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MAXILLOFACIAL INJURIES

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

www.india...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiological features
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Anatomy:
• central support to cheek
• buttress of lateral mid 3rd face
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Processes
Maxillary
Temporal
Frontal
Orbital
Lateral wall and f...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY

Arch

Temporal
Zygoma
Maxilla

Muscle attachments:
Zygomaticus...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiological features
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Mechanism of Injury
Direct & Indirect
In-bending at area of impact
Out-...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
•Clinical features
• Radiological features
•...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Flattening of cheek
Periorbital edema / Ecchymosis
Su...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
ENOPHTHALMOS
• Inferior & posterior
displacement
• Ex...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Paresthesia (V2) / Pain !!!
Trismus
Tenderness / Step...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical examination
Palpation:
• Step / tenderness / mobility
• Supra-...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiology
• Management...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Occipto-mental view (PNS view, Waters
position...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Submento-vertex view (jug handle view )
Zygoma...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
C.T. Scans:
• Axial

• Coronal

www.indiandent...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiology
• Management...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Immediate – primary care:
• ABC
• Nasal packs
Anterior / Pos...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
• Restoration of form & function
• Anatomic reduction
• Trea...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction
Arch fractures
Minimal disruption
(at 2 sut...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction

• Temporal approach
(Gillies 1927)

www.in...
Gillies Temporal Approach

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction

• Transcutaneous
approach

www.indiandenta...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Open Reduction & fixation
F-Z Suture
Infra-orbital rim & orb...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management :

Open Reduction

F-Z Suture
www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management :

Open Reduction

Zygomatico-maxillary suture
Infra-orbital...
MAXILLOFACIAL INJURIES
Complications
• Mal-union / Non-union / fibrous union
• Malocclusion
• Plate exposure
• TMJ disorde...
MAXILLOFACIAL INJURIES
Complications
Mal-union

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Non-union

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Fibrous union

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Malocclusion

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Plate Exposure / Wound dehiscence

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Ankylosis

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Infections

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Complications
Scarring

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiological features
...
MAXILLOFACIAL INJURIES

Mid face (Le-Fort) #

www.indiandentalacademy.com

Blow-out # of Orbit
Thank You
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Zygoma & complications / /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable

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  • {"5":"Arch: contributions from three bones temporal, zygomatic & maxillary\nMuscle attachments\nNerves \nZ facial br of zygomatic nerve enters orbit through inferior orbital fissure divides into\nZ temporal which supplies area around zf suture & z facial which passes along inferior and lateral surface of the orbit exciting through a foramen on malar eminence to supply that area\nInfraorbital nerve through posterior margin of inferior orbital fissure, travels through a in its first 2/3rds of its course obliquely and medially across orbital floor and then through a canal in the infraorbital rim to exit the zygoma @ 1cm below the infraorbital rim grove \n","11":"Paresthesia V2 contusion or compression of nrve by bone fragments within the area of infraorbital foramen specially medially displaced fractures and will resolve only after elevation of fracture.\nLimitation in mouth opening due to swelling with in muscular and soft tissue planes, medially displaced arch, and posteriorly displaced body\n","17":"This should be the first slide\n","12":"Difference betwqeen proptosis & exopthalmos\n","1":"This should be the first slide\n","18":"Tetanus immunization schedule microbiology of tetanus check with dinesh \nFully immunised : last dose with in 10yrs .5ml toxoid\nPartially immunised: more than 10yrs .5ml toxoid\n","7":"Direct violent forces to cotralateral side can cause disruption of zygoma due to reciprocal transfer of forces but not common, bilateral zygoma fracutres are usually in association with other facial bones involved as in lefort 3 and is because of higher energy involvemnt. \nFractures are dislocated posteriorly,inferiorly & medialy are most frequent. Orbital #s are compressed with overlapping # fragments & while reducing, orbital fractures become more severe. These are impacted fractures\nMore extensive injuries are dislocated posteriorly inferiorly and laterally. The arch and soft tissue attachments must be disrupted to permit this.\nAny zygomatic complex fracture should include a discontinuity along the floor of the orbit.\nThe direction of dislocation involves the rotation of the bone in several planes this has resulted in several classifications\n","35":"1) Clossure of periosteal incissions\nPrevents lengthening of soft tissues soft tissue diastasis\n2) Refixation of tissues at several points of facial skeleton\nDue to inacurate allignment ( common in comminuted fractures)\nFix #ed Zygoma to adjacent unfractured bone Therefore expose unfractured land marks and use as guide\nCommonly seen at\ninfra orbital rim, and junction of orbital process of zygoma to greater wing of sphenoid\n","8":"This should be the first slide\n","36":"This should be the first slide\n","3":"Prominent position – frequently fractured\nEither alone or in combination with other bones of midface\nFractures include disruption of any of 5 articulations\n","9":"Loss of prominence of malar eminence may partially conceled by soft tissue swelling\nProptosis due to swelling with in muscular planes and tissue planes\nEchymosis and hematoma usually confined to distribution of orbital septum spectacle hematoma\nEpistaxis on ipsilateral nostril secondary to hemorrhage into maxillary sinus \n","4":"Articulates with \nzygomatic process of maxillary bone: infraorbital rim\nZygomatic process of temporal bone :in front of the glenoid fossa\nExternal angular process of frontal bone:to form fz suture\nWith in orbit articulates with medially orbital floor & laterally G.W.sphenoid\nBy virtue of its attachments\nForms floor & lateral wall of orbit & roof and lateral wall of maxillary sinus\n","10":"Clinical pictures to be added.\n"}
  • Transcript of "Zygoma & complications / /certified fixed orthodontic courses by Indian dental academy "

    1. 1. MAXILLOFACIAL INJURIES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management www.indiandentalacademy.com
    3. 3. MAXILLOFACIAL INJURIES Zygomatic complex fractures Anatomy: • central support to cheek • buttress of lateral mid 3rd face Articulations: • Zygomatico-frontal •Zygomatico-maxillary • Zygomatico-temporal (arch) • Zygomatico-sphenoid(orbital floor) www.indiandentalacademy.com
    4. 4. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Processes Maxillary Temporal Frontal Orbital Lateral wall and floor orbit Roof and lateral wall maxillary sinus www.indiandentalacademy.com
    5. 5. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Arch Temporal Zygoma Maxilla Muscle attachments: Zygomaticus major / minor: malar eminence Levator labii superioris: infraorbital rim www.indiandentalacademy.com
    6. 6. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management www.indiandentalacademy.com
    7. 7. MAXILLOFACIAL INJURIES Zygomatic complex fractures Mechanism of Injury Direct & Indirect In-bending at area of impact Out-bending of weak areas (distant) Dislocation posterior inferior medial lateral www.indiandentalacademy.com
    8. 8. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy •Clinical features • Radiological features • Management www.indiandentalacademy.com
    9. 9. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Flattening of cheek Periorbital edema / Ecchymosis Subconjunctival haemorrhage Epistaxis / Surgical emphysema Proptosis / Enophthalmos www.indiandentalacademy.com
    10. 10. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features ENOPHTHALMOS • Inferior & posterior displacement • Expansion of orbit EXOPHTHALMOS • Medial dislocations www.indiandentalacademy.com
    11. 11. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Paresthesia (V2) / Pain !!! Trismus Tenderness / Step deformity Facial nerve weakness Drooping of upper lip DIPLOPIA www.indiandentalacademy.com
    12. 12. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical examination Palpation: • Step / tenderness / mobility • Supra-orbital rim • F-Z suture • Infra-orbital rim • Paresthesia (lip, nose 14-11 + gingiva) www.indiandentalacademy.com
    13. 13. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management www.indiandentalacademy.com
    14. 14. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Occipto-mental view (PNS view, Waters position) Fronto-zygomatic suture Zygomatico-maxillary buttress Inferior orbital rim www.indiandentalacademy.com
    15. 15. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Submento-vertex view (jug handle view ) Zygomatic arch Posterior displacement www.indiandentalacademy.com
    16. 16. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination C.T. Scans: • Axial • Coronal www.indiandentalacademy.com
    17. 17. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management www.indiandentalacademy.com
    18. 18. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Immediate – primary care: • ABC • Nasal packs Anterior / Posterior • Control of pain • Control of infection - Tetanus!! • Prevent surgical emphysema www.indiandentalacademy.com
    19. 19. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management • Restoration of form & function • Anatomic reduction • Treatment: “Surgical intervention” Closed v/s Open • Displacement & comminution • Exposure of fracture site • Alignment • Fixation www.indiandentalacademy.com
    20. 20. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction Arch fractures Minimal disruption (at 2 sutures) Intra-oral approach (Keen 1909) www.indiandentalacademy.com
    21. 21. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Temporal approach (Gillies 1927) www.indiandentalacademy.com
    22. 22. Gillies Temporal Approach www.indiandentalacademy.com
    23. 23. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Transcutaneous approach www.indiandentalacademy.com
    24. 24. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Open Reduction & fixation F-Z Suture Infra-orbital rim & orbital floor Zygomatico-maxillary buttress (Intra-oral) www.indiandentalacademy.com
    25. 25. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction F-Z Suture www.indiandentalacademy.com
    26. 26. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction Zygomatico-maxillary suture Infra-orbital rim www.indiandentalacademy.com
    27. 27. MAXILLOFACIAL INJURIES Complications • Mal-union / Non-union / fibrous union • Malocclusion • Plate exposure • TMJ disorders / Ankylosis • Infection • Nerve Damage (Paresthesia) • Scars www.indiandentalacademy.com
    28. 28. MAXILLOFACIAL INJURIES Complications Mal-union www.indiandentalacademy.com
    29. 29. MAXILLOFACIAL INJURIES Complications Non-union www.indiandentalacademy.com
    30. 30. MAXILLOFACIAL INJURIES Complications Fibrous union www.indiandentalacademy.com
    31. 31. MAXILLOFACIAL INJURIES Complications Malocclusion www.indiandentalacademy.com
    32. 32. MAXILLOFACIAL INJURIES Complications Plate Exposure / Wound dehiscence www.indiandentalacademy.com
    33. 33. MAXILLOFACIAL INJURIES Complications Ankylosis www.indiandentalacademy.com
    34. 34. MAXILLOFACIAL INJURIES Complications Infections www.indiandentalacademy.com
    35. 35. MAXILLOFACIAL INJURIES Complications Scarring www.indiandentalacademy.com
    36. 36. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management •Complications www.indiandentalacademy.com
    37. 37. MAXILLOFACIAL INJURIES Mid face (Le-Fort) # www.indiandentalacademy.com Blow-out # of Orbit
    38. 38. Thank You www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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