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Facial bone fractures
- 2. Introduction • Facial bones fractured are • Frontal bone • Nasal bone • Maxilla bone • Zygomatic bone • Mandible bone
- 3. • Nasal bones are the most common types of facial fractures –Face is specifically targeted during assaults
- 4. Etiology • Road Traffic Accident • Fall from height • Assault • Sports injury • In children –‘–‘Fall’ while playingFall’ while playing ––Child abuseChild abuse
- 5. Management of facial trauma • Manage airway, breathing and circulation • Control hemorrhage • Treat associated injuries of head, neck, cervical spine, chest, abdomen, pelvis and limbs • Wound debridement • Treatment of maxillo -facial bone injury
- 6. Examination of facial injuries • EYES :Palpate orbital margins especially floor • NOSE : Look for external deformity : Palpate for bony crepitus : Rule out septal hematoma/CSF leak • MIDDLE 3rd : Palpate bony contour of face : Step deformity : Surgical emphysema : Infraorbital & facial nerve deficit • MANDIBLE : Blood stained saliva : TMJ tenderness : Feel jaw outline
- 8. • Type of Nasal Injury depends on • Direction of Blow: Frontal/Lateral/ From Below • Force of Blow • Nasal Fractures divided into 3 Types ( Moore 1989) • Class 1: • Green Stick Injury • Simple Depression of Nasal Bone • Chevallet Fracture • Class 2 : Jarjavay Fracture
- 9. Depressed fracture • Medium forceMedium force –– Open book fractureOpen book fracture where nasal septumwhere nasal septum collapses and nasal bones splay outcollapses and nasal bones splay out • Greater forceGreater force –– Nasal bones shattered, splaying ofNasal bones shattered, splaying of frontal processes of maxillafrontal processes of maxilla
- 11. Angulated fracture • Medium force → Ipsilateral nasal bone fracture • Greater force → B/L nasal bones and septum fracture and deviation of nasal bridge
- 12. Clinical features • External nasal deformity • Epistaxis • Laceration of skin of nose • Edema over nasal bridge (within few hours of injury )
- 13. Plain X-ray soft tissue nasal bone lateral view
- 14. Treatment • Fractures without displacement : no treatment • Fractures with displacement : closed reduction • Open reduction required rarely for • Infection • Comminuted fracture
- 15. Guidelines for treatment of nasal bone fractures • Closed reduction done before edema appears (3hours) or after edema subsides (7 days) • Nasal fracture heals by 2 wk in adults and 1 wk in children. Closed reduction is to be done before healing
- 16. Closed reduction 1. Lift non-depressed nasal bone laterally with Walsham’s forceps 2. Lift depressed nasal bone laterally with Walsham’s forceps 3. Nasal septal fracture reduced by lifting it with Asch’s forceps 4. Both nasal bones brought into midline by firm digital pressure from outside
- 17. Closed reduction
- 18. Closed reduction
- 19. Instruments used for reduction of fracture nasal bone
- 23. Boies elevator • Boies elevator is inserted into the nostril deep to displaced nasal bone • Blade of elevator opposes thumb of surgeon placed outside the nose • Raise & depress misaligned bones to their original
- 25. Lead plate splinting for comminuted fractures
- 32. Types Le Fort 1 = Transverse Le Fort 2 = Pyramidal Le Fort 3 = Cranio -facial dysjunction
- 33. Le Fort 1 (Guerin) fracture Runs above nasal floor, through nasal septum, maxillary sinuses & inferior parts of pterygoid plates
- 34. Le Fort 2 fracture Runs obliquely from maxillary sinus floor to infraorbital margin, across orbital floor & lacrimal bone to nasion
- 35. Le Fort 3 fracture Runs from medial orbit wall to superior orbital fissure across sphenoid & zygomatic bone to zygomatico -frontal suture inferiorly to pterygoid plates
- 36. Fracture reduction • Closed methods • Hard palate disimpaction with Rowe’s forceps • External fixation on halo frame, box frame • Inter-maxillary fixation • Open methods • Inter-osseous wiring
- 43. Mechanism Medium strength blunt trauma to eyeball
- 44. Clinical Features • Enophthalmos • Orbital emphysema • Inferior rectus & orbital tissue get trapped in # site → prevents upward eye movement → diplopia • Orbital hemorrhage
- 45. Tear drop sign
- 46. Treatment Protocol • Release of entrapped orbital soft tissue & inferior rectus muscle • Removal of small bony fragments & repositioning of large bony fragments • Repair of bony defect with micro-plating & biocompatible implants • Approaches : Transconjunctival ,
- 52. Zygomatic arch fracture : Towel clip reduction
- 53. Gillie’s approach • Incision made 4 cm superior to zygomatic arch & posterior to temporal hairline • Periosteal elevator carried forward, between the temporalis fascia & temporalis muscle & positioned beneath zygomatic arch • Lateral traction is placed on zygomatic
- 58. Clinical features • Trismus • Malocclusion of teeth • Ecchymosis of oral mucosa • Tenderness at site of fracture • Crepitus at site of fracture • Step-deformity on palpation
- 59. Plain X-ray mandible Lateral oblique view
- 61. Fracture reduction • Closed methods (Inter-maxillary fixation)Closed methods (Inter-maxillary fixation) • Inter-dental wiringInter-dental wiring • Arch bars and rubber bandsArch bars and rubber bands • Open methodsOpen methods • Inter-osseous wiringInter-osseous wiring • Lag screwsLag screws • Compression plates & screwsCompression plates & screws
- 63. Arch bars & rubber bands
- 65. Lag screw