Oral and Maxillofacial surgery presentation

1. MAXILLOFACIAL
TRAUMA
BY: DR SHAMMA DUDHIA

2. INTRODUCTION
What is a fracture?
● A fracture is a breakage or discontinuity of bone,tooth or any
hard tissue of the body.
● Usually occurs due to road traffic accidents(RTA),assaults,
sports, gunshot wounds, accidents.
● Fractures are most common in young males around the age
of 18-30 years.

3. MANDIBULAR FRACTURES
● There are different classifications of mandibular fractures:
● The first classification is according to the anatomical location;
condylar,ramus,angle,body,symphyseal,alveolar and coronoid
process areas.

4. Symphysis fracture- any fracture in the region of the incisors that runs from the
alveolar process through the inferior border of the mandible in a vertical or almost
vertical direction.
Body fracture- any fracture that occurs in the region between the mental foramen
and the distal portion of the second molar extends from the alveolar process
through the inferior border.
Angle fracture- any fracture distal to the second molar extending from any point
on the curve formed by the junction of the body and the ramus in the retromolar
area to any point on the curve formed by the inferior border of the body and the
posterior border of the ramus of the mandible.
Condylar fracture- a fracture that runs from the segmoid notch to the posterior
border of the ramus of the mandible along the superior aspect of the ramus.

5. The second classification describe the condition of the bone fragments at the
fracture site and possible communication to the external environment:
Greenstick fractures are those involving incomplete fractures with flexible bone.
Greenstick fractures generally exhibit minimal mobility when palpated and the
fracture is incomplete.
A simple fracture is a complete transection of the bone with minimal mobility
fragmentation at the fracture site.
In a comminuted fracture, the fractured bone is left in multiple segments.
Gunshot wounds, penetrating objects and other high impact injuries to the jaw
frequently result in commuicated fractures.
A compound fracture results in a communication of the margin of the fractured
bone with the external environment.

7. The third classification depends on the angulation of the fracture and the force
of the muscle pull proximal and distal to the fracture.
In a favourable fracture, the fracture line and the muscle pull resists
displacement of the fracture.
In an unfavourable fracture, the muscle pull results in displacement of the
fractured segment.

8. DIAGNOSIS OF MANDIBULAR FRACTURES
1. History 2. Clinical examination 3. Radiographic examination
CLINICAL EXAMINATION
● Facial asymmetry
● Malocclusion
● Laceration
● Tenderness
● Mandible deviation
● Teeth malocclusion
● Step deformity
● Dislocation
● Paresthesia
● Submucosal echymosis
● Trismus
● Mobility of teeth

9. RADIOGRAPHIC EXAMINATION
● Panoramic radiograph
● Lateral oblique
● PA mandible
● CT Scan
● MRI
● 3D CT

10. TREATMENT OF MANDIBULAR FRACTURES
Principals of managing mandibular fractures:
1.Reduction(Closed or open) 2. Fixation 3. immobilization(intermaxillary
fixation) 4. Rehabilitation
GOALS
● Restore occlusion, establish bony union and avoid TMJ pathology
● Repair within first week.
● Postoperative care.

11. CLOSED REDUCTION
Closed reduction is usually done in favourable, minimally displaced noncondylar fractures. IMF is
done for about 4-6 weeks.
Advantages of closed reduction:
● Conservative procedure
● No surgical complications
● Can be done in medically compromised patients
Disadvantages of closed reduction:
● Loss of function
● Nutrition compromise
● speech/ social inconvenience
● Rehabilitation is challenging

12. OPEN REDUCTION
Open reduction is usually done for unfavourable fractures and multiple fractures.
Advantages of open reduction
● Fixation in desired position
● Return of function
● No nutrition compromise
Disadvantages of open reduction:
● Surgical procedure
● Complications of surgery

13. MID FACE FRACTURES
● Lefort I(transverse maxillary)
● Lefort II(pyramidal)
● Lefort III(Craniofacial dyjunction)
● Zygomatic complex
● Orbital floor
● Nasal fractures
● Naso-orbital / Ethmoid

14. LEFORT I (TRANSVERSE MAXILLARY)
The plane of injury is horizontal and typically results in a seperation of the teeth from the
upper face. The horizontal fracture line generally passes through the alveolar ridge which is
the bony socket that holds the teeth, the lateral nose and the inferior portion of the maxillary
sinus.
CLINICAL FEATURES
● Swelling on the upper lip
● Bruising of the buccal mucosa
● Malocclusion (anterior open bite)
● Loosening of the teeth
● Guerins sign(ecchymosis in the greater palatine vessels area)

15. LEFORT II(PYRAMIDAL)
Lefort II presents with a pyramidal shaped fracture. The upper teeth make up the base and
the nasofrontal suture(a band of tissue connecting the frontal bone and nasal bones)
makes up the point or apex of the pyramidal fracture. In other words, lefort II fracture
involves the separation of the maxilla and the nasal complex from the cranial base,
zygomatic orbital rim area, pterygoid maxillary suture area.
CLINICAL FEATURES
● Deformity and swelling of mid face(moon face appearance)
● Widening of the intercanthal space
● Mobility of upper jaw and nose
● Subconjunctival hemorrage only in the medial aspect
● Malocclussion
● Periorbital edema and eccyhmosis(panda face)
● Epistaxis
● Cerebrospinal fluid rhinorrhea.

16. LEFORT III(CRANIOFACIAL DYSJUNCTION)
Lefort III fracture is a complete separation of the midface at the level of the naso-orbital-ethmoid
complex and the zygomaticofrontal suture area. This type of fracture extends through the orbit
bilaterally.
CLINICAL FEATURES
● Moon face
● Panda face-raccoon eyes(periorbital ecchymosis)
● Subconjuctival hemorrage both medially and laterally
● chemosis(edema of eye)
● Diplopia
● Hooding of the upper eyelid
● Increase in the intercanthal distance
● CSF rhinorrhea

17. RADIOGRAPHIC EXAMINATION
PA skull view
Lateral skull view
Submentovertex view
CT Scan
MRI

18. TREAMENT
Closed reduction
Open reduction

19. POST OPERATIVE COMPLICATIONS
● Non union
● Delayed union
● Malunion
● Infection
● Ollusal derangment
● Facial asmmetry
● Injury to lacrimal system
● Neurological complications