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Mid face trauma
The document outlines the definition of the mid-face, its structure relations, and the aims of treatment for injuries in this area. It discusses factors affecting the risk of complications and principles for treatment, highlighting when closed or open reduction is appropriate. Additionally, it details various fixation and immobilization techniques used in treatment.
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Mid face trauma
- 1. 1 By- Dr. PrathameshFulsundar
- 2. Mid-face Definition: The area betweena superior plane drawn through the zygomatico-frontal sutures tangential to the base of the skull and inferior plane at the level of the maxillary dental occlussal surface. 2
- 3. Structures connection (structures inrelation) • Orbit • Maxillary sinus • Nasal bone • Naso-orbital ethmoid (NOE) complex • Zygomatic complex • Frontal bone and sinus 3
- 4. Vertical and horizontalpillars 4 •Area of strength •Vertical and horizontal pillars •Muscular attachment •Area of weakness •Sutures •Lining tissues and air-filled cavities
- 5. Aims of treatment •Relieve pain • Restore function. • Restore bone anatomy. • Prevent infection • Restore the dental occlusion • Restore jaw movement at the earliest possible stage • Restore normal nerve function 5
- 6. Factors affecting therisk • Association with multiple injuries. • Presence of uncontrolled haemorrhage • Impairment of the airway. • Presence of bone comminution • Association with a dural tear. • Association with a base of skull fracture. • Presence of a pre-existing dentofacial deformity. • Time elapsed since the injury. • Presence of a medical or surgical factor which would delay general anesthesia • Presence of any factor which would delay healing. (eg nutritional deficiency or alcoholism) • Stage of dental development (deciduous, mixed or permanent dentition) Presence of fractured teeth. • Total absence of teeth (edentulous) • Inability of the patient to co-operate with treatment. • Association with fractures of the mandible especially bilateral fractures of the condyles. 6
- 7. Principles of treatment Closedreduction may be appropriate in cases • Simple uncomplicated fractures • Complex or comminuted fractures • Medical or surgical contraindications to open reduction • Maxillary fractures in children 7
- 8. Open reduction maybe appropriate where • Immediate or early jaw function is desirable • Difficulty is encountered in reducing the fracture by a closed method • The fracture is unstable 8
- 9. Definitive treatment • Reduction Manualmanipulation Use of dis-impaction forceps 9
- 10. Fixation and immobilization Extraoralfixation Craniomandibular fixation Box-frame (pin fixation) Halo-frame Plaster of paries headcap Craniomaxillary fixation Supra-orbital pins Zygomatic pins Halo-frame 10
- 11. Immobilization within thetissue Direct fixation • Transosseous wiring at fracture sites • Frontozygomatic sutures • Infrorbital margin • Midline of the palate 11
- 12. Immobilization within thetissue Internal-wire suspension o Circumzygomatico-mandibular o Infraorbital border-mandibular o Frontomandibular o Pyriform fossa-mandibular Support via the maxillary sinus by filling materials o Ribbon gauze o Balloon o Folly catheter o Polyethylene material 12
- 13.