Mid face fractures /certified fixed orthodontic courses by Indian dental academy


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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 provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Mid face fractures /certified fixed orthodontic courses by Indian dental academy

  1. 1. MIDFACE FRACTURES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Introduction Upper 1/3rd Middle 1/3rd Lower 1/3rd www.indiandentalacademy.com
  3. 3. Maxillae MidFace Palatine bones Zygomatic bones Zygomatic processes of temporal bones nasal bones lacrimal bones Vomer Ethmoid bones & it’s concha inf. Turbinates Pterygoid plates of sphenoid www.indiandentalacademy.com
  4. 4. Surgical Anatomy Central midface : Crumple Zone Complex Articulation Protects brain and skull www.indiandentalacademy.com
  5. 5. Articulation with Skull Base www.indiandentalacademy.com
  6. 6. Areas of Weakness Developmental Sutures Air filled spaces Neurovascular bundle www.indiandentalacademy.com
  7. 7. Areas of Strength Thickened Bones Higher ratio of cortical:cancellous Analogus to architectural concepts of support Sicher & Tandler in 1928 www.indiandentalacademy.com
  8. 8. Vertical Buttresses Anterior / Nasomaxillary pillars Middle / Zygomatico-maxillary pillars Posterior/ Pterygomaxillary pillars www.indiandentalacademy.com
  9. 9. Horizontal Buttresses Supra-Orbital Rims with Frontal bones Infra-Orbital Rims Alveolar Process www.indiandentalacademy.com
  10. 10. Muscular Attachment Static structure Muscles of mastication Extra-ocular muscles Buccinator Facial mimetic muscles www.indiandentalacademy.com
  11. 11. Classification www.indiandentalacademy.com
  12. 12. FRACTURES NOT INVOVING OCCLUSION A. CENTRAL REGION Fractures of the nasal bones and / or nasal septum - lateral nasal injuries - anterior nasal injuries Fractures of the frontal process of the maxilla Fractures of (1) and (2) which extend into the ethmoid bone ( nasoethmoid) Fractures of types (1), (2) and (3) which extend into the frontal bone (fronto- orbitonasal dislocation) www.indiandentalacademy.com
  13. 13. B. LATERAL REGION Fractures involving the zygomatic bone, Zygomatic arch and maxilla (zygomatic complex) excluding the dento- alveolar component www.indiandentalacademy.com
  14. 14. FRACTURES INVOLVING OCCLUSION Dento alveolar Subzygomatic : -- Le Fort I ( low level) -- Le Fort II (pyramidal) Suprazygomatic --Le Fort III (High-level) www.indiandentalacademy.com
  16. 16. Classification Alphonse Guerin ( 1888) Rene LeFort (1901)  Experimental cadaveric studies  # along the lines of weakness  Assault from frontal / lateral impact  Avoided areas of strength  LeFort I  LeFort II  LeFort III www.indiandentalacademy.com
  17. 17. Le Fort I Guerin #,Floating # Fracture extends transversely above level of teeth Traumatic force directed to the lower maxillary region B/L or U/L U/L: auxillary # : midline of the palate www.indiandentalacademy.com
  18. 18. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I Fracture (Guerin # / Low level # / Floating #) Nasal floor Pyriform rim Zygomatic buttress Pterygoid lamella Lateral wall nose Nasal septum tuberosity www.indiandentalacademy.com
  19. 19. Le Fort II: Pyramidal # Begins above level of teeth a violent force to the central region of the mid Central portion mobilized independently Pa Skull- Pyramidal shaped. www.indiandentalacademy.com
  20. 20. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II Fracture ( Pyramidal # / Subzygomatic # ) Nasal bone Frontal bone Orbit Lacrimal bone Infraorbital foramen Maxillary antrum ZM suture www.indiandentalacademy.com
  21. 21. Le Fort III: Craniofacial Dysjunction Fracture extends through zygomatic arch Entire midface separated & suspended solely by soft www.indiandentalacademy.com tissues
  22. 22. MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort III Fracture ( High transverse/Suprazygomatic/Craniofacial disarticulation) Fronto-nasal suture Ethmoid cribriform plate Frontal process maxilla Medial wall orbit Optic foramen Inferior orbital fissure Pterygoid lamella Lateral wall of orbit Z-F suture www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  23. 23. These fractures may occur unilaterally or may be associated independently with a fracture of the zygomatic complex There may be midline separation of the maxilla and / or extension of the fracture pattern into the frontal or temporal bones www.indiandentalacademy.com
  24. 24. Factors influencing displacement Degree of force Direction of force Resistance to the force offered by the facial bones Point of application of force Cross sectional area of object Attached muscles www.indiandentalacademy.com
  25. 25. Diagnosis of Maxillofacial Injuries Inspection Palpation Diagnostic Imaging   Plain Radiographs CT -Axial section -Coronal section www.indiandentalacademy.com
  26. 26. Local clinical examination gently clean up the face Inspection Palpation Diagnostic Imaging Extra oral examination Lacerations or injury over head Check for edema, ecchymosis (periorbital, conjunctival, scleral) and soft tissue lacerations Any obvious bony deformities, haemorrhage, epistaxis or otorrhoea, rhinorrhoea occular involvement www.indiandentalacademy.com
  27. 27. Palpation It should begin at the back of the neck and cranium, Upper face,the zygomatic arch ,bone and orbit Ares of tenderness, deformities noted Step deformity,subcutaneous emphysema Mobility of maxilla Eyelids separated and vision tested, check for diplopia, light reflex Check for Paraesthesia www.indiandentalacademy.com
  28. 28. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. Intra oral examination Derangement of occlusion, gagging of occlusion, lacerations, ecchymosis Palpation Areas of tenderness, bony irregularities, crepitus mobility of teeth noted Examination of teeth Pharynx evaluated for laceration & bleeding www.indiandentalacademy.com
  31. 31. Clinical Features LeFort - I Swelling of the upper lip Ecchymosis present in the buccal sulcus beneath each zygomatic arch Patient keeping the mouth slightly open Occlusion derranged Midline split of the palate Subluxation of teeth www.indiandentalacademy.com
  32. 32. The impacted Le Fort I fracture (Telescoping fracture) –difficult to diagnose – ‘grating sound’ Percussion ‘cracked pot’ sound Haemorrhage in the maxillary sinuses www.indiandentalacademy.com
  33. 33. LeFort - II / III Swelling : gross; (moon face) eyelids conjunctiva Ecchymosis : bilateral circum-orbital (panda face/raccoon face) : subconjunctival Chemosis Infra orbital step (Le Fort II) Nasal deformity www.indiandentalacademy.com
  34. 34. Retropositioning of maxilla : Deranged occlusion : post gagging : V. D Mobility of midface Hematoma on palate Dish face Loss of function: Diplopia? Anosmia Nares filled with clotted blood Emphysema, Epiphora, CSF Rhinorrhea,Hooding of eye www.indiandentalacademy.com
  35. 35. LeFort - II No alteration of pupillary level Haematoma in the upper buccal sulcus Step deformity : infra orbital margins Limitation of orbital movement with diplopia and enopthalmos Anaesthesia or Paraesthesia of the cheek Gagging of occlusion and retro-positioning of the maxilla On manipulation: movement being detected at the infra orbital margins and nasal bridge www.indiandentalacademy.com
  36. 36. LeFort - III Lenghtening of the face Alteration of the occular level unilateral or bilateral hooding of the eye # of the zygomatic arch : flattening of the zygomatic complex Tenderness and deformity over the zygomatic arch Tenderness and separation at the F-Zsuture Mobility of the whole facial skeleton as a single block Gagging of occlusion in the molar area Disruption of the cribriform plate :CSF rhinnorhoea www.indiandentalacademy.com
  37. 37. Radiographic Evaluation Plain Radiographs : P - A skull PNS Lateral skull CT Scan Axial & Coronal sections www.indiandentalacademy.com
  38. 38. PNS view www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com