple midface fractures...
Nasal-Orbital-Ethmoid Fractures
• Diagnosis
Ophthalmalogic evaluation
Document visual acuity
Pupillary response to ligh...
Nasal-Orbital-Ethmoid Fractures
• Nasal fracture
Comminuted with
posterior displacement
Widened nasal bridge
Splaying o...
Nasal-Orbital-Ethmoid Fractures
• Clinical signs & symptoms
 Traumatic telecanthus
Difficult to measure due
to edema
– A...
Nasal-Orbital-Ethmoid Fractures
• Radiographic
examination
 CT - definitive imaging
modality
Axial images
supplemented w...
Nasal-Orbital-Ethmoid Fractures
CT Scans

www.indiandentalacademy.com
Nasal Fractures
• Depression or
angulation
• Periorbital
ecchymosis
• Epistaxis
• Tenderness
• Crepitus
• Septal deviation...
Nasal Hemorrhage
• Nasal packing
• Merocel sponge
• Nasopharyngeal
balloon
 Epistat
 Foley catheter

www.indiandentalaca...
Nasal-Orbital-Ethmoid Fractures
• Nasal fractures
 Rule out septal hematoma
 Remove clots with suction,
incise and drain...
Nasal-Orbital-Ethmoid Fractures
Nasal Fractures
• Treatment
 Restoration of form
and function
 Proper reduction of
nasal...
Nasal-Orbital-Ethmoid Fractures
• Surgical considerations
 Definitive surgery as
soon as possible after:
Appropriate
con...
Nasal-Orbital-Ethmoid Fractures
• Surgical considerations
The final phase involves reduction of
the NOE and nasal bone fr...
Nasal-Orbital-Ethmoid Fractures
• Lacrimal system injury
When the medial canthal ligament has
been injured or displaced, ...
Nasal-Orbital-Ethmoid Fractures
Surgical Reduction

www.indiandentalacademy.com
Nasal-Orbital-Ethmoid Fractures
Surgical Reduction

www.indiandentalacademy.com
Gunshot wound management
• Advanced trauma life
support
 Primary survey
ABC’s
C-Spine stabilization
Neurological
asses...
Animal Bites
 Hemostasis
 Debridement
 Approximate
wound edges
 Dressings
 Antibiotics/Tetanus
Augmentin

www.indian...
Acknowledgements
• DIS would like to thank Lt Col Jeff
Armstrong for his expertise in
providing this briefing for local
fa...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Maxillofacial trauma /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 trauma /certified fixed orthodontic courses by Indian dental academy "

  1. 1. Maxillofacial Trauma Readiness Briefing INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Maxillofacial Trauma Readiness Training for Dental Officers www.indiandentalacademy.com
  3. 3. Maxillofacial Trauma Evaluation and Management www.indiandentalacademy.com
  4. 4. Maxillofacial Injuries • Treatment divided into following phases Emergency or initial care Early care Definitive care Secondary care or revision www.indiandentalacademy.com
  5. 5. Emergency Care • • • • • Preserve the airway Control of hemorrhage Prevent or control shock C-Spine stabilization Control of life-threatening injuries head injuries, chest injuries, compound limb fractures, intra-abdominal bleeding www.indiandentalacademy.com
  6. 6. Emergency Care • Evaluate the airway Existence & identification of obstruction Manually clear of fractured teeth, blood clots, dentures Endotracheal intubation & packing of oronasal airway www.indiandentalacademy.com
  7. 7. Emergency Care • Airway Management Maintain an intact airway Protect airway in jeopardy Provide an airway • C-Spine injury may be present • Altered level of consciousness is the most common cause of upper airway obstruction www.indiandentalacademy.com
  8. 8. Airway Management • Chin lift to open intact airway • Intubation Oral: C-spine injury absent on X ray Nasotracheal intubation: C-spine injury suspected or certain • Surgical Airway Cricothyroidotomy Tracheosotomy www.indiandentalacademy.com
  9. 9. Emergency Care • Extensive vascularity of head & neck may lead to massive blood loss Monitor vital signs closely Intravenous infusion • Penetrating injuries need to be explored Arteriogram Esophagram www.indiandentalacademy.com
  10. 10. Treatment of Blood Loss & Shock • Hemorrhage most common cause of shock after injury • Multiple injury patients have hypovolemia • Goal is to restore organ perfusion www.indiandentalacademy.com
  11. 11. Treatment of Blood Loss & Shock • External bleeding controlled by direct pressure over bleeding site • Gain prompt access to vascular system with IV catheters • Fluid replacement Ringer’s Lactate Normal saline Transfusion www.indiandentalacademy.com
  12. 12. Stabilization of associated injuries • C-spine injury is primary concern with all maxillofacial trauma victims Any patient with injury above clavicle or head injury resulting in unconscious state Any injury produced by high speed Signs/symptoms of C-Spine injury Neurologic deficit Neck pain www.indiandentalacademy.com
  13. 13. Stabilization of associated injuries • C-spine injury suspected  Avoid any movement of spinal column  Establish & maintain proper immobilization until vertebral fractures or spinal cord injuries ruled out Lateral C-spine radiographs CT of C-spine Neurologic exam www.indiandentalacademy.com
  14. 14. Head/Neck/C-Spine Stabilization www.indiandentalacademy.com
  15. 15. Lateral C-Spine Film www.indiandentalacademy.com
  16. 16. C-spine CTs www.indiandentalacademy.com
  17. 17. Early Care Emergency care has stabilized patient Initial stabilization of fractures Debridement & dressing of soft tissues Elective tracheostomy Physical exam & history Laboratory tests Complete head & neck examination Diagnosis of maxillofacial injuries www.indiandentalacademy.com
  18. 18. Diagnosis of Maxillofacial Injuries • Inspection • Palpation • Diagnostic Imaging Plain films CT Stereolithography (where available) www.indiandentalacademy.com
  19. 19. Diagnosis of Maxillofacial Injuries • INSPECTION Hemorrhage Otorrhea Rhinorrhea Contour deformity Ecchymosis Edema Continuity defects Malocclusion www.indiandentalacademy.com
  20. 20. Inspection Sublingual ecchymosis Step defects, ridge discontinuity, malocclusion www.indiandentalacademy.com
  21. 21. Diagnosis of Maxillofacial Injuries • PALPATION “Step” Defect Crepitus Bony segments Subcutaneous emphysema Mobility www.indiandentalacademy.com
  22. 22. Diagnosis of Maxillofacial Injuries • DIAGNOSTIC IMAGING Panorex Plain films CT Stereolithography www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. CT Scans www.indiandentalacademy.com
  25. 25. 3D CT www.indiandentalacademy.com
  26. 26. Stereolithography www.indiandentalacademy.com
  27. 27. Definitive Care • Soft Tissue Injuries Contusions Abrasions Lacerations www.indiandentalacademy.com
  28. 28. Soft tissue injury Facial lacerations not complicated by associated injury can be managed in an ER setting Large extensive facial and scalp lacerations are preferably closed in an operating room environment www.indiandentalacademy.com
  29. 29. Soft tissue injury • Hemostasis • Debridement • Approximate wound edges Sutures Steristrips • Dressings • Antibiotics/Tetanus www.indiandentalacademy.com
  30. 30. Facial lacerations www.indiandentalacademy.com
  31. 31. Associated Soft Tissue Injury • Lacrimal System • Parotid Duct • Facial Nerve Surgical repair if posterior to vertical line drawn from outer canthus of eye www.indiandentalacademy.com
  32. 32. Associated Soft Tissue Injury Remember to think in 3D for there are always other structures involved! www.indiandentalacademy.com
  33. 33. Mandibular Fractures • Mandible is second most common fractured facial bone • 50% of mandibular fractures are multiple  Examine patient and radiographs closely and suspect additional fractures www.indiandentalacademy.com
  34. 34. Mandibular Fractures • Clinical Signs and Symptoms  Tenderness & pain  Malocclusion  Ecchymosis in floor of mouth  Mucosal lacerations  Step defects inferior border  CN V3 Disturbances www.indiandentalacademy.com
  35. 35. Mandibular Fractures • Treatment depends on fracture site and amount of segment displacement • Closed reduction Application of arch bars Placement into intermaxillary fixation (IMF) • Open Reduction Internal wire fixation Bone plates www.indiandentalacademy.com
  36. 36. Closed Reduction with IMF www.indiandentalacademy.com
  37. 37. Open Reduction www.indiandentalacademy.com
  38. 38. Open Reduction www.indiandentalacademy.com
  39. 39. Midface Fractures • • • • • • • LeFort I Transverse Maxillary Lefort II Pyramidal Lefort III Craniofacial Dysjunction Zygomatic Complex Orbital Floor Nasal Fractures Naso-orbital/Ethmoid www.indiandentalacademy.com
  40. 40. Midface Fractures • Three buttresses allow face to absorb force  Nasomaxillary (medial) buttress  Zymaticomaxillary (lateral) buttress  Pyterigomaxillary (posterior) buttress www.indiandentalacademy.com
  41. 41. Lefort Classification • Weakest areas of midfacial complex when assaulted from a frontal direction at different levels (Rene’ Lefort, 1901) Lefort I: above the level of teeth Lefort II: at level of nasal bones Lefort III: at orbital level www.indiandentalacademy.com
  42. 42. Lefort Classification Provides uniform method to describe the level of major fracture lines Allows references regarding the probable points of stability for surgical treatment Does not incorporate vertical or segmental fractures, comminution or bone loss www.indiandentalacademy.com
  43. 43. Lefort I Fracture Transverse Maxillary www.indiandentalacademy.com
  44. 44. Lefort II Fracture Pyramidal www.indiandentalacademy.com
  45. 45. Lefort III Fracture Craniofacial Dysjunction www.indiandentalacademy.com
  46. 46. Facial Examination • Evaluate for laceration • Obvious depression in skull • Asymmetry • Discharge from nose or ear  Assume CSF leak • Palpation to note bone discontinuity  Bimanually in systematic manner www.indiandentalacademy.com
  47. 47. Facial Examination • Evaluate mandibular opening • Palpation of buccal vestibule Crepitus of lateral antral wall • Occlusion evaluated Absence and quality of dentition noted • Ecchymosis common finding • Pharynx evaluated for laceration & bleeding www.indiandentalacademy.com
  48. 48. Facial Examination • Orbits evaluated  Periorbital edema and ecchymosis  Gross visual acuity determined  Diplopia  Pupillary size & shape  Subconjunctival hemorrhage  Funduscopic evaluation www.indiandentalacademy.com
  49. 49. Facial Examination • Orbits evaluated  Lid lacerations  Attachment of medial canthal tendon Rounding of lacrimal lake Increased intercanthal distance Epiphora  Prompt Ophthamology consult www.indiandentalacademy.com
  50. 50. Facial Examination Orbits Evaluated www.indiandentalacademy.com
  51. 51. Facial Examination Palpation of Midface/bridge of nose www.indiandentalacademy.com
  52. 52. Radiographic Evaluation • Plain Films Lateral Skull Waters View Posteroanterior view of skull Submental vertex • CT Scan 1.5 mm cuts axial and coronal views www.indiandentalacademy.com
  53. 53. Radiographic Evaluation Lateral skull Water’s View www.indiandentalacademy.com
  54. 54. Radiographic Evaluation CT Scan 3D CT www.indiandentalacademy.com
  55. 55. Radiographic Evaluation Stereolithography allows actual model of defect. A nice reconstruction tool to use if available www.indiandentalacademy.com
  56. 56. Treatment of Midface Fractures • Once patient’s condition stabilized, no need to rush to surgery  Address rapidly developing edema  Formulate treatment plan  Observe sequelae in the case of orbital injuries www.indiandentalacademy.com
  57. 57. Diagnosis of Lefort I Fractures • Direction of force • Maxilla displaced posteriorly and inferiorly  Open bite deformity • Hypoesthesia of infraorbital nerve • Malocclusion • Mobility of maxilla  Noted by grasping maxillary incisors www.indiandentalacademy.com
  58. 58. Treatment of Lefort I Fractures  Direct exposure of all involved fractures  Reduction and anatomic realignment of the maxillary buttresses to reestablish Anterior projection Transverse width Occlusion  Restoration of occlusion using IMF  Internal fixation using miniplate fixation www.indiandentalacademy.com
  59. 59. Treatment of Lefort I Fractures www.indiandentalacademy.com
  60. 60. Diagnosis of Lefort II and III • Clinical evaluation provides only a rough impression since swelling hides the underlying bony structures • Plain film radiographs and axial and coronal CT images are the basis for precise diagnosis & treatment plan www.indiandentalacademy.com
  61. 61. Diagnosis Lefort II and III • Bilateral periorbital edema & ecchymosis • Step deformity palpated infraorbital & nasofrontal area • CSF rhinorrhea • Epistaxis www.indiandentalacademy.com
  62. 62. Treatment of Lefort II and III • Fractures should be treated as early as the general condition of the patient allows • Team approach to treatment Neurosurgery Ophthamology ENT Plastic surgery Oral/Maxillofacial surgery www.indiandentalacademy.com
  63. 63. Treatment of Lefort II and III • Intubation must not interfere with ability to use IMF • Exposure & visualization of all fractures Approaches to inferior rim Infraorbital Subciliary Transconjunctival Mid lower lid Coronal approach Gingivobuccal incision www.indiandentalacademy.com
  64. 64. Fractures Teeth and occlusion are the key to reconstruction and provide the foundation upon which other facial structures are built www.indiandentalacademy.com
  65. 65. Treatment of Lefort II and III Severely comminuted fractures preliminary approximation may be performed with wire Establishment of the correct occlusion Correct reconstruction of the outer facial frame for proper facial dimensions Correct position for nasoethmoidal complex www.indiandentalacademy.com
  66. 66. Treatment of Lefort II and III Reestablishment of the correct intercanthal distance Infraorbital rim fixated Orbit is reconstructed Occlusion unit with IMF is fixated www.indiandentalacademy.com
  67. 67. Lefort II & III Reconstruction www.indiandentalacademy.com
  68. 68. Lefort II & III Reconstruction www.indiandentalacademy.com
  69. 69. Nasal-Orbital-Ethmoid (NOE) Fractures  Usually not isolated event  Frequently associated with multiple midface fractures  Secondary to traumatic insult to radix area of nose  Low resistance to directional force 35-80 gm necessary to produce fracture www.indiandentalacademy.com
  70. 70. Nasal-Orbital-Ethmoid Fractures • Diagnosis Ophthalmalogic evaluation Document visual acuity Pupillary response to light Neurologic evaluation Frontal lobe contusion Glasgow coma scale – Increase in ICP and need for monitoring www.indiandentalacademy.com
  71. 71. Nasal-Orbital-Ethmoid Fractures • Nasal fracture Comminuted with posterior displacement Widened nasal bridge Splaying of nasal complex  Epistaxis  Severe periorbital edema & ecchymosis  Subconjunctival hemorrhage www.indiandentalacademy.com
  72. 72. Nasal-Orbital-Ethmoid Fractures • Clinical signs & symptoms  Traumatic telecanthus Difficult to measure due to edema – Average 33-34 mm Can measure interpupillary distance and divide in half for approximate intercanthal distance – Average 60-65 mm  Damage to lacrimal apparatus-epiphora  CSF leak www.indiandentalacademy.com
  73. 73. Nasal-Orbital-Ethmoid Fractures • Radiographic examination  CT - definitive imaging modality Axial images supplemented with coronal Plain films to fail demonstrate the degree and location of fractures secondary to overlapping of bony architecture www.indiandentalacademy.com
  74. 74. Nasal-Orbital-Ethmoid Fractures CT Scans www.indiandentalacademy.com
  75. 75. Nasal Fractures • Depression or angulation • Periorbital ecchymosis • Epistaxis • Tenderness • Crepitus • Septal deviation • Septal hematoma www.indiandentalacademy.com
  76. 76. Nasal Hemorrhage • Nasal packing • Merocel sponge • Nasopharyngeal balloon  Epistat  Foley catheter www.indiandentalacademy.com
  77. 77. Nasal-Orbital-Ethmoid Fractures • Nasal fractures  Rule out septal hematoma  Remove clots with suction, incise and drain if present to prevent septal necrosis  Closed reduction for simple fractures  Open reduction for severely displaced fractures www.indiandentalacademy.com
  78. 78. Nasal-Orbital-Ethmoid Fractures Nasal Fractures • Treatment  Restoration of form and function  Proper reduction of nasal fractures  Correction of medial canthal ligament disruption  Correction of lacrimal system injuries www.indiandentalacademy.com
  79. 79. Nasal-Orbital-Ethmoid Fractures • Surgical considerations  Definitive surgery as soon as possible after: Appropriate consultations Definitive radiographic imaging Significant edema allowed to resolve www.indiandentalacademy.com
  80. 80. Nasal-Orbital-Ethmoid Fractures • Surgical considerations The final phase involves reduction of the NOE and nasal bone fractures Access to NOE through existing lacerations, bicoronal flap, or local incisions www.indiandentalacademy.com
  81. 81. Nasal-Orbital-Ethmoid Fractures • Lacrimal system injury When the medial canthal ligament has been injured or displaced, damage to the lacrimal system should be assumed Nasolacrimal duct is often damaged within its bony course Epiphora: Need to evaluate patency of the nasolacrimal system www.indiandentalacademy.com
  82. 82. Nasal-Orbital-Ethmoid Fractures Surgical Reduction www.indiandentalacademy.com
  83. 83. Nasal-Orbital-Ethmoid Fractures Surgical Reduction www.indiandentalacademy.com
  84. 84. Gunshot wound management • Advanced trauma life support  Primary survey ABC’s C-Spine stabilization Neurological assessment  Secondary survey Determine extent of injury  Definitive treatment www.indiandentalacademy.com
  85. 85. Animal Bites  Hemostasis  Debridement  Approximate wound edges  Dressings  Antibiotics/Tetanus Augmentin www.indiandentalacademy.com
  86. 86. Acknowledgements • DIS would like to thank Lt Col Jeff Armstrong for his expertise in providing this briefing for local facilities • For any questions concerning this presentation, please contact DIS at DSN 792-7676 www.indiandentalacademy.com
  87. 87. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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