Fractures of middle third of facial skeleton ih

2. FRACTURES OF MIDDLEFRACTURES OF MIDDLE
THIRD OF FACIALTHIRD OF FACIAL
SKELETONSKELETON
Presenter : Dr. Itrat HussainPresenter : Dr. Itrat Hussain

3. MIDDLE THIRDMIDDLE THIRD
 AREA BETWEEN THE SUPRA ORBITALAREA BETWEEN THE SUPRA ORBITAL
AREA AND THE CREST OF MAXILLARYAREA AND THE CREST OF MAXILLARY
ALVEOLUS/ INCISAL EDGESALVEOLUS/ INCISAL EDGES
OF THE MAXILLAROF THE MAXILLAR
ANTERIORSANTERIORS

5. BONES OF THE MIDDLE THIRDBONES OF THE MIDDLE THIRD
 2 MAXILLAE2 MAXILLAE
 2 PALATINE BONES2 PALATINE BONES
 2 ZYGOMATIC BONES2 ZYGOMATIC BONES
 2 ZYGOMATIC PROCESSES2 ZYGOMATIC PROCESSES
OF TEMPORAL BONESOF TEMPORAL BONES
 2 NASAL BONES2 NASAL BONES
 2 LACRIMAL BONES2 LACRIMAL BONES
 VOMERVOMER
 ETHMOID BONEETHMOID BONE
 BODY, LESSER, GREATER WINGS & PTERYGOIDBODY, LESSER, GREATER WINGS & PTERYGOID
PROCESSES OF SPHENOID.PROCESSES OF SPHENOID.

6. PECULIARITYPECULIARITY
 ALL ARE FLAT BONESALL ARE FLAT BONES
 ALL MEET IN THE SUTURAL JTS.ALL MEET IN THE SUTURAL JTS.
 IMMOBILEIMMOBILE
 FRAGILE & THIN - BUTTRESSED BYFRAGILE & THIN - BUTTRESSED BY
RIDGESRIDGES
 NON LOAD BEARINGNON LOAD BEARING
 GOOD VASCULARITY.GOOD VASCULARITY.

7. PECULIARITIESPECULIARITIES
 ARTICULATE WITH THE ANTERIORARTICULATE WITH THE ANTERIOR
CRANIAL FOSSACRANIAL FOSSA
 WORK AS SHOCK ABSORBINGWORK AS SHOCK ABSORBING
MECHANISMMECHANISM
 HOLLOWED BY SINUSES.HOLLOWED BY SINUSES.
 FRACTURE READILY TO PREVENTFRACTURE READILY TO PREVENT
INJURY TO CRANIAL CAVITY.INJURY TO CRANIAL CAVITY.

8. PECULIARITIESPECULIARITIES
 LIKE A BUILDING RESTING ON THREELIKE A BUILDING RESTING ON THREE
PILLARSPILLARS
 FRONTO - NASAL, FROTO-FRONTO - NASAL, FROTO-
ZYGOMATIC & PTERYGOIDSZYGOMATIC & PTERYGOIDS
 WITHSTANDS FORCE IN SUPERO-WITHSTANDS FORCE IN SUPERO-
INFERIOR THAN ANTERO-LATERALINFERIOR THAN ANTERO-LATERAL
DIRECTIONSDIRECTIONS

11. ABILITY TO WITHSTAND FORCEABILITY TO WITHSTAND FORCE
 BETTER IN INFERIO-SUPERIORBETTER IN INFERIO-SUPERIOR
DIRECTIONDIRECTION
 TRASMIT OCCLUSAL FORCETRASMIT OCCLUSAL FORCE
THROUGH ALVEOLAR PROCESS TOTHROUGH ALVEOLAR PROCESS TO
SKULL BASE AROUND ORBITAL &SKULL BASE AROUND ORBITAL &
NASAL CAVITIESNASAL CAVITIES
 VULNERABLE TO FRACTURE IFVULNERABLE TO FRACTURE IF
FORCE IS APPLIED IN PERPEDICULARFORCE IS APPLIED IN PERPEDICULAR
DIRECTIONDIRECTION

14. FRACTURES OF MIDDLE THIRDFRACTURES OF MIDDLE THIRD
OF FACEOF FACE
• CENTRAL MIDDLE THIRDCENTRAL MIDDLE THIRD
 LEFORT –ILEFORT –I
 LEFORT –IILEFORT –II
 LEFORT –IIILEFORT –III
 NASOETHMOIDAL FRACTURENASOETHMOIDAL FRACTURE
 NASOMAXILLARY FRACTURENASOMAXILLARY FRACTURE
• LATERAL MIDDLE THIRD FRACTURELATERAL MIDDLE THIRD FRACTURE
 ZYGOMATICO MAXILLARY COMPLEX FRACTUREZYGOMATICO MAXILLARY COMPLEX FRACTURE

15. CLASSIFICATIONCLASSIFICATION
CENTRALCENTRAL
 THOSE INVOLVING OCCLUSIONTHOSE INVOLVING OCCLUSION
 DENTOALVEOLARDENTOALVEOLAR
 LE FORT ILE FORT I
 LE FORT –IILE FORT –II
 LE FORT –IIILE FORT –III
 THOSE NOT INVOLVING OCCLUSIONTHOSE NOT INVOLVING OCCLUSION
 NASAL BONE#NASAL BONE#
 NASOETHMOIDALNASOETHMOIDAL
 ORBITAL #S- BLOW OUT, BLOW INORBITAL #S- BLOW OUT, BLOW IN

16. LATERAL FRACTURESLATERAL FRACTURES
 ZYGOMATIC BONE FRACTURESZYGOMATIC BONE FRACTURES
 ZYGOMATIC ARCH FRACTURESZYGOMATIC ARCH FRACTURES

17. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
 HIGH VELOCITY INJURIESHIGH VELOCITY INJURIES
RTARTA
Dash board injuriesDash board injuries
Acceleration decelerationAcceleration deceleration
 INTERPERSONAL VIOLENCEINTERPERSONAL VIOLENCE
 SPORTS INJURIESSPORTS INJURIES

21. DASHBOARD INJURYDASHBOARD INJURY

23. DISPLACEMENTDISPLACEMENT
 POSTERIORLY & INFERIORLYPOSTERIORLY & INFERIORLY

25. GENERAL CONSIDERATIONSGENERAL CONSIDERATIONS
 INVOLVEMENT OF AIR SINUSESINVOLVEMENT OF AIR SINUSES
MAXILLARYMAXILLARY
ETHMOIDALETHMOIDAL
IN LE FORT I,II,III FRACTURES, ZYGOMATICIN LE FORT I,II,III FRACTURES, ZYGOMATIC
AND NASOETHMOIDAL FRACTURESAND NASOETHMOIDAL FRACTURES

27. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
 BLEEDING PER NASALYBLEEDING PER NASALY
 SURGICAL EMPHYSEMASURGICAL EMPHYSEMA

28. INVOLVEMENT OF NERVESINVOLVEMENT OF NERVES
 INFRAORBITALINFRAORBITAL
 ANT & MIDDLE SUPERIOR ALVEOLARANT & MIDDLE SUPERIOR ALVEOLAR
 IIIRD, IVTH & VITH CRANIAL NIIIRD, IVTH & VITH CRANIAL N
 OLFACTORY (IST CRANIAL) NERVEOLFACTORY (IST CRANIAL) NERVE

29. INVOLVEMENT OF ANTERIORINVOLVEMENT OF ANTERIOR
CRANIAL FOSSACRANIAL FOSSA
 LE FORT III, NASOETHMOIDALLE FORT III, NASOETHMOIDAL
FRACTURESFRACTURES
 CLINICAL FEATURESCLINICAL FEATURES
BLACK EYE ( RACCON’S EYE)BLACK EYE ( RACCON’S EYE)
CSF RHINORRHOEACSF RHINORRHOEA
ANOSMIAANOSMIA
NEUROLOGICAL SIGNSNEUROLOGICAL SIGNS

30. COMPLICATIONSCOMPLICATIONS
CSF leakCSF leak
Intra cranial infectionsIntra cranial infections

33. INVOLVEMENT OF ORBITINVOLVEMENT OF ORBIT
 LE FORT II/ III FRACTURESLE FORT II/ III FRACTURES
 ZYGOMATIC FRACTURESZYGOMATIC FRACTURES
 ORBITAL WALL FRACTURESORBITAL WALL FRACTURES

34. CLINICAL FEATURESCLINICAL FEATURES
 CIRCUM ORBITAL ECCHYMOSISCIRCUM ORBITAL ECCHYMOSIS
 SUB CONJUNCTIVAL BLEEDSUB CONJUNCTIVAL BLEED
 PROPTOSISPROPTOSIS
 INOPHTHALMUSINOPHTHALMUS
 STRABISMUSSTRABISMUS
 DIPLOPIADIPLOPIA
 BLINDNESSBLINDNESS

40. INVOLVEMENT OF BLOODINVOLVEMENT OF BLOOD
VESSALSVESSALS
 EPISTXISEPISTXIS

41. LEFORT I FRACTURESLEFORT I FRACTURES
 LOW LEVEL #LOW LEVEL #
 GUERIAN FRACTUREGUERIAN FRACTURE
 BILATERAL- FLOATING FRACTUREBILATERAL- FLOATING FRACTURE

44. CLINICAL FEATURES OF LF I #CLINICAL FEATURES OF LF I #
 SLIGHT SWELLING OF UPPER LIPSLIGHT SWELLING OF UPPER LIP
 ECCHYMOSIS, LACERATIONS OF LABIAL MUCOSA ANDECCHYMOSIS, LACERATIONS OF LABIAL MUCOSA AND
GINGIVAGINGIVA
 ECCYMOSIS IN BUCCAL SULCUS BENEATHECCYMOSIS IN BUCCAL SULCUS BENEATH
ZYGOMATIC BUTTRESSZYGOMATIC BUTTRESS
 FLOATING MAXILLAFLOATING MAXILLA
 GRATING SOUND ON ATTEMPTED MOVEMENT OFGRATING SOUND ON ATTEMPTED MOVEMENT OF
UPPER JAWUPPER JAW

45. CLINICAL FEATURESCLINICAL FEATURES
 EPISTAXISEPISTAXIS
 GUERIAN SIGNGUERIAN SIGN
 HEAVYNESS IN GINGIVA AND TEETHHEAVYNESS IN GINGIVA AND TEETH
 DERANGEMENT OF OCCLUSIONDERANGEMENT OF OCCLUSION
 X BITEX BITE
 ANTERIOR OPEN BITEANTERIOR OPEN BITE
 POST GAGGINGPOST GAGGING
 SOMETIMES DIASTEMA & SCISSOR BITE (MIDSOMETIMES DIASTEMA & SCISSOR BITE (MID
PALATINE SPLIT)PALATINE SPLIT)

46.  TENDERNESSTENDERNESS
 CREPITUSCREPITUS
 SURGICAL EMPHYSEMASURGICAL EMPHYSEMA
 ABNORMAL MOBILITYABNORMAL MOBILITY OF THE UPPEROF THE UPPER
JAWJAW
 CRACKPOT SOUND ON PECUSSIONCRACKPOT SOUND ON PECUSSION

48. CLINICAL EXAMINATIONCLINICAL EXAMINATION

49. LE FORT II FRACTURESLE FORT II FRACTURES
 PYRAMIDALPYRAMIDAL
FRACTUREFRACTURE

50. CLINICAL FEATURES OF LF II #CLINICAL FEATURES OF LF II #
 STEP AND TENDERNESS AT NASALSTEP AND TENDERNESS AT NASAL
BRIDGE & INFRAORBITAL MARGINBRIDGE & INFRAORBITAL MARGIN
 MOBILITY OF MIDFACE AT NASAL BRIDGEMOBILITY OF MIDFACE AT NASAL BRIDGE
AND INFRAORBITAL MARGINAND INFRAORBITAL MARGIN
 ANESTHESIA OR PARESTHESIA OFANESTHESIA OR PARESTHESIA OF
INFRAORBITAL NERVEINFRAORBITAL NERVE
 STEP OR HEMATOMA AT ZYGOAMTICSTEP OR HEMATOMA AT ZYGOAMTIC
BUTTRESSBUTTRESS
 SUBCONJUNCTIVAL ECCCYMOSISSUBCONJUNCTIVAL ECCCYMOSIS
TOWARDS MEDIAL SIDE.TOWARDS MEDIAL SIDE.

51.  DISH FACE DEFORMITYDISH FACE DEFORMITY
 ABNORMAL MOBILITYABNORMAL MOBILITY
 EPISTAXISEPISTAXIS
 SURGICAL EMPHYSEMASURGICAL EMPHYSEMA
 POSTERIOR GAGGING OF OCCLUSIONPOSTERIOR GAGGING OF OCCLUSION
 DIPLOPIA MAY BE PRESENTDIPLOPIA MAY BE PRESENT

56. CAMPBELL AND TRAPNELL LINES

62. CLINICAL FEATURES OF LF III #CLINICAL FEATURES OF LF III #
 PANDA FACIES – FLAT NASAL BRIDGE,PANDA FACIES – FLAT NASAL BRIDGE,
PERIORBITAL ECCYMOSISPERIORBITAL ECCYMOSIS
 ROUND GROSSLY EDEMATOUS FACEROUND GROSSLY EDEMATOUS FACE
 TENDERNESS AND MOBILITY AT NASALTENDERNESS AND MOBILITY AT NASAL
BRIDGE, FRONTOZYGOMATIC SUTUREBRIDGE, FRONTOZYGOMATIC SUTURE
REGIONREGION
 LENGTHNING OF FACE AND DISHFACELENGTHNING OF FACE AND DISHFACE
DEFORMITYDEFORMITY
 HYPOGLOBUS ( # LINE PASSING ABOVEHYPOGLOBUS ( # LINE PASSING ABOVE
WHITNALL’S TUBERCLE)WHITNALL’S TUBERCLE)

63.  ANOSMIA (occasionally)ANOSMIA (occasionally)
 ENOPHTHALMOS AND HOODING OF EYESENOPHTHALMOS AND HOODING OF EYES
 GAGGING OF OCCLUSIONGAGGING OF OCCLUSION
 CSF RHINORRHOEA (OCCASIONALLY)CSF RHINORRHOEA (OCCASIONALLY)
 MOBILITY OF WHOLE OF THE FACIALMOBILITY OF WHOLE OF THE FACIAL
SKELETONSKELETON
 FACE APPEARS WIDENED( CHEEK BONEFACE APPEARS WIDENED( CHEEK BONE
FLATTENING)FLATTENING)
 TELECANTHUSTELECANTHUS

69. MANAGEMENTMANAGEMENT
 EMERGENCY MANAGEMENTEMERGENCY MANAGEMENT
 DEFINITIVE MANAGEMENTDEFINITIVE MANAGEMENT

70. PRIORITIESPRIORITIES
 LIFE SAVING TREATMENT FIRSTLIFE SAVING TREATMENT FIRST
 MANAGEMENT OF FRACTURES LATERMANAGEMENT OF FRACTURES LATER

71.  AIRWAY/ BREATHINGAIRWAY/ BREATHING
 SHOCK / CIRCULATIONSHOCK / CIRCULATION
 HEAD INJURYHEAD INJURY
 CERVICAL SPINE FRACTURECERVICAL SPINE FRACTURE

72. AIR WAYAIR WAY
 CLEAN THE ORAL CAVITY OF BLOOD,CLEAN THE ORAL CAVITY OF BLOOD,
CLOT, SECRETIONS, FBCLOT, SECRETIONS, FB
 PREVENT TONGUE FALL-AIR WAY,PREVENT TONGUE FALL-AIR WAY,
TONGUE STICHTONGUE STICH
 INTUBATEINTUBATE
 TRACHEOSTOMYTRACHEOSTOMY
 CYRCOTHYROIDECTOMYCYRCOTHYROIDECTOMY

73. HAEMORRHAGIC SHOCKHAEMORRHAGIC SHOCK
 FLUID RESUSCITATION-FLUID RESUSCITATION-
CRYSTALLOIDS,COLLOIDSCRYSTALLOIDS,COLLOIDS
 CONTROLL BLEEDINGCONTROLL BLEEDING
 VASOPRESSORS, STEROIDS, O2,VASOPRESSORS, STEROIDS, O2,
CORRECTION OF ACIDOSISCORRECTION OF ACIDOSIS
 BTBT

74. HEAD INJURYHEAD INJURY
 HISTORYHISTORY
 ORIENTATIONORIENTATION
 AMNESIAAMNESIA
 LEVEL OF CONCIOUSNESSLEVEL OF CONCIOUSNESS
 POSTUREPOSTURE
 NEUROLOGICAL EXAMINATIONNEUROLOGICAL EXAMINATION

75. Raccoon's eyes & Battle’s signRaccoon's eyes & Battle’s sign

76. CERVICAL SPINE FRACTURECERVICAL SPINE FRACTURE
 TENDERNESSTENDERNESS
 SPLINTINGSPLINTING
 CAREFUL SHIFTINGCAREFUL SHIFTING
 INTUBATION/ TRACHEOSTOMY- AVOIDINTUBATION/ TRACHEOSTOMY- AVOID

77. SUPPORTIVE TREATMENTSUPPORTIVE TREATMENT
 ANTIBIOTICSANTIBIOTICS
 ANAGESICSANAGESICS
 IMMUNIZATION AGAINST TETANUSIMMUNIZATION AGAINST TETANUS

78. DEFINITIVE MANAGEMENTDEFINITIVE MANAGEMENT
 DISIMPACTION AND REDUCTION OFDISIMPACTION AND REDUCTION OF
MAXILLAMAXILLA
 FIXATION OF MAXILLAFIXATION OF MAXILLA

79. DISIMPACTION ANDDISIMPACTION AND
REDUCTION OF MAXILLAREDUCTION OF MAXILLA
I.I. OPEN REDUCTIONOPEN REDUCTION
CLOSED REDUCTIONCLOSED REDUCTION
(WITH ROW’S DISIMPACTION FORCEPS,(WITH ROW’S DISIMPACTION FORCEPS,
HAYTON-WILLIAM FORCEP)HAYTON-WILLIAM FORCEP)
II.II. IMMEDIATE REDUCTIONIMMEDIATE REDUCTION
GRADUAL REDUCTION (BY TRACTIONGRADUAL REDUCTION (BY TRACTION
BIRD CAGE TRACTION, TRACTION BYBIRD CAGE TRACTION, TRACTION BY
WEIGHT)WEIGHT)

80. FIXATION OF MAXILLAFIXATION OF MAXILLA
I.I. INTERNAL FIXATIONINTERNAL FIXATION
A. DIRECT OSTEOSYNTHESISA. DIRECT OSTEOSYNTHESIS
BONE PLATESBONE PLATES
MINIPLATES AND SCREWSMINIPLATES AND SCREWS
MICROPLATESMICROPLATES
3-D PLATES3-D PLATES
BIORESORBABLE PLATESBIORESORBABLE PLATES
INTEROSSEOUS WIRINGINTEROSSEOUS WIRING

81. B. SUSPENSION WIRESB. SUSPENSION WIRES
FRONTAL (CENTRAL,FRONTAL (CENTRAL,
LATERAL)LATERAL)
CIRCUMZYGOMATICCIRCUMZYGOMATIC
ZYGOMATICZYGOMATIC
INFRAORBITALINFRAORBITAL
PYRIFORM APERTUREPYRIFORM APERTURE
PERALVEOLARPERALVEOLAR

82. II. EXTERNAL FIXATIONII. EXTERNAL FIXATION
A. CRANIOMANDIBULARA. CRANIOMANDIBULAR
B. CRANIOMAXILLARYB. CRANIOMAXILLARY
SUPRAORBITAL PINSSUPRAORBITAL PINS
ZYGOMATIC PINSZYGOMATIC PINS
HALOFRAMEHALOFRAME
LEVANT FRAMELEVANT FRAME
III. TRANSFIXATION WITH K-WIREIII. TRANSFIXATION WITH K-WIRE

87. FIXATION ANDFIXATION AND
IMMOBILIZATIONIMMOBILIZATION
 SUSPENSION WIRINGSUSPENSION WIRING
A. EXTERNALA. EXTERNAL
B. INTERNALB. INTERNAL
IMFIMF
INTEROSSEOUS WIRINGINTEROSSEOUS WIRING
BONE PLATINGBONE PLATING

106. MANAGEMENT PROTOCOL INMANAGEMENT PROTOCOL IN
MULTIPLE FACIAL # PATIENTSMULTIPLE FACIAL # PATIENTS
 OUTER TO INNER RING CONSTRUCTIONOUTER TO INNER RING CONSTRUCTION
 TREATMENT OF MANDIBULAR #TREATMENT OF MANDIBULAR #
 TREATMENT OF ZYGOMATIC #TREATMENT OF ZYGOMATIC #
 TREATMENT O FRONTAL #TREATMENT O FRONTAL #
 TREATMENT OF MAXILLA #TREATMENT OF MAXILLA #
 TREATMENT OF NASAL #TREATMENT OF NASAL #
 TREATMENT OF FACIAL LACERATIONSTREATMENT OF FACIAL LACERATIONS
 CARE OF FACIAL NERVE, LACRIMALCARE OF FACIAL NERVE, LACRIMAL
APPARATUS AND PAROTID DUCT IFAPPARATUS AND PAROTID DUCT IF
REQUIREDREQUIRED

113. ZYGOMATIC COMPLEX #ZYGOMATIC COMPLEX #

115. CLASSIFICATIONCLASSIFICATION
• UNDISPLACEDUNDISPLACED
• INFERIOR & INWARD DISPLACEMENTINFERIOR & INWARD DISPLACEMENT
• UPWARD & OUTWARD DISPLACEMENTUPWARD & OUTWARD DISPLACEMENT
• COMMUNITEDCOMMUNITED

121. CLINICAL FEATURESCLINICAL FEATURES
 SWELLING, BRUISING OVER CHEEKSWELLING, BRUISING OVER CHEEK
 DEPRESSED MALAR PROMINENCEDEPRESSED MALAR PROMINENCE
 TRISMUS & RESTRICTED MANDIBULARTRISMUS & RESTRICTED MANDIBULAR
MOVEMENTSMOVEMENTS
 STEP AND TENDERNESS AT INFRAORBITALSTEP AND TENDERNESS AT INFRAORBITAL
MARGIN, LATERAL ORBITAL MARGIN,MARGIN, LATERAL ORBITAL MARGIN,
ZYGOMATIC BUTTRESSZYGOMATIC BUTTRESS
 DIPLOPIADIPLOPIA
 PERIORBITAL ECCHYMOSIS &PERIORBITAL ECCHYMOSIS &
SUBCONJUNCTIVAL HEMORRHAGESUBCONJUNCTIVAL HEMORRHAGE
 PROPTOSIS/ INOPHTHALMUSPROPTOSIS/ INOPHTHALMUS
 ANESTHESIA PARESTHESIA OFANESTHESIA PARESTHESIA OF
INFRAORBITAL NERVEINFRAORBITAL NERVE
 EPISTAXISEPISTAXIS

122. CLINICAL FEATURESCLINICAL FEATURES

133. MANAGEMENTMANAGEMENT
 CONSERVATIVE MANAGEMENT WITHOUT ANYCONSERVATIVE MANAGEMENT WITHOUT ANY
INTERVENTIONINTERVENTION
 REDUCTIONREDUCTION
A. INDIRECT REDUCTIONA. INDIRECT REDUCTION
1. TEMPORAL FOSSA APPROACH1. TEMPORAL FOSSA APPROACH
2. UPPER BUCCAL SULCUS APPROACH2. UPPER BUCCAL SULCUS APPROACH
3. PERCUTANEOUS APPROACH3. PERCUTANEOUS APPROACH
4. INTRANASAL TRANSANTRAL4. INTRANASAL TRANSANTRAL
APPROACHAPPROACH
B. DIRECT REDUCTION (CARROLL-GIRARDB. DIRECT REDUCTION (CARROLL-GIRARD
SCREWSCREW

134. STABILIZATION AND ORSTABILIZATION AND OR
FIXATIONFIXATION
 NO FIXATION MAY BE REQUIRED IF #NO FIXATION MAY BE REQUIRED IF #
STABLE AFTER REDUCTIONSTABLE AFTER REDUCTION
 TEMPORARY SUPPORT (WITH ANTRALTEMPORARY SUPPORT (WITH ANTRAL
PACK, INFLATABLE BALLOON, HEAD CAPPACK, INFLATABLE BALLOON, HEAD CAP
WITH TRACTION WIRE, SILICONEWITH TRACTION WIRE, SILICONE
ELASTOMER WEDGE)ELASTOMER WEDGE)
 DIRECT FIXATION (WITH TRANSOSSEOUSDIRECT FIXATION (WITH TRANSOSSEOUS
WIRING OR BONE PLATING)WIRING OR BONE PLATING)
(ABSOLUTE INDICATIONS- FUNCTION, COSMESIS, UNSTABLE(ABSOLUTE INDICATIONS- FUNCTION, COSMESIS, UNSTABLE
#s)#s)

138. Gilli’s Temporal ApproachGilli’s Temporal Approach
Incision in the hair lineIncision in the hair line
Plane to be created between deep temporal fascia &Plane to be created between deep temporal fascia &
temporalistemporalis

140. MODIFIED KEEN’S APPROACHMODIFIED KEEN’S APPROACH

141. CARROL- GIRARD SCREW

142. POSSWILO’S HOOCKPOSSWILO’S HOOCK

159. OTHER MODALITIESOTHER MODALITIES
 TRANS ANTRALTRANS ANTRAL
 TRANS NASALTRANS NASAL
ANTRAL PACKANTRAL PACK

160. COMPLICATIONSCOMPLICATIONS
 DIPLOPIADIPLOPIA
 SUPERIOR ORBITAL FISSURESUPERIOR ORBITAL FISSURE
SYNDROMESYNDROME
 ORBITAL APEX SYNDROMEORBITAL APEX SYNDROME

161. DIPLOPIADIPLOPIA
 DOUBLE VISIONDOUBLE VISION
 BINOCULAR-MONOCULARBINOCULAR-MONOCULAR
ENTRAPMENT OF MUSCLESENTRAPMENT OF MUSCLES
NEUROLOGICALNEUROLOGICAL

163. HESS CHARTHESS CHART

164. FORCED DUCTION TESTFORCED DUCTION TEST

165. MANAGEMENTMANAGEMENT
 CORRECT POSITION OF THE GLOBECORRECT POSITION OF THE GLOBE
 RELEASE ENTRAPPED MUSCLERELEASE ENTRAPPED MUSCLE
 REDUCTION OF FRACTURE THUSREDUCTION OF FRACTURE THUS
RELEIVING INTRAOCCULARRELEIVING INTRAOCCULAR
PRESSUREPRESSURE
 STEROIDSSTEROIDS
 PHYSIOTHERAPYPHYSIOTHERAPY

166. SUPERIOR ORBITAL SYNDROMESUPERIOR ORBITAL SYNDROME
 Compression of the contents of theCompression of the contents of the
superior orbital fissure due to raisedsuperior orbital fissure due to raised
intraorbital pressureintraorbital pressure
Zygomatic fracturesZygomatic fractures
TumoursTumours
Cavernous sinus thrombosisCavernous sinus thrombosis

170. Clinical FeaturesClinical Features
 Ptosis (3Ptosis (3rdrd
cr.N)cr.N)
 External ophthalmoplagia(3External ophthalmoplagia(3rdrd
,4,4thth
& 6& 6thth
Cr.N)Cr.N)
 Fixed dialated pupil(3Fixed dialated pupil(3rdrd
cr.N) not reponding tocr.N) not reponding to
lightlight
(internal ophthalmoplagia)(internal ophthalmoplagia)
 Sensory deficit(5Sensory deficit(5thth
cranial N, ophthalmic division)cranial N, ophthalmic division)
 EdemaEdema
 No involvement of 2No involvement of 2ndnd
cranial nerve (Optic)cranial nerve (Optic)

171. ManagementManagement
 Decompression of orbitDecompression of orbit
 SteroidsSteroids
 PhysiotherapyPhysiotherapy

172. Fractures of the zygomatic archFractures of the zygomatic arch

173. ClassificationClassification
 UndisplacedUndisplaced
 V in typeV in type
 ComminutedComminuted

174. Clinical featuresClinical features
 Dimpling over the archDimpling over the arch
 SwellingSwelling
 Trismus (coronoid process getsTrismus (coronoid process gets
obstructed)obstructed)

182. Post operative precautionsPost operative precautions
 Do not handle the area while shifting theDo not handle the area while shifting the
patientpatient

Mark the zygomatic area with red inkMark the zygomatic area with red ink XX
 Do not allow to sleep on the same sideDo not allow to sleep on the same side