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Treatment of midface fracture

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A lecture for 5th stage dentistry students

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Treatment of midface fracture

  1. 1. Definitive treatment of midfacial fractures Dr.Mohamed Rahil (Maxillofacial surgeon) Tikrit dentistry college
  2. 2. Priority to saving patient life (ABC)
  3. 3. Principle of treatment Reduction Fixation Immobilization Follow up and rehabilitation
  4. 4. Dentoalveolar fracture I. Fracture of teeth a. Fracture of teeth without pulp exposure b. Fracture of teeth with pulp epxosure c. Subluxation d. Avultion II. Fracture of alveolus and maxillary tuberosity
  5. 5. Zygomatic complex fracture Indications for reduction • Diplopia • Restriction of mandibular movement • Restore orbit skeleton • Restore normal contour of face
  6. 6. Reduction • Time • Appraoches
  7. 7. Gillies approach
  8. 8. Keen approach
  9. 9. Quinn approach
  10. 10. Percutaneous approach
  11. 11. fixation • Trans-osseous wiring
  12. 12. plating
  13. 13. Fixation with pack in the maxillary sinus • Comminuted fracture of zygoma • Comminuted fracture of orbital floor • Ballon or back can be used
  14. 14. Pin fixation • Excessively mobile zygoma • Following surgical refractur of badly displaced zygomatic bone which has been healed
  15. 15. Fracture of zygomatic arch • Reduction through Gillies approach • Fixation un necessary in recent fracture
  16. 16. Fracture of orbital floor
  17. 17. Indications for treatment • Diplopia not resolved after 10 days after injury • Large herniation of tissue to the antrum • Restriction of eye globe movment • Enophthalmus greater than 3 mm
  18. 18. Nasal complex fracture • Reduction Walsham’s forceps Asche’s forceps
  19. 19. fixation • POP • Lead plate splint • Open reduction
  20. 20. LeFort fractures
  21. 21. Le Fort I fracture Rowe’s disimpaction forceps
  22. 22. Lefort II
  23. 23. Lefort III Usually multiple fractures Priority of treatment ; Reduction of zygomatic bone fracture Teeth bearing portion Naso-ethmoidal fracture And finally nasal complex immobilization
  24. 24. Immobilization of lefort fractures • Extra-oral immobilization • Immobilization within the tissue
  25. 25. Extra oral immobilization • 1. cranio-mandibular • A. box frame • B. halo frame • C. pop headcap • 2. craniomaxillary • a. supra – orbital pins • B. zygomatic pins • C. halo fram • 3. suspension
  26. 26. Immobilization within the tissues 1. Direct fixation • A.Transosseous wiring • B. K-wire • C. plating 2. internal wire suscpension 3.support
  27. 27. Type of plating • Minplate • Compression plate • Reconstruction plate
  28. 28. Rigid fixation VS non rigid fixation
  29. 29. Complications of fractures • Complication from head injury • Complications from fracture it self • Complications associated with lacrimal system • Ophthalmic complication • Complications from neural damage • Non - union
  30. 30. Thank you for listening

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