Facial trauma is routinely diagnosed in most of the road traffic accidents. A brief anatomy of mid face and various means of diagnosis and surgical management of mid face trauma is explained in the above presentation.

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By- Dr. Prathamesh Fulsundar

2. Mid-face
Definition:
The area between a
superior plane drawn
through the
zygomatico-frontal
sutures tangential to
the base of the skull
and inferior plane at
the level of the
maxillary dental
occlussal surface.
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3. Structures connection
(structures in relation)
• Orbit
• Maxillary sinus
• Nasal bone
• Naso-orbital ethmoid
(NOE) complex
• Zygomatic complex
• Frontal bone and sinus
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4. Vertical and horizontal pillars
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•Area of strength
•Vertical and horizontal pillars
•Muscular attachment
•Area of weakness
•Sutures
•Lining tissues and air-filled cavities

5. Aims of treatment
• Relieve pain
• Restore function.
• Restore bone anatomy.
• Prevent infection
• Restore the dental occlusion
• Restore jaw movement at the earliest possible stage
• Restore normal nerve function
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6. Factors affecting the risk
• Association with multiple injuries.
• Presence of uncontrolled haemorrhage
• Impairment of the airway.
• Presence of bone comminution
• Association with a dural tear.
• Association with a base of skull fracture.
• Presence of a pre-existing dentofacial deformity.
• Time elapsed since the injury.
• Presence of a medical or surgical factor which would delay general
anesthesia
• Presence of any factor which would delay healing. (eg nutritional
deficiency or alcoholism)
• Stage of dental development (deciduous, mixed or permanent
dentition) Presence of fractured teeth.
• Total absence of teeth (edentulous)
• Inability of the patient to co-operate with treatment.
• Association with fractures of the mandible especially bilateral
fractures of the condyles.
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7. Principles of treatment
Closed reduction may be appropriate in cases
• Simple uncomplicated fractures
• Complex or comminuted fractures
• Medical or surgical contraindications to open
reduction
• Maxillary fractures in children
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8. Open reduction may be appropriate where
• Immediate or early jaw function is desirable
• Difficulty is encountered in reducing the
fracture by a closed method
• The fracture is unstable
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9. Definitive treatment
• Reduction
Manual manipulation
Use of dis-impaction forceps
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10. Fixation and immobilization
Extraoral fixation
Craniomandibular fixation
Box-frame (pin fixation)
Halo-frame
Plaster of paries headcap
Craniomaxillary fixation
Supra-orbital pins
Zygomatic pins
Halo-frame
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11. Immobilization within the tissue
Direct fixation
• Transosseous wiring at
fracture sites
• Frontozygomatic sutures
• Infrorbital margin
• Midline of the palate
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12. Immobilization within the tissue
Internal-wire suspension
o Circumzygomatico-mandibular
o Infraorbital border-mandibular
o Frontomandibular
o Pyriform fossa-mandibular
Support via the maxillary sinus by filling materials
o Ribbon gauze
o Balloon
o Folly catheter
o Polyethylene material
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13. Thank you!!
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