Facial Fractures & Dental Injuries  JANINE FERRO, ATC, CSCS
Occular & Related Maxillofacial Injuries Injury to External Structures   Contusion/periorbital ecchymosis (black eye)  ...
Occular & Related Maxillofacial Injuries Anterior Segment         Posterior Segment    Foreign body             Injury...
Four Cardinal Complaints Indications for further evaluation/referral:   Change in vision    Change in appearance    Pa...
Fractures of the ZygomaticComplex- Tripod Fracture
Etiology & Pathology Etiology   Blunt trauma to the prominence of the zygomatic bone    (cheekbone) Pathology   Fractu...
Associated Ocular Complications Retinal detachment Dislocation of the lens Injuries to the globe Orbital floor fractures
Clinical Evaluation History   Blunt trauma to the prominence of the zygomatic bone Inspection   Flattened cheek with p...
Clinical Evaluation Palpation   Step-off defects of the infraorbital rim & at zygomaticofrontal    suture   Point tende...
Management Place athlete in comfortable position Cover one/both eyes (unison movement) Cold compress to periorbital reg...
Orbital Blow-Out Fractures
Etiology & Pathology Etiology   Blunt trauma to the globe of the eye (direct)   Results in rapid increase in intraorbit...
Associated Occular Complications Infraorbital nerve trauma Occular injuries   Retinal detachment   Dislocation of the ...
Clinical Evaluation History   Direct MOI (blunt trauma to the globe- ball, fist, etc.)   Indirect MOI (trauma to surrou...
Clinical Evaluation Palpation   Not indicated Functional Tests   Restricted superior/lateral gaze   Entrapment of ner...
Nasal Fractures      =
Etiology & Pathology Etiology   Blunt trauma to the dorsum of the nose      Force directed anteriorly results in depres...
Clinical Evaluation Complications   Septal hematoma   Abcess/ septal erosion   “Saddle nose” deformity History   Fro...
Clinical Evaluation Inspection   Lateral deviation of nasal bones/cartilages   Flattened nose   Edema & ecchymosis ove...
Naso-orbital Injuries
Etiology & Pathology Etiology   Blunt trauma to the naso-orbital area Pathology   Comminuted fracture of the nasal bon...
Clinical Evaluation History   Blunt trauma to the naso-orbital area Inspection   Signs associated with nasal fx.   As...
Clinical Evaluation Functional Tests   None. Management Referral Differential Diagnosis   Concussion   Blow-out fra...
Mandibular Fractures
Etiology & Pathology Etiology   Blunt trauma to the mandibular arch of symphysis Pathology   Fracture through cuspid a...
Clinical Evaluation History   Blunt trauma Inspection   Malocclusion   Facial asymmetry   Ecchymosis in the floor of...
Clinical Evaluation Palpation   Step-offs   Point tenderness at fracture site(s)   Crepitus/ inability to feel condyle...
Clinical Evaluation Complications   Mandibular n. trauma   Airway obstruction from blood   Avulsed teeth   Prolapse o...
Fractures of the Midface
Etiology & Pathology Etiology   Severe blunt trauma to the midface Pathology   LeFort I, II, or III fractures
Complications Infraorbital n. injury Occular injuries Airway obstruction in soft palate area due to  hemorrhage & edema...
Classification of Midface Fractures LeFort I   Fracture of the maxilla at the level of the nasal floor LeFort II (pyram...
Clinical Evaluation History   Severe blunt trauma- not usually from sport activity Inspection   Facial asymmetry (elon...
Clinical Evaluation Palpation   “Step-off” defects/ point tenderness at LeFort I, II, III fracture    site Functional T...
Dental Injuries/ Inflammatory           Injuries
General Information Subluxations/Avulsions   Partially displaced teeth (intruded, extruded)   Avulsed teeth Fractures ...
Subluxations/Avulsions Disruption of the supporting structures (periodontal membrane) involving:    Sensitivity w/o mobi...
Subluxations/ Avulsions Handle by crown only Rinse w/ sterile saline (don’t wipe) Replace Stabilize (bite on gauze) R...
Subluxations/AvulsionsIntruded Tooth        Lateral Luxation
Crown Fractures Direct trauma (hit by object)/ indirect (force through  mandible/ contact of mandible & maxillary teeth)...
Crown Fractures Enamel   Irritating   Not sensitive to temperature   Can wait Enamel & Dentin   Sensitive to tempera...
Crown Fractures
Root Fractures Etiology   Direct trauma (hip by object) or indirect trauma (force through    mandible/ contact of mandib...
Root Fractures
Alveolar Fractures Etiology   Direct trauma (hit by object) Pathology   Fracture of alveolar process of the mandible/ ...
Alveolar Fractures
Protect Your Teeth!!! Shoulda worn amouthguard littleman! Prom pictsaren’t gonna look    so good!
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Facial Fractures & Acute Dental Injuries

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Facial Fractures & Acute Dental Injuries

  1. 1. Facial Fractures & Dental Injuries JANINE FERRO, ATC, CSCS
  2. 2. Occular & Related Maxillofacial Injuries Injury to External Structures  Contusion/periorbital ecchymosis (black eye)  Lacerations of lids  Conjunctivitis  Various Fractures
  3. 3. Occular & Related Maxillofacial Injuries Anterior Segment  Posterior Segment  Foreign body  Injury to the  Corneal abrasion retina/choroid  Corneal laceration  Ruptured globe  Subconjunctival hemorrhage  Hyphema  Traumatic cataract  Dislocated lens  Traumatic iritis
  4. 4. Four Cardinal Complaints Indications for further evaluation/referral:  Change in vision  Change in appearance  Pain/discomfort  Trauma
  5. 5. Fractures of the ZygomaticComplex- Tripod Fracture
  6. 6. Etiology & Pathology Etiology  Blunt trauma to the prominence of the zygomatic bone (cheekbone) Pathology  Fracture of zygomatic arch; fracture dislocation at zygomaticofrontal & zygomaticomazillary suture lines  Inferior, medial, & posterior displacement of zygomatic bone into maxillary sinus area
  7. 7. Associated Ocular Complications Retinal detachment Dislocation of the lens Injuries to the globe Orbital floor fractures
  8. 8. Clinical Evaluation History  Blunt trauma to the prominence of the zygomatic bone Inspection  Flattened cheek with periorbital ecchymosis  Subconjunctival hemorrhage/ hyphema  Lowered lateral palpebral (eyelid) fissure  Unilateral nosebleed on affected side  Ala (winging) of the nose & lip on affected side
  9. 9. Clinical Evaluation Palpation  Step-off defects of the infraorbital rim & at zygomaticofrontal suture  Point tenderness at fracture site Functional Tests  Trismus (inability to open mouth due to impingement of zygoma on coronid process)  Anesthesia/paraesthesia over cheek, ½ of nose, & upper lip (infraorbital n. distribution)  Diplopia (on outer upward & downward gaze)  Restricted eye movement (upward gaze)
  10. 10. Management Place athlete in comfortable position Cover one/both eyes (unison movement) Cold compress to periorbital region Observe for nausea/ vomiting Avoid blowing nose! URGENT EMERGENT REFERRAL!
  11. 11. Orbital Blow-Out Fractures
  12. 12. Etiology & Pathology Etiology  Blunt trauma to the globe of the eye (direct)  Results in rapid increase in intraorbital pressure Pathology  Comminuted fractures of the orbital floor/ medial wall  Extrusion of inferior orbital soft tissue into maxillary sinus  Entrapment of inferior extraocular ms. in fracture defect  Infraorbital nerve trauma
  13. 13. Associated Occular Complications Infraorbital nerve trauma Occular injuries  Retinal detachment  Dislocation of the lens  Injury to the globe  Hyphema  Bleeding into the orbit causing acute proptosis  High intraorbital pressure from intraocular bleeding
  14. 14. Clinical Evaluation History  Direct MOI (blunt trauma to the globe- ball, fist, etc.)  Indirect MOI (trauma to surrounding areas) Inspection  Periorbital ecchymosis/edema  Lowered globe/sunken eye  Retraction of globe  Hyphema  Subconjunctival hemorrhage
  15. 15. Clinical Evaluation Palpation  Not indicated Functional Tests  Restricted superior/lateral gaze  Entrapment of nerve/muscle  Vertical diplopia  Paresthesia/ hypoesthesia in infraorbital n. distribution Management  Same as zygomatic complex fx. Care- EMERGENCY!!
  16. 16. Nasal Fractures =
  17. 17. Etiology & Pathology Etiology  Blunt trauma to the dorsum of the nose  Force directed anteriorly results in depressed nasal fx  Force directed laterally results in lateral fx/ dislocation Pathology  Comminuted fracture of the nasal bones  Associated disruption of the septal, lateral, & alar cartilages
  18. 18. Clinical Evaluation Complications  Septal hematoma  Abcess/ septal erosion  “Saddle nose” deformity History  Frontal/ lateral blunt trauma to the dorsum of the nose
  19. 19. Clinical Evaluation Inspection  Lateral deviation of nasal bones/cartilages  Flattened nose  Edema & ecchymosis over the dorsum of the nose  Epistaxis (nosebleed)  Septal hematoma & intranasal lacerations Palpation  Bony irregulatities (step-offs)  Tenderness over dorsum of nose Functional Tests  Have patient look in a mirror!
  20. 20. Naso-orbital Injuries
  21. 21. Etiology & Pathology Etiology  Blunt trauma to the naso-orbital area Pathology  Comminuted fracture of the nasal bones  Disruption of the septal, lateral, and alar cartilages  Associated rupture of the medial canthal (palpebral) ligaments
  22. 22. Clinical Evaluation History  Blunt trauma to the naso-orbital area Inspection  Signs associated with nasal fx.  Associated telecanthus (increased intercanthal distance) & almond shaped medial palpebral fissure (normally elliptical) Palpation  Bony irregularities (step-offs)  Tenderness over dorsum of the nose
  23. 23. Clinical Evaluation Functional Tests  None. Management Referral Differential Diagnosis  Concussion  Blow-out fracture  Globe injury
  24. 24. Mandibular Fractures
  25. 25. Etiology & Pathology Etiology  Blunt trauma to the mandibular arch of symphysis Pathology  Fracture through cuspid area (common); multiple fracture including:  Cusid area & 3rd molar area on opposite side  Cuspid area & subcondylar area on opposite side  Symphysis & angle of the mandible  Symphysis & one/ both subcondylar areas
  26. 26. Clinical Evaluation History  Blunt trauma Inspection  Malocclusion  Facial asymmetry  Ecchymosis in the floor of the mouth  Bleeding at base of tooth (3rd molar)  External contusion/edema/ecchymosis  Otorrhea (condylar fx)
  27. 27. Clinical Evaluation Palpation  Step-offs  Point tenderness at fracture site(s)  Crepitus/ inability to feel condyle w/ finger in ear (condylar fx) Functional Tests  Crepitus & instability (passive “rocking” of mandible)  Paresthesia/ anesthesia over jaw & lower lip (mandibular n.)  Positive “tongue blade test”
  28. 28. Clinical Evaluation Complications  Mandibular n. trauma  Airway obstruction from blood  Avulsed teeth  Prolapse of tongue (w/ mandibular instability) Management  Immobilize; refer  Surgical repair (plate) frequently required  Fixation 4-6wks  Return to sport 8-12wks
  29. 29. Fractures of the Midface
  30. 30. Etiology & Pathology Etiology  Severe blunt trauma to the midface Pathology  LeFort I, II, or III fractures
  31. 31. Complications Infraorbital n. injury Occular injuries Airway obstruction in soft palate area due to hemorrhage & edema (LeFort I) Nasal airway obstruction due to bony displacement/hemorrhage & edema (LeFort II &III) Cerebrospinal rhinorrhea due to fx in cranial vault (LeFort II & III) Intracranial injuries
  32. 32. Classification of Midface Fractures LeFort I  Fracture of the maxilla at the level of the nasal floor LeFort II (pyramidal fx)  Fracture in the central portion of the face that includes both maxillae, medial ½ of both antra, medial ½ of the infraorbital rim, medial portion of the orbit & orbital floor, & nasal bones LeFort III (craniofacial disjunction)  A LeFort fx plus fractures of both zygomatic bones/ separation of facial bones from cranial vault
  33. 33. Clinical Evaluation History  Severe blunt trauma- not usually from sport activity Inspection  Facial asymmetry (elongation, flattened/ “dish panned” naso- orbital area)  Gagged/ open-bite occulusion (impaction of upper & lower molars)  Telecanthus (increased intercanthal distance)  Facial edema/ ecchymosis  Intraoral ecchymosis in zagomaticomaxillary buttress areas  Cerebrospinal rhinorrhea (LeFort III)
  34. 34. Clinical Evaluation Palpation  “Step-off” defects/ point tenderness at LeFort I, II, III fracture site Functional Tests  Instability- grab front teeth & try to move  Crepitus (passive “rocking” of maxilla)  Paresthesia/ anesthesia over cheek, ½ nose, & upper lip (infraorbital n.)
  35. 35. Dental Injuries/ Inflammatory Injuries
  36. 36. General Information Subluxations/Avulsions  Partially displaced teeth (intruded, extruded)  Avulsed teeth Fractures  Crown fractures  Root fractures  Alveolar fractures Inflammatory Conditions  Gingivitis  Periodontitis  Pericoronitis  Dental Abscess
  37. 37. Subluxations/Avulsions Disruption of the supporting structures (periodontal membrane) involving:  Sensitivity w/o mobility/ displacement  Mobility w/o displacement  Intrusion/ partial displacement  Extrusion/ partial displacement  Complete avulsion
  38. 38. Subluxations/ Avulsions Handle by crown only Rinse w/ sterile saline (don’t wipe) Replace Stabilize (bite on gauze) Re-implant w/in 30min (highest success) If unable to re-implant:  Save a Tooth  Cold, whole milk  Saline-gauze  Under tongue  Water
  39. 39. Subluxations/AvulsionsIntruded Tooth Lateral Luxation
  40. 40. Crown Fractures Direct trauma (hit by object)/ indirect (force through mandible/ contact of mandible & maxillary teeth) Fractures involving:  Enamel with/ without loss of tooth structure (cracked/ chipped)  Enamel & dentin or  Enamel, dentin, & pulp
  41. 41. Crown Fractures Enamel  Irritating  Not sensitive to temperature  Can wait Enamel & Dentin  Sensitive to temperature  Possibly cover with sugarless gum for temporary relief Pulp  Extremely painful- “hot tooth”  Exposed nerve  Bloody  Save broken portion (Save A Tooth)
  42. 42. Crown Fractures
  43. 43. Root Fractures Etiology  Direct trauma (hip by object) or indirect trauma (force through mandible/ contact of mandibular & maxillary teeth) Pathology  Vertical crown-root fracture with/without pulp exposure, or  Horizontal root fracture of apical (apex) middle, or cervical third  Pain  Mobility on finger pressure (primary sign)  Pulpal necrosis  If tooth is pushed back, it should not be forced forward (broken below gum line)
  44. 44. Root Fractures
  45. 45. Alveolar Fractures Etiology  Direct trauma (hit by object) Pathology  Fracture of alveolar process of the mandible/ maxilla with disruption of the tooth socket Signs & Symptoms  Pain  Displacement/ simultaneous mobility or two/ more adjacent teeth (primary sign)  Pulpal necrosis
  46. 46. Alveolar Fractures
  47. 47. Protect Your Teeth!!! Shoulda worn amouthguard littleman! Prom pictsaren’t gonna look so good!
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