A Comprehensive educational presentation on the fractures of the middle third of the facial skeleton.
By: Dr. Abdul Karim Sharif, MD, PGD
Ghalib University Lecturer
Kabul, Afghanistan
2015
This document discusses the bilateral sagittal split osteotomy (BSSO) procedure for mandibular advancement or setback. It provides details on:
1) The contraindications and advantages of BSSO, including quick healing, ability to correct asymmetries, and use of rigid fixation.
2) The potential complications of BSSO, such as nerve damage, unfavorable splits, and difficulty correcting significant asymmetries.
3) The steps of the BSSO procedure, including corticotomies, splitting the mandible, repositioning bone segments, and rigid fixation.
Mid facial fractures and their managementRuhi Kashmiri
The document discusses midfacial fractures, including the causes, anatomy, classifications, and management. It describes the LeFort fracture classifications (I, II, III), which involve horizontal fractures of the midface. LeFort I fractures are low-level fractures, while LeFort III fractures are the most severe, involving separation of the midface from the cranial base. Clinical findings, radiographic imaging, and treatment methods such as manual reduction or open reduction are reviewed for managing different types of midfacial fractures.
The document provides information on internal derangement of the temporomandibular joint (TMJ). It begins with definitions of internal derangement and Wilkes classification system for stages of derangement. It then discusses etiology, including trauma as a common cause. Physical findings and non-surgical and surgical treatment procedures are outlined. Non-surgical options include splint therapy, medications, acupuncture and others aimed at reducing pain and improving joint function.
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
The document discusses mandibular fractures, including:
- Classification systems for mandibular fractures based on location and other factors.
- Clinical signs used to diagnose mandibular fractures through examination.
- Radiographic imaging like panoramic x-rays that can help evaluate mandibular fractures.
- General principles of treatment including closed or open reduction methods and rigid fixation techniques like plates to stabilize fractured mandible segments.
This document discusses the bilateral sagittal split osteotomy (BSSO) procedure for mandibular advancement or setback. It provides details on:
1) The contraindications and advantages of BSSO, including quick healing, ability to correct asymmetries, and use of rigid fixation.
2) The potential complications of BSSO, such as nerve damage, unfavorable splits, and difficulty correcting significant asymmetries.
3) The steps of the BSSO procedure, including corticotomies, splitting the mandible, repositioning bone segments, and rigid fixation.
Mid facial fractures and their managementRuhi Kashmiri
The document discusses midfacial fractures, including the causes, anatomy, classifications, and management. It describes the LeFort fracture classifications (I, II, III), which involve horizontal fractures of the midface. LeFort I fractures are low-level fractures, while LeFort III fractures are the most severe, involving separation of the midface from the cranial base. Clinical findings, radiographic imaging, and treatment methods such as manual reduction or open reduction are reviewed for managing different types of midfacial fractures.
The document provides information on internal derangement of the temporomandibular joint (TMJ). It begins with definitions of internal derangement and Wilkes classification system for stages of derangement. It then discusses etiology, including trauma as a common cause. Physical findings and non-surgical and surgical treatment procedures are outlined. Non-surgical options include splint therapy, medications, acupuncture and others aimed at reducing pain and improving joint function.
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
The document discusses mandibular fractures, including:
- Classification systems for mandibular fractures based on location and other factors.
- Clinical signs used to diagnose mandibular fractures through examination.
- Radiographic imaging like panoramic x-rays that can help evaluate mandibular fractures.
- General principles of treatment including closed or open reduction methods and rigid fixation techniques like plates to stabilize fractured mandible segments.
The document discusses temporomandibular joint ankylosis, including its causes, clinical features, diagnosis using radiographs, and various treatment methods. Key points include: TMJ ankylosis is the fusion of the mandibular condyle with the glenoid fossa, immobilizing the mandible. Common causes are trauma, infection, and inflammation. Treatment involves surgical resection of the ankylotic mass with coronoidectomy and interpositional arthroplasty using grafts to prevent re-ankylosis, followed by aggressive physiotherapy. Complications can include recurrence if physiotherapy is not continued long-term.
The document discusses the anatomy and treatment of condylar fractures of the mandible. It describes the anatomy of the condyle and temporomandibular joint. Various types of condylar fractures are defined, including simple, displaced, comminuted, and pathological fractures. Treatment approaches include closed or open reduction, and fixation methods like plating, wiring, and screws. Post-treatment care involves jaw immobilization, exercises to regain motion, and monitoring for complications like malunion, nerve injury, or joint dysfunction.
This document provides information about impaction of teeth. It begins with definitions of terms like impacted tooth and discusses various theories of impaction such as orthodontic theory and phylogenic theory. It then covers the causes, order of frequency, and complications of impacted teeth. The document outlines indications and contraindications for removal of impacted teeth and classifications of impaction. Surgical procedures for removal are also summarized, including incisions, osteotomy techniques, tooth sectioning, and closure methods.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
The document discusses the history, anatomy, classification, examination, diagnosis, and treatment of mandibular fractures. It traces the history from descriptions in ancient texts to modern techniques. The mandible has a unique anatomy as a bent bone that provides both compression and tension zones. Fractures are classified in various ways including by location, number of fragments, involvement of surrounding tissues, and relation to occlusion. Clinical examination involves inspection, palpation, and neurological and range of motion tests while radiographs help confirm and characterize fractures.
Genioplasty is a surgical procedure to alter the shape and projection of the chin bone. It can be done to augment a recessed chin or reduce a prominent chin, improving facial aesthetics and proportions. The surgery involves making precise bone cuts below the mental nerves and sliding the bony segment to reposition the chin. Careful preoperative evaluation and planning is required to determine the optimal surgical approach and amount of correction needed. Potential risks include injury to the mental nerves or poor healing of the bone cuts.
This document discusses the anatomy, classification, diagnosis, and management of zygomatic complex fractures. It begins with the anatomical details of the zygomatic bone and its articulations. It then reviews various classification systems for zygomatic fractures, which typically categorize fractures based on the involved bone segments and degree of displacement. Common causes of these fractures are also mentioned. The diagnosis section outlines the clinical exam findings and imaging studies used to evaluate zygomatic fractures. Finally, the management section discusses indications for surgery, different surgical approaches, reduction techniques, and fixation methods like plates and screws. Complications of zygomatic fractures are also briefly outlined.
This document discusses Le Fort fractures and their management. It begins by describing the three areas that make up the facial skeleton: upper third, lower third, and middle third. It then provides detailed descriptions and classifications of Le Fort I, II, and III fractures based on the location and direction of the fracture lines. For each type of fracture, it outlines the characteristic signs, symptoms, and clinical features both externally and internally. It also discusses other midface fractures and dentoalveolar fractures. In summary, the document provides an in-depth overview of Le Fort fractures, including their anatomical basis, classification, and clinical presentation.
Brief notes on the inflammation of Alveolar bone that surrounds a tooth that has recently been extracted. It occurs as a complication of tooth extraction.
- Oroantral fistula is an abnormal communication between the maxillary sinus and oral cavity, usually resulting from tooth extraction or trauma.
- Symptoms include sinusitis, nasal discharge, pain, and escape of air/fluid through the nose or mouth. Diagnosis involves clinical exam, nasal blowing test, and radiographs.
- Treatment depends on whether the fistula is fresh or established. Immediate closure of small fistulas is attempted using sutures to hold a blood clot. Larger fistulas require local flaps like buccal or palatal flaps to close the defect without tension. Delayed fistulas may need grafting if bone is missing.
This document discusses oroantral communications and fistulas. It defines them as abnormal connections between the oral and maxillary sinus cavities. Causes include tooth extraction, tumors, cysts, and trauma. Signs and symptoms may include unpleasant taste/odor, fluid/food reflux into the nose, and air leakage. Examination involves inspection, suctioning the socket, and radiographs. Management includes immediate closure attempts and antibiotics to prevent sinusitis. Surgical techniques like buccal and palatal flaps are used for larger defects or fistulas based on factors like location, size, and presence of infection.
This document discusses extraction techniques for primary and permanent teeth in children. It notes key differences in primary versus permanent teeth that impact extraction, such as root shape and size. Techniques are described for different types of teeth, including use of smaller forceps designed for primary teeth and expanding the socket more due to widely-splayed primary molar roots. Management of buried teeth and potential post-operative complications are also outlined. The importance of pre-operative preparation and instructions for the child and parent are emphasized.
The document provides an overview of periapical diseases and their classification. It begins with an introduction to periapical diseases and their causes. The document then classifies periapical diseases into symptomatic and asymptomatic categories. Within each category, it describes specific conditions such as symptomatic apical periodontitis, acute alveolar abscess, chronic alveolar abscess, radicular cyst, and condensing osteitis. For each condition, it discusses causes, symptoms, diagnosis, differential diagnosis, and treatment. The document provides a comprehensive review of different periapical diseases and conditions that can affect the tissues around the root apex.
- Ankylosis is a stiffening of the temporomandibular joint (TMJ) that results in restricted opening of the mouth. It can range from fibrous restrictions to complete bony fusion of the joint.
- Common causes include trauma, infection, and systemic diseases. Intra-articular fractures lead to bleeding in the joint cavity and bone fragments with high osteogenic potential can fuse the joint.
- Management involves surgical procedures like condylectomy to remove the head of the condyle, gap arthroplasty to create an artificial space, or interpositional arthroplasty using grafts to prevent re-fusion. Post-operative physiotherapy is important to maintain mobility of the joint. Complications include restricted mouth opening
- Mandibular fractures are common injuries that may be encountered by dental surgeons. They can be classified based on type, site, and cause of the fracture.
- Signs and symptoms depend on the specific site of the fracture and may include pain, swelling, limitation of mouth opening, and malocclusion. Radiographs are important for diagnosis.
- Management involves addressing the airway, hemorrhage, and pain. Definitive treatment consists of reduction to realign fragments followed by immobilization to allow bone healing, which depends on the stability and mobility at the fracture site. Teeth in the line of fracture may require extraction.
Fractures of the zygomatic complex are common facial injuries that often involve displacement of the zygomatic bone from its normal position. Clinical examination involves inspection for deformities and palpation of the zygomatic bone and arch. Radiographic evaluation with CT scanning is important to fully assess the fracture pattern and displacement. Successful management requires accurate reduction and fixation of the zygomatic bone to restore facial contour and function.
This document discusses desquamative gingivitis, which is characterized by intense redness, peeling, and ulceration of the gums. It is not a specific disease but rather a gum condition associated with various underlying causes. The document goes on to classify, describe clinically, and discuss the diagnosis and management of desquamative gingivitis. Several diseases that can clinically present as desquamative gingivitis are described in detail, including lichen planus, mucous membrane pemphigoid, bullous pemphigoid, pemphigus vulgaris, dermatitis herpetiformis, and linear IgA disease. Histopathological features of these conditions are also summarized
MPDS, or myofascial pain disorder syndrome, is a pain disorder characterized by unilateral pain referred from trigger points in muscles of the head and neck. These trigger points are localized tender areas within taut muscle bands caused by micro- or macro-trauma to the musculoskeletal system. Accumulation of chemicals like lactic acid and prostaglandins in the muscles lowers the pain threshold, leading to MPDS symptoms like pain, limited jaw motion, and joint noises. Diagnosis involves assessing range of motion, palpating muscles for tenderness, and grading joint clicks. Treatment aims to inactivate trigger points, prevent recurrence, and correct perpetuating factors through therapies like physical modalities, anesthesia, pharmacotherapy, and occasionally
The document discusses maxillary fractures, their classification, and treatment. It notes that René LeFort classified maxillary fractures into 3 types based on the location of fracture lines. LeFort I involves the alveolar process, LeFort II the maxilla and nasal bones, and LeFort III separates the midface from the cranium. Treatment involves reduction using disimpaction forceps followed by fixation methods like wire osteosynthesis, rigid plates, or semi-rigid miniplates depending on the fracture type and location. Complications can include nerve damage, malocclusion, infection, and nonunion if not treated properly.
The document discusses temporomandibular joint ankylosis, including its causes, clinical features, diagnosis using radiographs, and various treatment methods. Key points include: TMJ ankylosis is the fusion of the mandibular condyle with the glenoid fossa, immobilizing the mandible. Common causes are trauma, infection, and inflammation. Treatment involves surgical resection of the ankylotic mass with coronoidectomy and interpositional arthroplasty using grafts to prevent re-ankylosis, followed by aggressive physiotherapy. Complications can include recurrence if physiotherapy is not continued long-term.
The document discusses the anatomy and treatment of condylar fractures of the mandible. It describes the anatomy of the condyle and temporomandibular joint. Various types of condylar fractures are defined, including simple, displaced, comminuted, and pathological fractures. Treatment approaches include closed or open reduction, and fixation methods like plating, wiring, and screws. Post-treatment care involves jaw immobilization, exercises to regain motion, and monitoring for complications like malunion, nerve injury, or joint dysfunction.
This document provides information about impaction of teeth. It begins with definitions of terms like impacted tooth and discusses various theories of impaction such as orthodontic theory and phylogenic theory. It then covers the causes, order of frequency, and complications of impacted teeth. The document outlines indications and contraindications for removal of impacted teeth and classifications of impaction. Surgical procedures for removal are also summarized, including incisions, osteotomy techniques, tooth sectioning, and closure methods.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
The document discusses the history, anatomy, classification, examination, diagnosis, and treatment of mandibular fractures. It traces the history from descriptions in ancient texts to modern techniques. The mandible has a unique anatomy as a bent bone that provides both compression and tension zones. Fractures are classified in various ways including by location, number of fragments, involvement of surrounding tissues, and relation to occlusion. Clinical examination involves inspection, palpation, and neurological and range of motion tests while radiographs help confirm and characterize fractures.
Genioplasty is a surgical procedure to alter the shape and projection of the chin bone. It can be done to augment a recessed chin or reduce a prominent chin, improving facial aesthetics and proportions. The surgery involves making precise bone cuts below the mental nerves and sliding the bony segment to reposition the chin. Careful preoperative evaluation and planning is required to determine the optimal surgical approach and amount of correction needed. Potential risks include injury to the mental nerves or poor healing of the bone cuts.
This document discusses the anatomy, classification, diagnosis, and management of zygomatic complex fractures. It begins with the anatomical details of the zygomatic bone and its articulations. It then reviews various classification systems for zygomatic fractures, which typically categorize fractures based on the involved bone segments and degree of displacement. Common causes of these fractures are also mentioned. The diagnosis section outlines the clinical exam findings and imaging studies used to evaluate zygomatic fractures. Finally, the management section discusses indications for surgery, different surgical approaches, reduction techniques, and fixation methods like plates and screws. Complications of zygomatic fractures are also briefly outlined.
This document discusses Le Fort fractures and their management. It begins by describing the three areas that make up the facial skeleton: upper third, lower third, and middle third. It then provides detailed descriptions and classifications of Le Fort I, II, and III fractures based on the location and direction of the fracture lines. For each type of fracture, it outlines the characteristic signs, symptoms, and clinical features both externally and internally. It also discusses other midface fractures and dentoalveolar fractures. In summary, the document provides an in-depth overview of Le Fort fractures, including their anatomical basis, classification, and clinical presentation.
Brief notes on the inflammation of Alveolar bone that surrounds a tooth that has recently been extracted. It occurs as a complication of tooth extraction.
- Oroantral fistula is an abnormal communication between the maxillary sinus and oral cavity, usually resulting from tooth extraction or trauma.
- Symptoms include sinusitis, nasal discharge, pain, and escape of air/fluid through the nose or mouth. Diagnosis involves clinical exam, nasal blowing test, and radiographs.
- Treatment depends on whether the fistula is fresh or established. Immediate closure of small fistulas is attempted using sutures to hold a blood clot. Larger fistulas require local flaps like buccal or palatal flaps to close the defect without tension. Delayed fistulas may need grafting if bone is missing.
This document discusses oroantral communications and fistulas. It defines them as abnormal connections between the oral and maxillary sinus cavities. Causes include tooth extraction, tumors, cysts, and trauma. Signs and symptoms may include unpleasant taste/odor, fluid/food reflux into the nose, and air leakage. Examination involves inspection, suctioning the socket, and radiographs. Management includes immediate closure attempts and antibiotics to prevent sinusitis. Surgical techniques like buccal and palatal flaps are used for larger defects or fistulas based on factors like location, size, and presence of infection.
This document discusses extraction techniques for primary and permanent teeth in children. It notes key differences in primary versus permanent teeth that impact extraction, such as root shape and size. Techniques are described for different types of teeth, including use of smaller forceps designed for primary teeth and expanding the socket more due to widely-splayed primary molar roots. Management of buried teeth and potential post-operative complications are also outlined. The importance of pre-operative preparation and instructions for the child and parent are emphasized.
The document provides an overview of periapical diseases and their classification. It begins with an introduction to periapical diseases and their causes. The document then classifies periapical diseases into symptomatic and asymptomatic categories. Within each category, it describes specific conditions such as symptomatic apical periodontitis, acute alveolar abscess, chronic alveolar abscess, radicular cyst, and condensing osteitis. For each condition, it discusses causes, symptoms, diagnosis, differential diagnosis, and treatment. The document provides a comprehensive review of different periapical diseases and conditions that can affect the tissues around the root apex.
- Ankylosis is a stiffening of the temporomandibular joint (TMJ) that results in restricted opening of the mouth. It can range from fibrous restrictions to complete bony fusion of the joint.
- Common causes include trauma, infection, and systemic diseases. Intra-articular fractures lead to bleeding in the joint cavity and bone fragments with high osteogenic potential can fuse the joint.
- Management involves surgical procedures like condylectomy to remove the head of the condyle, gap arthroplasty to create an artificial space, or interpositional arthroplasty using grafts to prevent re-fusion. Post-operative physiotherapy is important to maintain mobility of the joint. Complications include restricted mouth opening
- Mandibular fractures are common injuries that may be encountered by dental surgeons. They can be classified based on type, site, and cause of the fracture.
- Signs and symptoms depend on the specific site of the fracture and may include pain, swelling, limitation of mouth opening, and malocclusion. Radiographs are important for diagnosis.
- Management involves addressing the airway, hemorrhage, and pain. Definitive treatment consists of reduction to realign fragments followed by immobilization to allow bone healing, which depends on the stability and mobility at the fracture site. Teeth in the line of fracture may require extraction.
Fractures of the zygomatic complex are common facial injuries that often involve displacement of the zygomatic bone from its normal position. Clinical examination involves inspection for deformities and palpation of the zygomatic bone and arch. Radiographic evaluation with CT scanning is important to fully assess the fracture pattern and displacement. Successful management requires accurate reduction and fixation of the zygomatic bone to restore facial contour and function.
This document discusses desquamative gingivitis, which is characterized by intense redness, peeling, and ulceration of the gums. It is not a specific disease but rather a gum condition associated with various underlying causes. The document goes on to classify, describe clinically, and discuss the diagnosis and management of desquamative gingivitis. Several diseases that can clinically present as desquamative gingivitis are described in detail, including lichen planus, mucous membrane pemphigoid, bullous pemphigoid, pemphigus vulgaris, dermatitis herpetiformis, and linear IgA disease. Histopathological features of these conditions are also summarized
MPDS, or myofascial pain disorder syndrome, is a pain disorder characterized by unilateral pain referred from trigger points in muscles of the head and neck. These trigger points are localized tender areas within taut muscle bands caused by micro- or macro-trauma to the musculoskeletal system. Accumulation of chemicals like lactic acid and prostaglandins in the muscles lowers the pain threshold, leading to MPDS symptoms like pain, limited jaw motion, and joint noises. Diagnosis involves assessing range of motion, palpating muscles for tenderness, and grading joint clicks. Treatment aims to inactivate trigger points, prevent recurrence, and correct perpetuating factors through therapies like physical modalities, anesthesia, pharmacotherapy, and occasionally
The document discusses maxillary fractures, their classification, and treatment. It notes that René LeFort classified maxillary fractures into 3 types based on the location of fracture lines. LeFort I involves the alveolar process, LeFort II the maxilla and nasal bones, and LeFort III separates the midface from the cranium. Treatment involves reduction using disimpaction forceps followed by fixation methods like wire osteosynthesis, rigid plates, or semi-rigid miniplates depending on the fracture type and location. Complications can include nerve damage, malocclusion, infection, and nonunion if not treated properly.
Le fort fracture by Dr. Amit Suryawanshi .Dentist in Kolhapur (MDS). Oral &...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Dentist in Kolhapur (MDS) Oral & Maxillofacial surgeon from Kolhapur, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
This document discusses fractures of the middle third of the face and mandible. It begins by outlining the boundaries and structures that make up the middle third of the face. It then describes the three types of Lefort fractures - Lefort I, II, and III - providing details on their characteristics, signs and symptoms, and treatment approaches. The document also discusses fractures of the zygomatic complex, mandible classifications and treatments. It concludes by covering potential complications from maxillofacial injuries.
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This document provides an overview of maxillofacial injuries, including:
- Causes such as road traffic accidents and violence
- Principles of management including airway control, hemorrhage control, and imaging
- Types of facial bone fractures like frontal sinus fractures, nasal-orbital fractures, zygomatic fractures, LeFort fractures, and mandible fractures
- Guidelines for treatment including closed versus open reduction, fixation methods, and fracture-specific considerations.
Head and Neck Trauma by Dr. Kenneth DickieKenneth Dickie
Dr. Kenneth Dickie from Royal Centre of Plastic Surgery in Barrie, Ontario explained the care for Head & Neck Trauma.
f you have any questions, please contact Dr. Kenneth Dickie at http://royalcentreofplasticsurgery.com/
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.for more details please visit
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Nasal bone fractures are the most common facial trauma because the nose protrudes from the face. A frontal or lateral force can cause a nasal bone fracture depending on the magnitude. There are two main types - depressed fractures which result from a frontal blow causing the nasal bones to collapse inward, and angulated fractures from a lateral force which cause deviation of the nasal bridge. Clinical features include nasal swelling, bruising around the eyes, tenderness, deformity, and occasionally nosebleeds or nasal obstruction. Diagnosis is usually made through physical exam but x-rays can help show the fracture, though may sometimes miss it. Treatment depends on if there is displacement - non-displaced fractures may need no treatment, while displaced
The document discusses different types of nasal injuries including nosebleeds and nasal fractures. It provides information on causes, signs and symptoms, and first aid treatment for nosebleeds and nasal fractures. For nosebleeds, it recommends having the person pinch their nose and lean forward to stop bleeding. For nasal fractures, it advises applying ice to reduce swelling and pain, and seeing a doctor for more serious fractures or blocked nasal passages.
Wiring techniques in maxillofacial surgerySyed Abuthagir
This document discusses various techniques for closed reduction of mandibular fractures including direct and indirect interdental wiring methods like Essig's, Gilmer's, and Risdon's wiring. It also covers arch bar fixation, circummandibular wiring, perialveolar wiring, and suspension wiring techniques like frontal suspension and circumzygomatic wiring. The advantages of closed reduction are that it is more conservative than surgery and can be used for medically compromised patients, but disadvantages include airway compromise, loss of function, decreased nutrition, and effects of prolonged intermaxillary fixation like joint adhesions and osteoporosis.
This document discusses maxillary and periorbital fractures. It begins by describing the classic tripod, orbital floor, and LeFort fractures, noting that precise anatomic reduction is key. It then covers the epidemiology, mechanisms of injury, clinical assessment, radiographic assessment, management principles, and various types of upper face fractures including nasal fractures, naso-orbital-ethmoidal fractures, frontal sinus fractures, and orbital fractures.
Mandibular fractures have been documented since ancient Greece. Hippocrates described reducing displaced but incomplete mandibular fractures by pressing on the lingual surface with fingers while applying counterpressure externally. The Edwin Smith Treatise also described examining for mandibular fractures by feeling for crepitus under the fingers. Mandibular fractures typically involve the body, angle, condyle, symphysis, or ramus. Physical exam may reveal changes in occlusion, inability to open or close the mouth, anesthesia of the lower lip, or trismus. Diagnosis is made by identifying these physical exam findings along with the patient's mechanism of injury.
This document discusses maxillofacial trauma, including the pathophysiology, etiology, anatomy, emergency management, history, physical examination, and treatment of various facial bone fractures including the frontal sinus, nasal bones, orbits, zygoma, maxilla, and mandible. Key points covered include airway management, hemorrhage control, imaging modalities like CT scans, fracture classifications like LeFort fractures, and the involvement of specialty services like ENT and neurosurgery.
This document discusses fractures of the middle third of the face, including naso-orbital fractures, fractures of the zygoma (tripod fracture), fractures of the zygomatic arch, and fractures of the orbital floor (blowout fractures). It describes the causes, clinical features, diagnosis, and treatment options for each type of fracture through open or closed reduction and internal fixation.
The document discusses various facial injuries that may occur in sports. It notes that approximately 10-42% of all facial fractures and 60-90% of injuries occur in male participants between 10-29 years old. Common facial injuries from sports include contusions, abrasions, lacerations, nasal fractures, septal hematomas, and auricular hematomas. Treatment depends on the type and severity of the injury, and return to play is determined by whether bleeding is controlled and if protective devices are worn.
Mid face fractures /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
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1. The document discusses classification and management of LeFort fractures of the middle third of the face. LeFort fractures are classified based on the location and structures involved.
2. Signs and symptoms are provided for LeFort I, II, and III fractures. Management involves either direct internal fixation using plates, screws and wires or indirect internal suspension through various techniques such as circumzygomatic or zygomatic suspension.
3. Potential complications of treatment include infection, malunion, deformity, derangement of occlusion, anesthesia, and ankylosis of the temporomandibular joint. Proper treatment and immobilization aims to minimize these risks.
Le fort fracture by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
This document discusses midface fractures, known as LeFort fractures. It begins by defining the midface region and describing the bones that make up the midface. It then discusses the classic classifications of LeFort fractures as proposed by LeFort himself and others. Specifically, it describes LeFort I, II, and III fractures in terms of their etiology, fracture lines, and clinical signs. Radiographic examination including waters view and CT are important for diagnosis. Pre-operative planning considers the type of fixation and stabilization needed. Management involves open reduction with plates, screws or wires as well as intermaxillary fixation devices.
This document discusses midface fractures, including:
- The Le Fort classification system divides midface fractures into 3 types based on the fracture lines. Le Fort I involves the maxilla, Le Fort II is a pyramidal fracture, and Le Fort III is a craniofacial disjunction.
- Common causes of midface fractures are motor vehicle accidents, assaults, and falls. Maxillary bones and the zygomatic bone are frequently involved.
- Clinical features of a Le Fort I fracture include swelling of the upper lip and palate, a "cracked pot" sound from tapping teeth, and mobility of the maxilla. Le Fort II fractures result in "moon face" swelling and "raccoon
Its a Clinical Presentation of Midface fractures-specifically, Lefort fractures. Classification, Anatomical Landmarks, Clinical Features, Diagnosis & Management protocols are discussed.
A seminar prepared during my omfs posting hours. Short points are added for easiness to study and bihart. Reference taken from Balaji and Neelima Anil Malik
The document discusses mid facial fractures, which involve the bones of the central face between the forehead and upper jaw. It describes the classification systems for mid facial fractures proposed by Le Fort and others. Le Fort I fractures involve the upper jaw, Le Fort II involve the pyramidal bones, and Le Fort III involve separation of the mid face from the skull. Common causes are motor vehicle accidents and assaults. Clinical features vary depending on the fracture type but may include swelling, bruising, numbness, and mobility of facial bones. Diagnosis involves imaging like CT scans. Treatment goals are to restore facial structure and function, often through closed or open reduction and internal fixation of the bones.
This document discusses maxillary fractures, including:
- The anatomy of the maxilla and buttressing structures that resist forces.
- Common causes of maxillary fractures like motor vehicle accidents.
- The Le Fort classification system for maxillary fractures and its limitations.
- Signs and symptoms of different types of Le Fort fractures like ecchymosis, mobility, and malocclusion.
- Investigations like CT scans to evaluate fractures.
- Management considerations including airway protection, stabilization, and definitive surgical treatment.
This document provides information on midfacial fractures, including the LeFort classifications. It describes:
1) The LeFort I, II, and III fracture patterns involving the maxilla and midface bones. LeFort I involves the maxilla, LeFort II separates the midface, and LeFort III separates the entire midface from the skull.
2) Clinical signs of each type include swelling, mobility of teeth, and malocclusion for LeFort I; moon face and raccoon eyes for LeFort II; and severe edema and flattening of the cheeks for LeFort III.
3) Treatment involves reducing and fixing the fractures, usually through closed or open reduction using manual manipulation or specialized instruments to re
This document discusses maxillary fractures, including their classification, signs and symptoms, radiographic evaluation, management, and treatment. It describes Erich's and Marciani's classifications of maxillary fractures, which are based on the fracture lines and levels. Signs and symptoms are provided for LeFort I, II, and III fractures. Treatment involves stabilization, reduction, fixation, and immobilization. Management principles focus on airway control, stabilization, debridement, reduction, fixation, and rehabilitation.
Area between a superior plane drawn through the FZ sutures tangential to the skull base and inferior plane at the level of maxillary occlusal surface
Triangular region with widest dimension facing anterior
Definition:
Middle third of the facial skeleton may be defined as that area bounded superiorly by a transverse line connecting the 2 zygomaticofrontal sutures & inferiorly by occlusal plane of the maxillary teeth, or alveolar ridge in edentulous patient.
This document provides information on maxillary fractures including:
- Applied anatomy of the maxilla including its horseshoe shape and delicate nature.
- Favorable characteristics that allow it to withstand forces including complexity, pillars/buttresses, and angulation to the cranial base.
- Classification systems for maxillary fractures including the LeFort system and modifications.
- Clinical signs and symptoms of different fracture types like LeFort I, II, III.
- Investigations like CT scans and management approaches including emergency care, reduction, and fixation.
The key goals of management are restoration of occlusion, projection, height and stabilization of buttresses to prevent late sequelae.
FRACTURES OF MAXILLA AND NASO-ETHMOID COMPLEX.pptxdrdhanushya
The maxilla is the middle third of the facial skeleton, formed by two pyramidal halves. It has four processes and a hollow body forming the maxillary sinuses. It assists in forming several structures and is attached to the skull base by strong buttresses that distribute forces. The maxilla has transverse and vertical buttresses. Children have smaller sinuses and tooth buds, while adults have larger sinuses penetrating the midface. The alveolar process provides tooth support but weakens with tooth loss. Maxillary fractures can occur from direct impacts and vary in severity and pattern. The Le Fort classification identifies fracture patterns based on lines of weakness. Treatment involves reduction, immobilization with intermaxillary fixation, and stabilization with plates or wires
Dentist in pune.(BDS. MDS) - Dr. Amit T. Suryawanshi..Zygomaticomaxillary com...All Good Things
Dentist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar-Canine Impaction.
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Maxillofacial Surgery
Dental Students Fifth Year First semester
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This document discusses the classification of Lefort fractures of the maxilla. It describes the Lefort I, II, and III classifications originally proposed by Rene Lefort in 1901 based on the level of injury. It also discusses modifications to the Lefort classification by Marciani in 1993. The document provides details on the characteristics, signs and symptoms, examination, investigations, and treatment including manual/closed reduction and internal or external fixation options for Lefort fractures.
This document provides an overview of midfacial fractures, including:
1. LeFort fractures are classified based on the location and direction of force (LeFort I, II, III).
2. Clinical findings vary depending on the type of LeFort fracture but may include malocclusion, mobility of teeth, swelling, and ecchymosis.
3. Other common midfacial fractures include zygomatic complex fractures, orbital blowouts, and nasal bone fractures.
4. A thorough history and physical exam is needed to properly diagnose and classify midfacial fractures.
This document discusses maxillary fractures, including:
1) It classifies maxillary fractures according to Le Fort's classification system into Le Fort I, II, and III fractures based on the fracture pattern and location.
2) It describes the signs, symptoms, and features of each type of fracture both externally such as swelling and internally such as dental mobility.
3) It discusses methods for evaluating and managing maxillary fractures including reduction techniques, fixation methods, and immobilization.
Traditional classification were given 100 years back when RTA , assaults, sports injuries, industrial accidents were minimal.
Over the past 100 years RTA (high speed & Low speed) assaults, sports injuries (high contact/ low contact), industrial accidents have increased.
Fracture patterns which are not matching the traditional injuries pattern.
Can speed up diagnosis and treatment planning
Cohorting / clubbing of complication to Specific Fractures.
It facilitate communication between peers and assist documentation and research.
It also have prognostic value for patients and assist Surgeons in planning their management.
It serves as a basis for treatment and for evaluation of the results.
Different fractures/ Areas of fracture has different treatment plan / approaches.
Undisplaced fracture : conservative/ surgical
Displaced Fractures: Surgical/ conservative with traction
Similar to Fractures of the Middle third of the Facial Skeleton (20)
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
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1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Fractures of the Middle third of the Facial Skeleton
1. FRACTURES OF THE MIDDLE
THIRD OF THE FACIAL
SKELETON
ABDUL KARIM SHARIF, MD, PGD
School of Dentistry, Ghalib University
Kabul, Afghanistan
October 2015
2. Bones constituting the Middle Third of the
Face
• Maxilla (2)
• Palatine bones (2)
• Zygoma (2)
• Zygomatic Processes of Temporal bone (2)
• Nasal bone (2)
• Lacrimal bones (2)
• Ethmoid and its attached conchae (1)
• Inferior conchae (2)
• Pterygoid plates of sphenoid (2)
• Vomer (1)
3. Physical Characteristics of the Midfacial
Skeleton
• Made up of considerable number of bones – rarely
fractured in isolation
• All the bones are comparatively fragile, articulate in a
most complex fashion
• Greatest portion is maxilla
• Capable to absorb force and transmit to the adjacent articulating
bones
• Acts as a cushion for the trauma directed to the cranium
• Middle third is anatomically complicated – Generally
comminuted fractures
4. Classification of Fractures of the Middle
Third of the Facial Skeleton
• Rene LeFort – 1901 – Paris
• LeFort I
• LeFort II
• LeFort III
5. Classification of Fractures of the Middle
Third of the Facial Skeleton …
• Erich’s – 1942 – Direction of fracture line
• Horizontal Fracture
• Pyramidal Fracture
• Transverse Fracture
6. • Depending on the relationship of the fracture line to the
zygomatic bone;
• Subzygomatic Fracture
• Suprazygomatic Fracture
Classification of Fractures of the Middle
Third of the Facial Skeleton …
7. • Depending of the level of a fracture line:
• Low level fracture
• Mid level fracture
• High level fracture
Classification of Fractures of the Middle
Third of the Facial Skeleton …
8. LeFort I Fracture
• Low Level Fracture
• Subzygomatic Fracture
• Guerin’s Fracture
• Floating Maxilla
• Horizontal Fracture of the Maxilla
9. LeFort I Fracture
• Separation of complete
dentoalveolar part of the maxilla
(pterygomaxillary dysjunction)
• Fractured fragment held by the
means soft tissues
• Fractured fragment is freely
moblie
• A violent force applied over a
more extensive are, above the
level of the teeth
10. • Commences at the anterior nasal
aperture passes above the
nasal floor passes laterally
above the canine fossa and
traverses the lateral antral wall
passes below the zygomatic
buttress to the pterygomaxillary
fissure and fractures the
pterygoid lamina at the junction
of their lower third and upper
two-thirds.
• Line of fracture is the same at the
opposite side
LeFort I Fracture (Fracture Line)
11. • Slight swelling and edema of the lower part of the face
along with the upper lip swelling (gross edema not
present)
• Ecchymosis in the labial and buccal vestibule
• Contusion of the skin of the upper lip may be seen
• Bilateral epistaxis
LeFort I Fracture (Signs and Symptoms)
12. LeFort I Fracture (Signs and Symptoms) …
• Mobility of the upper dentoalveolar portion of the jaw to
digital pressure
• Disturbed occlusion
• Pain while speaking and moving the jaw
• Sometimes upward displacement of the entire fragment –
anterior open bite
• Percussion to maxillary teeth – dull cracked up sound
13. LeFort I Treatment
• Bone Plate
• Circumzygomatic Wiring (IMF + Zygomatic arch
suspension)
17. LeFort II Fracture
• Violent force applied from anterior direction on the central
region of middle third of the facial skeleton.
• Force delivered at the level of the nasal bone
18. LeFort II Fracture (Fracture Line)
• Starts below the
nasofrontal suture
crosses the frontal
processes of maxilla on
either side passes
anteriorly across the
lacrimal bones
immediately anterior to
the nasolacrimal canal
passes downward,
forward and laterally
crossing the inferior
orbital margin in the
region of
zygomaticomaxillary
suture crosses the
lateral wall of antrum
rest as LeFort I
19. LeFort II Fracture (Signs and Symptoms)
• Ballooning or Moon Face
• Circumorbital edema and ecchymosis (Black Eye)
• Bilateral subconjunctival hemorrhage (Middle half of the eye)
• Flat face (Nasal depression or disfigurement)
• Bilateral epistaxis
• Difficulty in mastication and speech
20. LeFort II Fracture (Signs and Symptoms)
• Shortening of the face, anterior open bite
• Elongation of the face (Dish-shaped face)
• Loss of occlusion
• Airway obstruction
• CSF leakage
• Step deformity at the infraorbital margins may be seen
• Anesthesia/paresthesia of the cheek
21. LeFort II Fracture (Treatment)
• Zygomatic Arch Suspension or Frontal Bone Suspension
• Intraosseous wiring may be done at infraorbital margins
22. LeFort III Fracture
• Transverse fracture
• Suprazygomatic fracture
• High level fracture
• Craniofacial dysjunction
23. LeFort III Fracture
• The line of fracture extends above the zygomatic bones
on both sides as a result of trauma being inflicted over a
wider area, at the orbital level
24. LeFort III Fracture (Fracture Line)
• Starts at naso frontal
suture crosses nasal
bone and the frontal
process of the maxilla
upper limit of the
lacrimal bones
continues posteriorly
and crosses the thin
orbital plates
traverses the lateral
orbital wall.
25. LeFort III Fracture (Signs and Symptoms)
• Clinically similar to the LeFort II, but close examination demonstrates LeFort III
• Gross edema of the face, balooning. “Panda Facies”, 24 –
48 hrs
• Bilateral Circumorbital ecchymosis and gross edema
(Racoon Eye)
• Bilateral subconjunctival hemorrhage (Posterior limit will not be seen)
26. LeFort III Fracture (Signs and Symptoms)
• Tenderness and separation at the frontozygomatic sutures
• Lengthening of the face
• Lowering the ocular level
• Characteristic “dish face” deformity
• May be enophthalmous, diplopia or impairment of vision,
temporary blindness …
• Flattening and widening
and deviation of the nasal bridge
• Epistaxis, CSF rhinorrhea
27. Treatment
• Intraosseous wiring at zygomaticofrontal sutures +
Frontomalar suspension wiring
• Intraosseous wiring at the infraorbital margin, if step
deformity exists