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Middle third fractures

A lecture for 5th stage dentistry students

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Middle third fractures

  1. 1. Middle third fractures Dr. Mohamed Rahil (Maxillofacial surgeon) Tikrit dentistry college
  2. 2. Etiology 1.RTA 2. Fall from hight 3.occupational accident 4.fighting 5.Sport injury 6.War injury
  3. 3. Physical characteristics of midfacial skeleton 1.middle third consist from multiple bones which is rarely fractured in isolation 2.this type of structures able to withstand considerable force from below but early fractured from other directions 3. it act as a cushion for trauma directed to the cranium
  4. 4. Classification of mid face fractures • Dentoalveolar fractures • Zygomatic complex fracture • Orbital floor fracture • Nasal complex fracture • Le Fort I • Le Fort II • Le Fort III
  6. 6. Dentoalveolar fractures • Damage to the teeth • Damage to the lip • Alveolar fracture
  7. 7. Fracture of zygomatic ((complex))
  8. 8. Classification of zygomatic complex fracture I . Fracture of the body a. Minimal or no displacement b. Inward and downward displacement c. Inward and posterior displacement d. Outward displacement e. Comminution
  9. 9. II. Fracture of zygomatic arch a. Minimal or no displacement b. V-type fracture c. comminuted
  10. 10. Signs and symptoms I. Extra oral  Inspection a. Circumorbital ecchymosis b. Subconjunctival heamorrhage c. Edema d. Flattening zygoma region e. Limitation of ocular movement f. Diplopia g. Strabismus h. Enophthalmos i. Limitation of mouth opening j. Unilateral epistaxis
  11. 11. Palpation a. Tenderness over the cheek bones b. Tenderness and separartion at frontozygomatic suture c. Step at inferior orbital rim d. Parasthesia of the cheek
  12. 12. Intra oral examination  By inspection a. Ecchymosis at the buccal vestibule in the region of zygomatico-maxillary suture b. Possible of occlusion gagging in molar region By palpation Tenderness Anasthesia at the upper lip
  13. 13.  Classification a. Minimal or no displacement b. V- shaped displacement c. Comminuted fracture
  14. 14. Orbital floor fracture
  15. 15. Signs and symptoms • Edema , COE , SCE , Emphysema • Unilateral epistaxis • Parasthesia within the distribution of infra-orbital nerve • Limitation of eye movement • Enophthalmus,diplopia,ptosis • proptosis
  16. 16. Invesigations • Forced duction test • Cardinal position of the gaze • Hess chart
  17. 17. Forced duction test: This test use to differentiate between Muscle entrapment and muscle paralysis
  18. 18. Radiology a. Opacity of sinusis b. Hanging drop sign
  19. 19. Nasal complex fracture
  20. 20. • Edema , SCH, COE ,lacerations • Epistaxis • Deviation of the nose • Mobility of bone • epiphoria Signs and symptoms
  22. 22. Lefort I
  23. 23. • Clinical findings: – Facial edema – Malocclusion of the teeth – Motion of the maxilla while the nasal bridge remains stable
  24. 24. LeFort II
  25. 25. • Clinical findings: – Marked facial edema – Nasal flattening – Traumatic telecanthus – Epistaxis or CSF rhinorrhea – Movement of the upper jaw and the nose.
  26. 26. LeFort III – Fractures through: • Maxilla • Zygoma • Nasal bones • Ethmoid bones • Base of the skull
  27. 27. LeFort III • Clinical findings: – Dish faced deformity – Epistaxis and CSF rhinorrhea – Motion of the maxilla, nasal bones and zygoma – Severe airway obstruction
  28. 28. CSF leak
  29. 29. Radiograph for maxillofacial trauma
  30. 30. Occipitomental view
  31. 31. Sub-mentovertex view
  32. 32. Thank you for listening