This document discusses several controversies in the management of maxillofacial trauma, including:
1) The management of fractures through the angle of the mandible, regarding factors like the location and extension of the fracture line and whether teeth in the line require extraction.
2) The management of condylar process fractures, debating whether closed or open reduction is preferred based on factors like displacement, facial contour, and risk of malocclusion.
3) The techniques for managing comminuted mandible fractures, including traditional conservative approaches versus open reduction and internal fixation using reconstruction plates.
It provides an overview of key points of debate and considerations in the treatment of various types of maxillofacial fractures
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
William R Proffit was respected in orthodontics. His life journey started in 1936 and ended in 2018. In between, he did lots of research work in orthodontics. He publishes around 170 research articles most of the articles are very helpful for postgraduate students. His nickname was Bill. He joined the faculty at the University of Kentucky in 1965 and served as the first chairman of the orthodontics department, and then taught at the University of Florida for 2 years.
In 1975, he returned to UNC and joined the orthodontics faculty. He served as a professor and later became chair of the department of orthodontics, a post he held for 26 years. Dr Proffit's textbook, Contemporary Orthodontics, the standard used in dental schools throughout the world, is the world's most influential orthodontic resource.
He contributed to and guided every chapter in every edition, and that is its strength and reason for its endurance.
He coauthored Contemporary Treatment of Dentofacial Deformity and 2 other books on surgical-orthodontic treatment.
Clinical & surgical management of the mandibular condylar process fractures has generated a great deal of controversy in maxillofacial trauma and there are many various approaches to treat this injury. Before, many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but recently open treatment of condylar fractures with rigid internal fixation (RIF) has become more common & acceptable. The objective of this presentation was to evaluate the factors that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
Mandibular fractures
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Fractures of the mandible are a common form of facial injury in adults and occur most frequently in males during the third decade of life. The main causes of mandibular fractures are road traffic accidents, interpersonal violence, falls and sport injuries. Mandibular fractures are classified according to various criteria. The three main factors to consider are the cause of the fracture, the type of fracture and the site of the fracture. Clinical diagnosis as well as radiographic examinations are presented. Treatment modalities are discussed. Moreover, treatment-related complications are given.
Similar to Controversies in maxillofacial trauma (20)
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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2. INCLUSIONS
• INTRODUCTION
• CURRENT
• CONTROVERSIES
• CONCLUSION
• REFERENCES
1. Management of Fractures Through the Angle of the
Mandible
2. Management of Condylar Process Fractures
3. Management of Comminuted Fractures of the Mandible
4. Management of Atrophic Mandible Fractures
5. Management of Mandibular Fractures in Children
6. Management of Nasal Fractures
7. Management of Orbital Fractures
8. Management of Naso-Orbital-Ethmoidal Fractures
9. Management of Frontal Sinus Fractures
10. Fixation of zygomaticomaxillary complex
11. Sequencing of fixation in case of pan facial trauma
12. Management of Parotid Gland and Duct Injuries
13. Use of Prophylactic Antibiotics in Preventing Infection of
Traumatic Injuries
3. INTRODUCTION
• Controversy can be defined as a dispute, generally with a right and a wrong
side of the argument.
• Controversy can also be defined as a discussion marked by the expression
of opposing
• When there are different approaches to surgical management, it is often not
a matter of right or wrong, but rather what the surgeon believes gives the
best results views.
4. 1. Management of Fractures Through the Angle
of the Mandible
A. Does the angle
fracture have to
extend through the
Goinal Angle of
mandible ??
B. Inclusion of different
type of fractures in
the same series.
• Anatomic region
• Start of fracture line
• Anterior to gonion
• Vertically and posteriorly
• To the gonion
• Slightly above it
• anteriorly
C. Tension & compression zones change
with different biting position and
fracture lines.
5. D. Use of antibiotics
E. Timing of treatment
F. Teeth in the fracture line
Ellis - 85% contained a third molar.
Spiessl- lists three undesirable effects of extracting
an unerupted tooth in the line of an angle fracture :
The possibility of converting a closed fracture to an
open one
Loss of the bony buttress on the tension side
(superior surface)
Loss of the possibility for inserting a tension band
plate
Ellis E. Outcomes of patients with teeth in the line of mandibular angle fractures treated
with stable internal fixation. J Oral Maxillofac Surg 2002;60: 863–5.
Soriano E, Kankou V, Morand B, et al. Fractures of the mandibular angle: factors
predictive of infectious complications. Rev Stomatol Chir Maxillofac 2005; 106:146–8.
Spiessl B. Closed fractures. Chapter 5. In: Spiessl B, editor. Internal fixation of the
mandible. Berlin: Springer-Verlag; 1989. p. 199.
No difference in the rate of infection
with closed reduction
Presence of a third molar
associated with a fracture through
the angle of the mandible increases
the risk of infection irrespective of
whether or not the tooth is erupted
or impacted, or whether or not the
tooth is removed during surgery.
6. D. Use of antibiotics
E. Timing of treatment
F. Teeth in the fracture line
G. Close versus open reduction
Even when the fracture is not
displaced, open treatment is usually
provided so that internal fixation
devices can be placed to maintain
the alignment of the fragments and
obviate postoperative MMF.
Only indication of MMF
7. H. Internal fixation schemes Wire fixation + weeks of MMF
Other fixation device without MMF
Bicortical screws & one large and one
small bone plate, or two small plates
Good stability, infection
Bending/ torsional forces
Spiessl B. Closed fractures. Chapter 5. In: Spiessl B, editor. Internal
fixation of the mandible. Berlin: Springer-Verlag; 1989. p. 199.
Champy M, Lodde JH, Must D, et al. Mandibular osteosynthesis by miniature
screwed plates via buccal approach. J Maxillofac Surg 1978;6:14–9.
Levy FE, Smith RW, Odland RM, et al. Monocortical miniplate fixation of
mandibular fractures. Arch Otolaryngol Head Neck Surg 1991;117:149–54.
Alkan A, Celebi N, Ozden B, et al. Biomechanical comparison of different
plating techniques in repair of mandibular angle fractures. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2007;104:752–6.
Ellis E, Walker L. Treatment of mandibular angle fractures using two
noncompression miniplates. J Oral Maxillofac Surg 1994;52:1032–6.
8. H. Internal fixation schemes
I. Postoperative care
• Force distribution through soft tissues explains why a single miniplate
can be very successful in the management of fracture through the angle.
• Association with co-existing fractures of mandible
• Comminuted angle fractures
Rudderman RH, Mullen RL, Phillips JH, et al. The biophysics of mandibular fractures: an evolution toward
understanding. Plast Reconstr Surg 2008; 121:596–607.
requirement
of additional
fixation
Antibiotics
Mouth wash & oral hygiene
Gap at the inferior border
Use of elastics
9. 2. Management of Condylar Process Fractures
Parameters
Closed reduction
(3-6 weeks for adults & 10-
14 days for children)
Open reduction
MIO (maximum
interincisal opening)
Equal or more Faster rate of recovery
Movements Clinically acceptable Faster rate of recovery
Occlusion Chances of malocclusion More satisfactory result
Facial contour No difference No difference
Chin deviation No difference - deviation Less incidences
Post treatment TMJ /
masticatory muscle pain
Frequent pain Less incidences
Procedure related
complications
In particular medical situations Present
Laskin D M. Management of Condylar Process Fractures. Oral Maxillofacial Surg Clin N Am 21 (2009) 193–196.
10. Zide MF, Kent JN (1983) Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 41:89–98.
11. DEGREE OF DISLOCATION &
ANGLE OF DISPLACEMENTS
Mandibular condyle
fractures evaluation of the
Strasbourg Osteosynthesis
Research Group
classification
12.
13. EDWARD ELLIS III – Symposium
on condylar fractures 2004
• ABSOLUTE INDICATIONS
- Displacement into the middle cranial fossa/external auditory meatus
- Inability to obtain occlusion by non surgical/closed method
- Invasion by foreign body
- Lateral extra capsular displacement
• RELATIVE INDICATIONS
- Bilateral fractures in edentulous jaws
- IMF contraindicated for medical reasons
- Bilateral fractures associated with comminuted midface fractures
- Severe periodontal problems & loss of teeth
- patients desire to avoid IMF
14.
15. Kang-Young Choi, Jung-Dug Yang, Ho-Yun Chung, Byung-Chae Cho. Current Concepts in the
Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction.
Arch Plast Surg. Jul 2012; 39(4): 301–308.
16.
17. • The problem with most comparative studies that have
been reported is that they are generally retrospective
rather than prospective and that there is considerable
variation in the patient selection and outcome criteria
used as well as in the follow-up time.
• Therefore, until better-designed comparative studies
are available that will allow evidence-based decisions to
be made, one can only look at individual case series for
some guidance.
18. 3. Management of Comminuted Fractures of
the Mandible
• 5-7 % of all mandibular fractures, usually compound type.
Joe Hall Morris appliance for
comminuted fracture of the symphysis
Traditional conservative
management
MMF + external fixator
Long healing period
Restricted function
Morbidity
MMF
Roger Anderson appliance
controlling multiple comminuted
mandibular fractures.
Indications
Significant head injury
Necessary equipments
are not available
19. OPEN REDUCTION AND
INTERNAL FIXATION
• Load bearing reconstruction plate
• Decreases healing time
• Post op MMF is not required
• No scarring of skin
• Good functional out come
Technical points
• Stabilize the teeth and alveolus with arch bars
• Intact lingual periosteum
• Simplification of fracture
Technical points
• Reconstruction plate with 3-4 screws on
either side of fractures
• Defect closure with bone graft
20. 4. Management of Atrophic Mandible Fractures
Closed reduction techniques for atrophic edentulous mandible fractures
1. Gunning splints with arch bars
2. Circummandibular wiring of
oblique fractures
3. External fixator
Anterior and posterior
pin connected by a
transverse bar
spanning the fracture
4. No treatment / soft diet
21. A. Indications
B. Approaches (intraoral - vestibular/
extraoral)
Open reduction and internal fixation techniques for atrophic edentulous
mandible fractures
22. C. Fixation with
Reconstruction plate Locking / non-locking
minplates
Titanium or other
mesh crib with
autografts
Lag screw
Alloplastic materials –
• Hydroxyapatite,
• Tricalcium phosphate,
• Glass ceramics,
• Glass carbonate
• Injectable calcium phosphate cements
Future materials –
• Gene therapy
• Tissue engineering
23. 5. Management of Mandibular Fractures in
Children
1. Diagnosis – because of child co-operation
2. Fracture pattern & displacement of segments
3. Open versus closed reduction and closed functional treatment
4. Duration of MMF
5. Role of other treatment modalities
6. Titanium, stainless steel or bioresorbable materials for fixation
24. Hiu GA, Prabhu IS, Morton ME, et al. Acrylated stainless steel basket splint
for mandibular fractures in children. Br JOralMaxillofacSurg 2012;50:577–8.
The occlusion was satisfactory, without
infection or malocclusion. None required
revision, and there was no deviation of the
mandible, ankylosis, or disturbances of growth.
Five children with mandibular
fractures were treated with a
split acrylic splint, which
secured the fracture by wiring
around the mandible.
25. 6. Management of Nasal Fractures
1. TIMING OF NASAL FRACTURE
TREATMENT
• If a patient is seen shortly after trauma,
before significant edema develops
• Lacerations with exposure of the underlying
skeletal or cartilaginous elements
• Presence of a septal hematoma
• Within the first 10 days of injury are less likely to require a revision
septorhinoplasty
26. 2. Local v/s general anesthesia
• In the presence of minor nasal bony deviation and no
associated septal or nasal tip displacement, closed reduction
under local anesthesia has been suggested as the first line of
treatment.
• Complex or severely displaced fractures may require
treatment under general anesthesia.
27. 3. OPEN V/s CLOSED TECHNIQUES
• Closed reductions - most acute isolated nasal fractures with minimal bony and
septal injury (within 10 days).
• Internal packing for 3 days & external for 7 to 10 days.
• 14% to 50% cases - Postreduction deformities - secondary rhinoplasty.
• The final decision - condition of the septum and the need to preserve the
connection between the septum, upper lateral cartilages, and nasal bones.
Denver splint.
28. Outcomes of nasal
fracture treatment may be
compromised by the fact
that late morphologic
changes can occur over 1
or more years because of
scarring.
29. 7. Management of Orbital Fractures
1. INDICATION FOR SURGICAL REPAIR OF ORBIT
Lack of ocular motility
Diplopia : Surgery may increase the risk of diplopia, at
least temporarily.
Enophthalmos : define this as greater than 1 cm3 &
greater than 2.0 mm typically indicates the need for
surgical
30. Ahn HB, Ryu WY, Yoo KW, et al. Prediction of enophthalmos by computer-based volume measurement
of orbital fractures in a Korean population. Ophthal Plast Reconstr Surg 2008;1:36–9.
• There seems to be a direct relationship between the increase of
orbital volume and measured enophthalmos.
a. Volume increase of < 1 mL, enophthalmos ~ 0.9 mm,
b. Volume 2.3 mL ~ 2 mm.
# For every 1 mL increase of volume there is approximately a
0.9 mm increase in enophthalmos.
# However, in normal orbits, there can be a natural volume
difference of up to 8% between the left and right sides.
31. 2. TIMING OF ORBITAL SURGERY
Dortzbach and later Leitch and coworkers : surgery for orbital floor fractures
within 14 and 21 days after trauma.
Cole and coworkers : gave indications for immediate repair
i. Trumatic optic neuropathy (alteration in visual acuity & color desaturation test)
ii. Occulocardiac reflex
iii. Penetrating injuries
iv. Age – younger patients
3. USE OF STEROIDS : Corticosteroids can be used as the only
treatment if the visual acuity is better than 20/400
Cole P, Boyd V, Banerji S, et al. Comprehensive management of orbital fractures. Plast Reconstr Surg 2007;120:57–61.
Hawes MJ, Dortzbach RK. Surgery on orbital floor fractures: influence of time of repair and fracture size. Ophthalmology 983;90(9):1066–70.
Leitch RJ, Burke JP, Strachan IM. Orbital blowout fractures: the influence of age on surgical outcome. Acta Ophthalmol 1990;68:118–24.
32. 4. MATERIALS FOR
RECONSTRUCTION
Potter JK, Malmquist M, Ellis E III. Biomaterials for
Reconstruction of the Internal Orbit. Oral Maxillofacial
Surg Clin N Am. 2012; 24 (4):609–627.
35. Abbreviations: BAG, bioactive glass; FF, very favorable; F, favorable; HA, hydroxyapatite;
PDS, polydioxanone; PGA, polyglycolide; PLA/PGA, polylactide/polyglycolide; PLDLA,
poly L/D lactide copolymer; PLLA, poly L lactide; Sil, silicone; Tef, Teflon; Tit, titanium; U,
unfavorable; UU, very unfavorable.
36. 8. Management of Naso-Orbital-Ethmoidal
Fractures
• NOE fractures rarely occur as isolated events.
1. Extent of fracture : NOE fractures
associated with panfacial injuries are
associated with a diffuse facial edema,
whereas isolated NOE fractures are
associated with localized ecchymosis and
edema in the nasal and periorbital regions.
2. Requirement of treatment : examination of
canthus containing fragments and telecantus
37. 3. Early versus late management : waiting no more than 2 weeks.
4. Closed versus open reduction : indications, approaches, fixation
5. Position of reattachment of medial canthus
38. 9. Management of Frontal Sinus Fractures
Repair Obliteration (ablation) Cranialization
Preservation of the sinus
anatomy, including the
nasofrontal duct, sinus
mucosa, and its anterior and
posterior bony walls
Obliteration involves the
elimination of the frontal
sinus cavity while
maintaining the anterior and
posterior tables
similar to frontal sinus
obliteration with the
exception that the
posterior table is
completely removed
No treatment
39. • Volume of material needed is highly variable, averaging
approximately 35 to 40 cm3 to as much as 200 cm3
Endoscopic-
Assisted Repair
40.
41. 10. Fixation of zygomaticomaxillary complex
Rodrigo Otávio Moreira Marinho, Belini
Freire-Maia. Management of Fractures of
the Zygomaticomaxillary Complex. Oral
Maxillofacial Surg Clin N Am 25 (2013)
617–636.
Zingg M et al Classification of ZMC fractures. (A) Type A1: isolated
zygomatic arch fracture. (B) Type A2: lateral orbital wall fracture. (C)
Type A3: infraorbital rim fracture. (D) Type B: complete monofragment
zygomatic fracture. (E) Type C: multifragment zygomatic fracture.
Judgement of fracture reduction
1. Zygomaticosphenoid suture
2. Zygomaticomaxillary buttress
3. Infraorbital rim
4. Frontozygomatic suture
42. Priority of fixation
1. Zygomaticomaxillary buttress
2. Frontozygomatic suture
3. Infraorbital rim
4. Zygomatic arch
Sequence of fixation
1. Frontozygomatic suture
2. Infraorbital rim
3. Zygomaticomaxillary buttress
4. Zygomatic arch
43. 11. Sequencing of fixation in case of pan facial
trauma
Classical approaches
“bottom up and inside out”
“top down and outside in”
Booth PW, Eppley BL, Schmelzeisen R, editors.
Maxillofacial trauma and esthetic facial reconstruction.
Philadelphia: Saunders; 2012.
46. 12. Management of Parotid Gland and Duct
Injuries
1. DIAGNOSIS :
Use of dye - excessive extravasation from the lacerated duct may
complicate surgery.
Saline can be injected if difficulty is encountered in finding the
proximal end.
No fluid seen in the wound indicates that the duct is intact.
2. TIMING OF REPAIR :
Done early, preferably in the first 24 hours.
• Late complications, such as a parotid fistula, are difficult to treat.
3. WOUND CLOSURES WITHOUT DUCT REPAIR
47. # MANAGEMENT OF
INJURIES TO THE GLAND
AND DUCT
• Repair of the injury, putting a
stent in the duct, and placing a
pressure dressing, botox in
chronic cases.
• Injury to the duct - repair of the
duct over a stent, ligation of the
duct, or fistulization of the duct
into the oral cavity.
48. • Injury of the duct orifice - insertion of a drain.
4. Leaving the stent in place after duct repair – subsequent swelling can cause
obstruction of duct
5. Use of an autogenous graft for repair of continuity defect of duct
49. 14. Use of Prophylactic Antibiotics in
Preventing Infection of Traumatic Injuries
1. PROPHYLACTIC
ANTIBIOTICS IN PATIENTS
WITH SKIN WOUNDS
• According to the principles of
presurgical prophylaxis, antibiotics, if
they are to be given at all, should be
administered as soon as possible after
the injury, if possible within the first 3
hours and continued for 3 to 5 days.
• Staphylococcus aureus and
streptococci : Cloxacillin and first-
generation cephalosporins
1. Open joints or fractures
2. Human or animal bites
3. Intraoral lacerations
4. Heavily contaminated wounds
(eg, those involving soil, feces,
saliva or other contaminants).
5. Patients who have prosthetic
devices and at risk for developing
endocarditis.
6. Systemic antibiotics also are
recommended when there is a lapse
of more than 3 hours since injury,
7. Lymphedematous tissue
involvement,
8. Host is immunocompromised.
INDICATIONS
50. 2. USE OF PROPHYLACTIC ANTIBIOTICS FOR
PREVENTION OF INFECTION OF INTRAORAL
WOUNDS
• ‘‘through-and-through’’ lacerations - a course of prophylactic
antibiotics to prevent infection after these wounds are repaired.
3. TOPICALANTIBIOTICS FOR TREATMENT OF
TRAUMATIC WOUNDS
• Ointments - bacitracin, neomycin, or polymyxin have been
routinely used.
51. 4. ANTIBIOTIC PROPHYLAXIS IN PATIENTS WITH OPEN
FRACTURES AND JOINT WOUNDS
• Classification Of Open Fractures And Joint
Type of Description
Involved
pathogens
Empirical
antibiotics
I
Is an open fracture with a skin
wound that is clean and less than 1
cm long
S aureus,
streptococci
Spp, and aerobic
gram-negative
bacilli
First- or second-
generation
Cephalosporin
within 6 hours + 24
hours postop
II
An open fracture with a laceration
That is more than 1 cm long, but
without evidence of extensive soft
tissue damage, flaps, or avulsion
III
An open segmental fracture or
An open fracture with extensive
soft tissue damage or a traumatic
amputation
Certain environmental exposures
More no. Of gram
negative
Organisms
Clostridium,
Acinetobacter,
Pseudomonas,
Clostridium, Aeromonas,
Pseudomonas, Aeromonas,
Vibrio
Cephalosporin &
aminoglycoside
Penicillin
within 6 hours + 24
hours postop
52. Why there is controversy ??
i. clinical studies fail to demonstrate a lower infection rate
among patients with uncomplicated wounds treated
with prophylactic antibiotics
ii. studies have assessed their efficacy after suture wound
closure
53. CONCLUSION
• In the treatment of many kinds of traumatic injuries of the
Maxillofacial region, too few randomized, controlled
studies are available to supply strong supporting evidence
for definitely selecting one surgical technique or
procedure over another. Therefore, we have to rely upon
expert opinion, as well as the literature, to guide us in the
decision-making process.
54. REFERENCES
1. Oral Maxillofacial Surg Clin N Am 21 (2009). doi:10.1016/j.coms.2009.01.001
2. Jiewen Dai, Guofang Shen, Hao Yuan, Wenbin Zhang, Shunyao Shen, Jun Shi.
Titanium Mesh Shaping and Fixation for the Treatment of Comminuted
Mandibular Fractures. J Oral Maxillofac Surg 74:337.e1-337.e11, 2016.
3. Booth PW, Eppley BL, Schmelzeisen R, editors. Maxillofacial trauma and
esthetic facial reconstruction. Philadelphia: Saunders; 2012.
4. William Curtis, Bruce B. Horswell. Oral Maxillofacial Surg Clin N Am 25
(2013) 649–660.
Editor's Notes
Mandibular condyle fractures evaluation of the Strasbourg Osteosynthesis Research Group classification
5-7 % of all mandibular fractures, usually compound type.
MMF + external fixators – 70 years (WW I, WWII, Korean war, Vietnam war.)
Many oral and maxillofacial surgeons are inexperienced
in managing such injuries because they
occur so rarely. In addition, because of this infrequency,
surgical literature offers little updated
information about management.
Titanium mesh is used in mandibular reconstruction to improve stability of bone grafts, in reconstruction of anterior wall of frontal sinus and orbital reconstruction as the metal is more biocompatible
Associated injures often include central nervous system injury, cribriform plate fracture, cerebrospinal fluid rhinorrhea, and fractures of the frontal bone, orbital floor, and middle third of the face, as well as injury to the lacrimal system.
This approach uses a stable fronto-orbital frame from which to proceed inferiorly and outside-in.
Working from a “known” or stable area (less isplacement or comminution) and proceeding to an “unknown” area can make proper reduction more manageable and achievable.
The primary goal in the management of traumatic wounds is to achieve rapid healing with optimal functional and esthetic results.
This is best accomplished by providing an environment that prevents infection of the wound during healing
The primary goal in the management of traumatic wounds is to achieve rapid healing with optimal functional and esthetic results.
This is best accomplished by providing an environment that prevents infection of the wound during healing
The primary goal in the management of traumatic wounds is to achieve rapid healing with optimal functional and esthetic results.
This is best accomplished by providing an environment that prevents infection of the wound during healing