Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Maxillofacial Fractures    Copyright of Allan G. Farman
Teeth
Recent Tooth Fracture Thin  radiolucent line(s) extending through  any portion of tooth. “Step defect.” Well-defined ye...
Traumatic dentalinjury:rootfracture ofmaxillaryleft centralincisor(topographicocclusal view).
Fractured right maxillarycentral incisor.
Tooth Displacement Concussion   – no radiologic sign or pdl  widening, most frequently apically. Subluxation – often too...
Subluxation of mandibularanterior teeth followingtrauma.
Later changes followingluxation. Pulp necrosis – widened pulp due to  absence of continued 2y dentin formation. Apical p...
Resorption of root of maxillary centralincisor following trauma (thermalprint of RVG 32000 digital images).
Alveolus
Alveolar Fracture Sharply defined, uncorticated and  occasionally jagged radiolucent line in  alveolus. Fracture line(s)...
Alveolar fracturein anterior mandible.
Alveolar fracture in anterior mandible(red arrows).There is also a fracture inthe right molar region of the same jaw(yello...
Alveolar fracturecombined withfracture throughsymphysis:topographicocclusalprojection.
Alveolar fracture inanterior maxilla.
Mandible
Mandibular Condyle Condylar  head “sheared off” and  telescoped inward on itself. Step defect. Overlap of trabecular pa...
Fracture of rightmandibular condyleand at left angle ofmandible.
RFracture of left mandibular condyle withmedial displacement of condylar head(Reverse Towne’s projection).
RFractures of mandibularsymphysis and left condyle.
Mandibular Body Radiographic  visible line of cleavage if x-  ray beam parallels fracture line. Line of cleavage may be ...
Mandibular fracture (depressed) inleft canine/premolar region. Notefracture line and step in cortical outline.
Fracture at left mandibularangle shown on panoramicdental radiograph.
Mandibular fracture ofleft angle followingsurgical realignment andfixation.
RMandibular fracture at angle on rightside (PA view).
Mandibular fracture: this is the same case buthere the fracture is not so obvious. It is actuallyat the right mandibular a...
Mandibular fracturesin right molar andleft premolar regions(incidentally, molarsare taurodonts).
LMandibular fracturein right thirdmolar region.
R    Comminuted fracture of left    mandibular body (positioning error    are not unusual in trauma victims    – the patie...
LComminuted fracture of leftmandibular ramus caused bygunshot injury.
RComminuted fracture of left mandibularramus caused by gunshot injury (PA viewof same patient).
R
R
Pathological fracture associatedwith large apical cyst in leftmandibular first molar region.
LPathologic fracture associated withlarge radicular cyst (lateral-oblique viewfrom same patient).
Maxilla
Zygomatic Arch
Zygomatic Arch Fractures Together   with zygomatico-maxillary  fractures, represent 25% of all facial  fractures. Depres...
Depressed fractureof left zygomatic arch(2 different cases):(submentovertexviews).
Detail of depressedfracture of leftzygomatic arch:fractureleft side ofsubmentovertexprojection.
Zygomaticomaxillary Fractures Widening   of zygomaticofrontal,  zygomaticomaxillary and zygomaticotemporal  suture lines....
RTripod fracture (depressed)of left malar complex (arrow).
RTripod fracture of left zygomaticcomplex (PA view).
Depressed fracture of left zygomatic arch(blue arrow) and blow-out fracture of leftorbital floor (yellow arrow) - Water’s ...
Depressed fracture of left zygomatic arch(blue arrow) and blow-out fracture (yellowarrow) of left orbital floor (Water’s v...
Orbit
Blow-out Fracture Force   transmitted to thin orbital floor, which  generally fractures near infraorbital canal. Soft ti...
Fracture of lateral wall plus blow-outfracture of left orbit (coronal CT). Note lackof continuity of orbital rim.
Blow-out fracture of left orbital floor inregion of infraorbital canal (coronal CT).
Blow-out fractureof left orbital floor:Water’sprojection.
Blow-out fracture of right orbital floorindicated solely by thickening of mucosalining superior antral wall (Water’s view).
Blowout fracture of right orbital floorindicated by thickening of roof of maxillarysinus (PA tomographic view) – see arrow.
Blow-out fracture of right orbit shows typical“trap door” sign. There is opacificationof the affected sinus (coronal tomog...
Le Fort Type I Fracture  above level of maxillary teeth involving  alveolar process, palate and pterygoid plates. Cloudi...
RLeFort I midfacial fracture with bilateral fracturesof the walls of the left and right maxillary sinuses.Both sinuses sho...
Le Fort Type II Pyramidal  fracture across nasal bones and  frontal processes of maxilla, extending laterally  through la...
LLe Fort II midfacial fracture: fracture linesextend obliquely through nasofrontal sutures,through the medial and inferior...
PA view          Axial CTR    Le Fort II    fracture
Le Fort II fracture (same case) shown withsurface-rendered 3-D reconstruction of axialCT slices.
Le Fort II fracture:note lack ofcontinuity inoutlines ofmaxillary sinuses(axial CT).
Le Fort Type III Craniofacial dysjunction with shearing of facial  complex from cranial base. Involves nasofrontal,  maxi...
Le Fort III midface fractures: PA view showsfractures of lateral walls of both maxillary sinuseswith concomitant opacifica...
Le Fort III fractures involvingnasoethmoidal region (lateral view).
Le Fort III fracture: lateral view demonstratesfracture lines in the nasoethmoidal region andanterior maxilla (both Le For...
Grafts
R     L        BUC   LINGR   L
R   L   R   L   R   LR   L   R   L   R   L
Maxillofacial Fractures(1) CT is both the state-of-the-art and the    current standard of care for maxillary fracture    e...
Maxillofacial fractures
Maxillofacial fractures
Maxillofacial fractures
Maxillofacial fractures
Maxillofacial fractures
Maxillofacial fractures
Maxillofacial fractures
Upcoming SlideShare
Loading in …5
×

Maxillofacial fractures

24,368 views

Published on

Maxillofacial fractures

Published in: Education
  • Dating direct: ❤❤❤ http://bit.ly/369VOVb ❤❤❤
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Follow the link, new dating source: ❶❶❶ http://bit.ly/369VOVb ❶❶❶
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • I would like to invite trauma enthusiasts to become members of our new Society. www.headandnecktrauma.org Membership is free. There is no charge. I am keen that this includes the entire professional remit of care, from roadside to rehabilitation and I am therefore looking for enthusiastic members worldwide, who may wish to contribute to the site. There is an education section, news feed, YouTube channel and a forum which I hope members will use to discuss various trauma related topics. If anyone is interested in publishing online we have facility for this too. Please have a look. It has only just been launched, so there is still much to do. I hope you will find it interesting.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Maxillofacial fractures

  1. 1. Maxillofacial Fractures Copyright of Allan G. Farman
  2. 2. Teeth
  3. 3. Recent Tooth Fracture Thin radiolucent line(s) extending through any portion of tooth. “Step defect.” Well-defined yet soft radiolucent band (where central x-ray beam cuts fracture line obliquely). For crown, transillumination and/or disclosing solutions often useful.
  4. 4. Traumatic dentalinjury:rootfracture ofmaxillaryleft centralincisor(topographicocclusal view).
  5. 5. Fractured right maxillarycentral incisor.
  6. 6. Tooth Displacement Concussion – no radiologic sign or pdl widening, most frequently apically. Subluxation – often tooth mobility with no radiologic sign or pdl widening. Luxation – Widened pdl (unless intrusive); minor alveolar fracture(s); step in dental occlusion.
  7. 7. Subluxation of mandibularanterior teeth followingtrauma.
  8. 8. Later changes followingluxation. Pulp necrosis – widened pulp due to absence of continued 2y dentin formation. Apical periodontal pathosis. External root resorption and possible ankylosis. Pulpal obliteration.
  9. 9. Resorption of root of maxillary centralincisor following trauma (thermalprint of RVG 32000 digital images).
  10. 10. Alveolus
  11. 11. Alveolar Fracture Sharply defined, uncorticated and occasionally jagged radiolucent line in alveolus. Fracture line(s) mostly horizontal. Segment of teeth may be displaced. Widened pdl spaces. Possible associated root fractures.
  12. 12. Alveolar fracturein anterior mandible.
  13. 13. Alveolar fracture in anterior mandible(red arrows).There is also a fracture inthe right molar region of the same jaw(yellow arrow).
  14. 14. Alveolar fracturecombined withfracture throughsymphysis:topographicocclusalprojection.
  15. 15. Alveolar fracture inanterior maxilla.
  16. 16. Mandible
  17. 17. Mandibular Condyle Condylar head “sheared off” and telescoped inward on itself. Step defect. Overlap of trabecular pattern seen as band of increased opacity. Deviation of mandible to affected side. Rarely, condylar head maintains integrity.
  18. 18. Fracture of rightmandibular condyleand at left angle ofmandible.
  19. 19. RFracture of left mandibular condyle withmedial displacement of condylar head(Reverse Towne’s projection).
  20. 20. RFractures of mandibularsymphysis and left condyle.
  21. 21. Mandibular Body Radiographic visible line of cleavage if x- ray beam parallels fracture line. Line of cleavage may be indistinct if x-ray beam is not parallel to fracture line. Step defect. Contralateral condylar head frequently fractured.
  22. 22. Mandibular fracture (depressed) inleft canine/premolar region. Notefracture line and step in cortical outline.
  23. 23. Fracture at left mandibularangle shown on panoramicdental radiograph.
  24. 24. Mandibular fracture ofleft angle followingsurgical realignment andfixation.
  25. 25. RMandibular fracture at angle on rightside (PA view).
  26. 26. Mandibular fracture: this is the same case buthere the fracture is not so obvious. It is actuallyat the right mandibular angle. Two views at rightangles are suggested when looking for fractures.
  27. 27. Mandibular fracturesin right molar andleft premolar regions(incidentally, molarsare taurodonts).
  28. 28. LMandibular fracturein right thirdmolar region.
  29. 29. R Comminuted fracture of left mandibular body (positioning error are not unusual in trauma victims – the patient’s chin was too low and head too far forward in this case).
  30. 30. LComminuted fracture of leftmandibular ramus caused bygunshot injury.
  31. 31. RComminuted fracture of left mandibularramus caused by gunshot injury (PA viewof same patient).
  32. 32. R
  33. 33. R
  34. 34. Pathological fracture associatedwith large apical cyst in leftmandibular first molar region.
  35. 35. LPathologic fracture associated withlarge radicular cyst (lateral-oblique viewfrom same patient).
  36. 36. Maxilla
  37. 37. Zygomatic Arch
  38. 38. Zygomatic Arch Fractures Together with zygomatico-maxillary fractures, represent 25% of all facial fractures. Depression of zygomatic arch on submentovertex, Waters and PA views. Close proximity of coronoid process to zygomatic arch.
  39. 39. Depressed fractureof left zygomatic arch(2 different cases):(submentovertexviews).
  40. 40. Detail of depressedfracture of leftzygomatic arch:fractureleft side ofsubmentovertexprojection.
  41. 41. Zygomaticomaxillary Fractures Widening of zygomaticofrontal, zygomaticomaxillary and zygomaticotemporal suture lines. Step defects at junction of frontal and zygomatic bones, zygoma and maxilla, or zygoma and temporal bone (“tripod” fractures) . CT used for assessing on nasolacrimal canal, lateral rectus muscle of eye and posible intra- cranial hemorrhage .
  42. 42. RTripod fracture (depressed)of left malar complex (arrow).
  43. 43. RTripod fracture of left zygomaticcomplex (PA view).
  44. 44. Depressed fracture of left zygomatic arch(blue arrow) and blow-out fracture of leftorbital floor (yellow arrow) - Water’s view.
  45. 45. Depressed fracture of left zygomatic arch(blue arrow) and blow-out fracture (yellowarrow) of left orbital floor (Water’s view).
  46. 46. Orbit
  47. 47. Blow-out Fracture Force transmitted to thin orbital floor, which generally fractures near infraorbital canal. Soft tissue swelling over orbital rim. Opacification of affected maxillary sinus. Displaced orbital floor (“trap door”). Polypoid density in roof of maxillary sinus through herniation of orbital contents. Cheek paresthesia if infraorbital canal involved.
  48. 48. Fracture of lateral wall plus blow-outfracture of left orbit (coronal CT). Note lackof continuity of orbital rim.
  49. 49. Blow-out fracture of left orbital floor inregion of infraorbital canal (coronal CT).
  50. 50. Blow-out fractureof left orbital floor:Water’sprojection.
  51. 51. Blow-out fracture of right orbital floorindicated solely by thickening of mucosalining superior antral wall (Water’s view).
  52. 52. Blowout fracture of right orbital floorindicated by thickening of roof of maxillarysinus (PA tomographic view) – see arrow.
  53. 53. Blow-out fracture of right orbit shows typical“trap door” sign. There is opacificationof the affected sinus (coronal tomograph).
  54. 54. Le Fort Type I Fracture above level of maxillary teeth involving alveolar process, palate and pterygoid plates. Clouding of maxillary sinus on one or both sides. Discontinuity of lateral maxillary sinus walls on plain radiographs. Sharp horizontal line of cleavage through maxilla, pterygoid plates and sphenoid. Canted maxilla relative to cranial base and mandibular teeth.
  55. 55. RLeFort I midfacial fracture with bilateral fracturesof the walls of the left and right maxillary sinuses.Both sinuses show opacification.
  56. 56. Le Fort Type II Pyramidal fracture across nasal bones and frontal processes of maxilla, extending laterally through lacrimal bones, inferior rim of orbit near zygomaticomaxillary suture, lateral walls of maxilla and pterygoid plates. Increased width of frontonasal suture. Radiolucent cleavage lines. Step defect in orbital rim. Sinus shadows obscurred by hemorrhage. Disruption in dental occlusion.
  57. 57. LLe Fort II midfacial fracture: fracture linesextend obliquely through nasofrontal sutures,through the medial and inferior aspects ofboth orbits and the lateral walls of both maxillarysinuses (PA view).
  58. 58. PA view Axial CTR Le Fort II fracture
  59. 59. Le Fort II fracture (same case) shown withsurface-rendered 3-D reconstruction of axialCT slices.
  60. 60. Le Fort II fracture:note lack ofcontinuity inoutlines ofmaxillary sinuses(axial CT).
  61. 61. Le Fort Type III Craniofacial dysjunction with shearing of facial complex from cranial base. Involves nasofrontal, maxillofrontal and zygomaticofrontal sutures orbit, ethmoid sinus and sphenoid sinus floors. Widened frontonasal, maxillofrontal, zygomaticofrontal and zygomaticotemporal sutures. Radiolucent cleavage lines through frontal processes of maxilla, both pterygoid plates and one or both orbital floors. Sinus shadows obscurred by hemorrhage.
  62. 62. Le Fort III midface fractures: PA view showsfractures of lateral walls of both maxillary sinuseswith concomitant opacification of the sinuses.Glabella and right zygomaticofrontal sutures alsoevidence fracture lines.
  63. 63. Le Fort III fractures involvingnasoethmoidal region (lateral view).
  64. 64. Le Fort III fracture: lateral view demonstratesfracture lines in the nasoethmoidal region andanterior maxilla (both Le Fort III and Le Fort I).
  65. 65. Grafts
  66. 66. R L BUC LINGR L
  67. 67. R L R L R LR L R L R L
  68. 68. Maxillofacial Fractures(1) CT is both the state-of-the-art and the current standard of care for maxillary fracture evaluation.(2) Panoramic radiography is the best modality for evaluation of the mandible following trauma.

×