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Traumatic injuries
By Gihan Omar
Professor of Oral Radiology
Causes of trauma
Accidents
Falls
sports
Assault
Importance of radiographs:
• Presence of fracture
• Site and direction of fracture
• Degree of displacement
• Relation to teeth
• Presence of contributing disease
• Foreign bodies in hard and soft tissues
• Follow up
• Post traumatic complications
Traumatic injuries to teeth
Approximation of fracture to the pulp
Degree of development of the root
Detect fracture of the root
Importance of radiographic
Examination (cont)
1- Concussion: crushing injury
Clinically
2- Luxation
Dislocation of articulation and mobility
Luxation ……………..Extrusion
Luxation …………..Intrusion
3- Avulsion
Complete displacement of tooth from its socket.
4- Teeth fracture
Crown fracture
Root fracture
Horizontal fracture
Vertical and oblique
fractures of the root
PS: Vertical fracture
Radiographic examination of
trauma to teeth
• Two periapical radiographs of
different horizontal angulations
• Occlusal topographic
• Panorama
• Chest x-ray
• Radiograph of traumatized soft
tissues
Fracture of the mandible
Symphyseal fracture
occlusal radiographs
(topographic& cross-
sectional)
PA
panorama
Body fracture
panorama
PA
lateral oblique
occlusal
Angle fracture
panorama
PA
lateral oblique
Ramus fracturePanorama
 PA
lateral
oblique
Coronoid fracture
Panorama
lateral
oblique
 sinus
Condyle fracture
Panorama
TMJ views
 Towen`s
lateral oblique
tomograms
Children
Displacement of fractured segments
Two views at right angle
Or two views at different angles
CT
Radiological appearance of mandibular fracture
Radiographic appearance of fractures
Note: how the two fracture lines meet at the inferior cortex
38
• Radiographic
limitations:
Fracture of facial
skeleton
1- maxillary fractures
Alveolar ridge fractures:
 periapical
 Occlusal topographic
 Postro-anterior
 panorama
2- Midface fractures
may involve the maxilla alone or may involve other
bones (frontal, nasal, ethmoidal and sphenoidal)
Panorama
PA
waters`
SMV
CT for
complex
midfacial
fractures
Le forte 1
-Horizontal
fracture in the
maxilla
separating
tooth bearing
fragment from
middle face.
Le forte 1
PA
waters`
CT .
Le forte 2
- Maxilla is
separated
from base
of the skull.
- Nasal bones,
max sinus,
floor of orbit
PA
Tomograms
sinus
CT
Le forte 2
Le forte 3
 middle third of facial
bone from cranium.
 Orbital fractures,
ethmoid and
sphenoid sinus,
zygoma
Sinus
Tomograms
CT
Le forte 3
3- Zygomatic fractures:
- zygomatic
arch
fracture
(unilateral
or
bilateral).
SMV
waters
Towne’s
Base of skull fractures
• CT
Facial bone fracture follow-up.
Inter and intra maxillary fixation IMF
What to do??
Now
relax
and
…. listen
by Louis Armstrong and Kenny G from the
album Classics in the Key of G
ENJOY
Please, let the show run on its own.
Music will start on next slide 
I see trees of green,
what a wonderful world
what a wonderful world
what a wonderful world
what a wonderful world.
Have a
wonderful week
end in a
wonderful world!!

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Maxiloofacial trauma