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Facial trauma and oroantral fistula
- 1. BRIG ANWAR UL HAQ
- 3. BRIG ANWAR UL HAQ
- 4. Trauma may involve ◦ Soft tissues ◦ Bones ◦ Cartilages
- 5. General management Soft tissue injuries and their management Bony injuries and their management
- 6. Airway ◦ Injuries ◦ Blood ◦ Secretions Haemorrhage ◦ Pressure ◦ Ligation ◦ Coagulation Associated injuries ◦ Head, chest, neck, larynx, cervical spine
- 7. Facial lacerations Parotid gland and duct Facial nerve
- 9. Frontal Bone ◦ Frontal Sinus ◦ Anterior wall ◦ Posterior wall ◦ Injury to nasofrontal duct Supraorbital ridge Frontal Bone
- 10. Anterior wall of Frontal Sinus ◦ Depressed deformity ◦ Reduction through the wound ◦ Elevation though eye brow incision
- 11. Posterior wall of Frontal Sinus ◦ Dural tear ◦ CSF Rhinorrhoea ◦ Temoralis Fascia Repair ◦ Obliteration of Sinus
- 12. Frontonasal Duct ◦ Obstruction of Sinus ◦ Mucocele ◦ Surgical Obliteration of Sinus
- 13. MIDDLE THIRD
- 14. Nasal bone and septum Naso orbital fractures
- 15. Nasal bone and septum Naso orbital fractures Fractures of zygoma Fractures of zygomatic arch
- 16. Nasal bone and septum Naso orbital fractures Fractures of zygoma Fractures of zygomatic arch Fractures of orbital floor
- 17. Nasal bone and septum Naso orbital fractures Fractures of zygoma Fractures of zygomatic arch Fractures of orbital floor Fractures of maxilla
- 18. Most prominent part ◦ More likely Amount of injury ◦ Magnitude of trauma ◦ Direction Ant lateral
- 20. Swelling Periorbital echymosis Tenderness Crepitus Nasal deformity Epistaxis Nasal obstruction Lacerations ◦ Internal ◦ external
- 21. Physical examination ◦ Inspection ◦ Palpation - crepitus X-Ray - +/- Waters’ view Lateral - Rt + Lt
- 22. No displacement - No treatment Reduction ◦ Closed ◦ Open Timing ◦ Immediately ◦ 5-7 days later Children- early union - earlier reduction
- 23. Depressed fractures ◦ Straight elevation ◦ Digital manipulation Laterally displaced fractures ◦ Digital manipulation In opposite direction
- 24. Rarely required Associated septal injuries Late ◦ Rhinoplasty ◦ Septorhinoplasty
- 25. Direct force over the Nasion ◦ Fracture nasal bone ◦ Ethmoids ◦ Cribriform plate ◦ Medial orbital wall ◦ Frontal sinus ◦ Fronto-nasal duct ◦ Exra occular muscles ◦ Lacrimal apparatus
- 26. Telecanthus Pig nose
- 27. Telecanthus Pig nose Peri-orbital echymosis Peri-orbital haematoma
- 28. Telecanthus Pig nose Peri-orbital echymosis Peri-orbital haematoma Epistaxis CSF rhinorrhoea
- 29. Telecanthus Pig nose Peri-orbital echymosis Peri-orbital haematoma Epistaxis Csf rhinorrhoea Displacement of eye ball Squint (mal alignment of eyes) Diplopia (Double Vision)
- 30. X rays ◦ Various films ◦ Different angles CT Scan ◦ Better option
- 31. Close reduction ◦ Uncomplicated fractures ◦ Ashes’ forceps ◦ Fixation Steel wire Fixed over lead plates Intra nasal packing ◦ Splinting - 10 days
- 32. Indications ◦ Multiple communications Nasal cavities Frontal sinus ◦ Injuries Lacrimal apparatus Extra ocular muscles Medial canthal ligaments Frontal sinus
- 33. H shaped incision Nasal bones reduced under vision Medial canthal ligaments fixed with wire Repair of lacrimal apparatus Preference ◦ Medical canthal ligament ◦ Lacrimal apparatus Nasal bridge and shape ◦ Can be corrected later
- 35. Second most common Direct trauma Lower segment pushed medially posteriorly ◦ Flattening of malar prominance ◦ Zygoma – fractured -separated Zygomatico frontal Zygomatico maxillary- orbital floor Zygomatico temporal
- 36. Zygomatico frontal Zygomatico temporal Zygomatico maxillary - orbital floor
- 37. Zygomatico maxillary - orbital floor Orbital contents - herniates – maxillary sinus Tear drop sign
- 38. Flattening of malar prominance Step deformity of infra orbital margin Trismus (inability to open mouth) Oblique palpebral fissure ◦ Displacement of LPL Restriction of ocular movement – diplopia Peri-orbital echymosis Infra orbital anaesthesia
- 39. Waters’ view (Occipito-Mental View) Blood in maxillary sinus - opaque CT scan – more beneficial Fracture of zygoma (Tripode fracture)
- 40. No displacemment - no treatment Open reduction Lateral brow incision Reduction - putting elevator behind the zygoma Fixation - wire Transantral approach ◦ Caldwell luc operation ◦ Intra nasal antrostomy
- 41. Zygomatic arch fractures in two segments Fractures at both ends Depressed fracture
- 42. Depression - Depressed fracture Painful mastication
- 43. Clinical examination X ray sub mento vertical view Waters’ view Diagnosis Fractures of zygomatic arch
- 44. Incision - anterior to ear in the hair Elevator ◦ Deep to the temporalis fascia Intra oral superior sulcus Usually does not require fixation Treatment Fractures of zygomatic arch
- 45. Accompanies ◦ Zygomatic fractures ◦ Maxilla fracture Le Fort II Isolated blow out fractures ◦ Large blunt object strikes globe ◦ Orbital contents herniate in the maxillary antrum
- 46. Tear drop sign
- 47. Echymosis of lid, conjuctiva and sclera Enophthalmos Diplopia Infra orbital anaesthesia
- 48. X ray PNS - Tear drop sign CT Scan - 3D Reconstruction Restricted eye movement ◦ Inferior rectus ◦ Inf oblique Cannot see up
- 49. Surgical ◦ Enophthalmos ◦ Diplopia Infra orbital approach Transantral approach Repair ◦ Nasal septal cartilage ◦ Illiac crest ◦ Silicon plate Fractures of orbital floor
- 59. Malocclusion Elongation of midface Mobility of maxilla CSF rhinorrhoea ◦ Le fort II & Le fort III
- 60. X Ray ◦ Waters’ view ◦ Postro anterior view ◦ Lateral view CT CSAN
- 62. Complex General management Interdental wiring Intermaxillary wiring Open reduction and fixation Wire slings ◦ Frontal bone ◦ Zygoma ◦ Infra orbital rim
- 64. Mandible Classified according to the location ◦ Chondylar process ◦ Angle ◦ Body ◦ Symphysis ◦ Choronoid process ◦ Ramus ◦ Alveolar process ◦ Combination
- 67. If not displaced ◦ Pain ◦ Trismus Inability to open ◦ Tenderness If displaced ◦ Malocclusion ◦ Deviation
- 68. Palpation ◦ Intraoral & extraoral ◦ Step deformity Malocclusion Tenderness Crepitus Echymosis of oral mucosa
- 69. X RAY PA VIEW OBLIQUE VIEW- RT/LT Panoramic view
- 71. Closed ◦ Interdental wiring ◦ Inter maxillary fixation ◦ External pin fixation
- 72. • Open reduction ◦ Interosseous wiring – figure of 8 ◦ Compression plates ◦ Immobalization – prolonged avoided
- 73. Communication ◦ Oral cavity ◦ Maxillary Sinus Location ◦ Alveolus ◦ Gingivolabial Sulcus
- 74. Dental Extraction ◦ Second premolar ◦ Molars Failure to heal Cald well Luc incision Erosion by carcinoma Penetrating injuries of Maxilla Osteitis of Maxilla Syphilus Malignant Granuloma
- 75. Regurgitation of food Discharge Inability to blow Inability to suck Nose sinus Oral cavity
- 76. Probing the fistula
- 77. Conservative ◦ Antibiotis ◦ Nasal Decongestants Opturator CaldWell Luc Operation Antrostomy Surgical repair ◦ Labial Mucosal Flap ◦ Platal Falp