The document discusses maxillary fractures, their classification, and treatment. It notes that René LeFort classified maxillary fractures into 3 types based on the location of fracture lines. LeFort I involves the alveolar process, LeFort II the maxilla and nasal bones, and LeFort III separates the midface from the cranium. Treatment involves reduction using disimpaction forceps followed by fixation methods like wire osteosynthesis, rigid plates, or semi-rigid miniplates depending on the fracture type and location. Complications can include nerve damage, malocclusion, infection, and nonunion if not treated properly.
ODONTOGENIC MYXOMA :
Benign mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue
Derived from odontogenic ectomesenchymeClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effected
Radiographic feature :
Radiolucent and it appear as a well circumscribed or diffuse lesion
Often multilocular with honey comb pattern
Cortical plate expansion, root displacement or resorption may be seen Histopathology :
Tumor consist of acellular myxomatous connective tissue.
Benign fibroblast and myofibroblast with some amount of collagen are found in matrix
Bony island representing residual tubeculae
Capillaries are scattered through out the lesion
ODONTOGENIC MYXOMA :
Benign mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue
Derived from odontogenic ectomesenchymeClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effected
Radiographic feature :
Radiolucent and it appear as a well circumscribed or diffuse lesion
Often multilocular with honey comb pattern
Cortical plate expansion, root displacement or resorption may be seen Histopathology :
Tumor consist of acellular myxomatous connective tissue.
Benign fibroblast and myofibroblast with some amount of collagen are found in matrix
Bony island representing residual tubeculae
Capillaries are scattered through out the lesion
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
Le fort fracture by Dr. Amit Suryawanshi .Dentist in Kolhapur (MDS). Oral &...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Dentist in Kolhapur (MDS) Oral & Maxillofacial surgeon from Kolhapur, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
Le fort fracture by Dr. Amit Suryawanshi .Dentist in Kolhapur (MDS). Oral &...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Dentist in Kolhapur (MDS) Oral & Maxillofacial surgeon from Kolhapur, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Naso orbital ethmoid fractures- part 2 /certified fixed orthodontic courses ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Its a Clinical Presentation of Midface fractures-specifically, Lefort fractures. Classification, Anatomical Landmarks, Clinical Features, Diagnosis & Management protocols are discussed.
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Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
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Pride Month Slides 2024 David Douglas School District
Middle face fracture
1.
2.
3.
4. • The middle third of the face consists of orbit,The middle third of the face consists of orbit,
nose, maxilla, zygoma, and nasoethmoidnose, maxilla, zygoma, and nasoethmoid
bone.bone.
• In 1901, René LeFort used 32 cadaversIn 1901, René LeFort used 32 cadavers
skulls and subjected them to various types ofskulls and subjected them to various types of
trauma, then he removed soft tissues andtrauma, then he removed soft tissues and
examined skulls:examined skulls:
• He found that generally if the face wasHe found that generally if the face was
fractured, the skull was not.fractured, the skull was not.
• He then stated that fractures occurredHe then stated that fractures occurred
through three weak lines in the facial bonythrough three weak lines in the facial bony
structures that protect the cranial cavity andstructures that protect the cranial cavity and
circumscribe the midfacecircumscribe the midface
5. • Six buttresses are responsible forreinforcementSix buttresses are responsible forreinforcement
of facial bones:of facial bones:
A.A. V ERTC A L BU TTRES S ES :V ERTC A L BU TTRES S ES :
1 .1 . Naso m axillaryNaso m axillary
2.2. Zyg o m atico m axillaryZyg o m atico m axillary
3.3. Pte ryg o m axillaryPte ryg o m axillary
6. B.B. HO RIZ O N TA L BU TTRES S ES :HO RIZ O N TA L BU TTRES S ES :
1 .1 . Fro ntal barFro ntal bar
2.2. Alve o lar Ridg eAlve o lar Ridg e
3.3. Infrao rbitalrimInfrao rbitalrim
7. LeFort classification system
1.1. LeFortLeFort I (horizontal or transversefracture) :I (horizontal or transversefracture) :
• The fracture line extends above the rootThe fracture line extends above the root
apices from the piriform aperture of the nose.apices from the piriform aperture of the nose.
• The fractured segment includes:The fractured segment includes:
MaxillaryMaxillary teethteeth
alveolar bone,alveolar bone,
part of the basal bone,part of the basal bone,
lowerthird of nasal septumlowerthird of nasal septum
lowerthird of pterygoid plates posteriorly.lowerthird of pterygoid plates posteriorly.
9. 2.2. LeFortLeFort II:II:
• It involves most of the nasal bone.It involves most of the nasal bone.
• The fracture line extends from below theThe fracture line extends from below the
nasofrontal suture, through the nasal bonenasofrontal suture, through the nasal bone
along the maxilla to the zygomatico-maxillaryalong the maxilla to the zygomatico-maxillary
suture (suture (below the zygoma which is intact)below the zygoma which is intact) andand
include the medial inferior third of the orbit theninclude the medial inferior third of the orbit then
the fracture continuous till the pterygoid platesthe fracture continuous till the pterygoid plates
at a higher level thanat a higher level than lefort I.lefort I.
11. 3.3. LeFort III:LeFort III:
• It separates the middle third from the cranium.It separates the middle third from the cranium.
• It involves most of the orbital bone.It involves most of the orbital bone.
• The fracture line extends from the nasofrontalThe fracture line extends from the nasofrontal
suture along the medial wall of the orbit throughsuture along the medial wall of the orbit through
the superior orbital fissure.the superior orbital fissure.
• It then extends along the inferior orbital fissuresIt then extends along the inferior orbital fissures
and the lateral orbital wall to theand the lateral orbital wall to the zygomatico-zygomatico-
frontalfrontal suture; thesuture; the zygomatico-temporalzygomatico-temporal suture issuture is
also separated.also separated.
• Then the fracture extend along the sphenoid boneThen the fracture extend along the sphenoid bone
separating the pterygoid plates.separating the pterygoid plates.
13. Clinical examination :
A.A. E X T R A O R A L E X A M I N A T I O N :E X T R A O R A L E X A M I N A T I O N :
• InspectionInspection
Laceration of the skinLaceration of the skin..
Abrasion& ecchymosis areasAbrasion& ecchymosis areas..
Facial edemaFacial edema..
EpistaxisEpistaxis..
Cerebrospinal fluid leakageCerebrospinal fluid leakage..
Asymmetry of the noseAsymmetry of the nose..
Flat nasal bridgeFlat nasal bridge..
Dish-shaped faceDish-shaped face..
• PalpationPalpation
Bilateral palpation over the expected lines of fracture isBilateral palpation over the expected lines of fracture is
performed to feel bony steps or deformitiesperformed to feel bony steps or deformities
• ..
14. • The level of fracture can be determined extraorally:The level of fracture can be determined extraorally:
One hand holds the bridge of the nose while the otherOne hand holds the bridge of the nose while the other
manipulates the maxilla; movement at the alveolus suggestsmanipulates the maxilla; movement at the alveolus suggests
Lefort ILefort I fracture.fracture.
the first hand is placed over thethe first hand is placed over the
frontonasal suture while the otherfrontonasal suture while the other
one manipulates the maxilla;one manipulates the maxilla;
movement at the frontonasal suturemovement at the frontonasal suture
suggestssuggests lefort II orlefort IIIlefort II orlefort III fractures.fractures.
15. B.B. I N T R A O R A L E X A M I N A T I O N :I N T R A O R A L E X A M I N A T I O N :
• InspectionInspection
Fractured teethFractured teeth..
Vestibular ecchymosis & edemaVestibular ecchymosis & edema..
Mucosal laceration & bleedingMucosal laceration & bleeding..
Steps or diastema in the maxillary teethSteps or diastema in the maxillary teeth..
MalocclusionMalocclusion..
• PalpationPalpation
Step deformity in the occlusal plane or theStep deformity in the occlusal plane or the
alveolar ridge in case of edentulous patient.alveolar ridge in case of edentulous patient.
16. Imaging:
1.1. Axial & coronal CT scan:Axial & coronal CT scan:
The coronal CT scan is the best diagnostic radiographThe coronal CT scan is the best diagnostic radiograph
in case of suspected orbital floor fractures.in case of suspected orbital floor fractures.
It can demonstrate soft tissue differences of hematomaIt can demonstrate soft tissue differences of hematoma..
it can demonstrate edema of subcutaneous tissue,it can demonstrate edema of subcutaneous tissue,
muscle and fat.muscle and fat.
2.2. Postero-anteriorviewPostero-anteriorview
3.3. Waters viewWaters view
4.4. Lateral viewLateral view
5.5. Occipitomental viewOccipitomental view
17. Treatment
I.I. ReductionReduction ::
• Rowe disimpaction forcepsRowe disimpaction forceps isis
used to disimpact the maxillaused to disimpact the maxilla
in LeFort fracture .in LeFort fracture .
• it consists of two forceps ( right &it consists of two forceps ( right &
left ) acting togetherleft ) acting together
• one of the forceps two arms hasone of the forceps two arms has
high curvature to engage thehigh curvature to engage the
palate without injuring teeth.palate without injuring teeth.
• The other arm of less curvatureThe other arm of less curvature
is inserted into the nostrils.is inserted into the nostrils.
19. • It is an old but yet a successfully usedIt is an old but yet a successfully used
method.method.
• Many designs are available:Many designs are available:
One design includes drilling of four holes forOne design includes drilling of four holes for
wiring.wiring.
Another design use two holes onlyAnother design use two holes only
Another design use two holes & circumscribe theAnother design use two holes & circumscribe the
bony edge.bony edge.
• The main disadvantage of wireThe main disadvantage of wire
osteosynthesis is that it does not maintainosteosynthesis is that it does not maintain
three dimensional stability.three dimensional stability.
11 Wire OsteosynthesisWire Osteosynthesis
20. • By m e ans o f arch bars o r wiringBy m e ans o f arch bars o r wiring to anto an
intact m andibleintact m andible
• It is the m o st re liable te chniq ueIt is the m o st re liable te chniq ue fo rfo r
e stablishing ante rio r pro je ctio n o f thee stablishing ante rio r pro je ctio n o f the
m andible .m andible .
Intermaxillary fixationIntermaxillary fixation
21. • It had been introduced specifically for long boneIt had been introduced specifically for long bone
fracture as it is cortical bone with decreasedfracture as it is cortical bone with decreased
amount of blood supply &amount of blood supply & subjected tosubjected to highhigh
stresses, so rigid fixation is needed to ensurestresses, so rigid fixation is needed to ensure
intimate contact between fractured parts andintimate contact between fractured parts and
enhance healing.enhance healing.
• Types:Types:
A.A. Dynamic compression platesDynamic compression plates
B.B. Eccentric dynamic compression plateEccentric dynamic compression plate
22 Rigid fixationRigid fixation
22. A. Dynamic compression plates :
• Provided with oval holes.Provided with oval holes.
• The pointed tip of the oval shape is directedThe pointed tip of the oval shape is directed
outward while the wide portion is directed towardoutward while the wide portion is directed toward
the midline of the plate.the midline of the plate.
• When the screw is introduced into the thin portionWhen the screw is introduced into the thin portion
of the hole it will escape toward the wide portionof the hole it will escape toward the wide portion
(midline)(midline) pushing bony fragments toward thepushing bony fragments toward the
midline.midline.
• The action of screws on both sides helps toThe action of screws on both sides helps to
approximate bony fragments and enhances theirapproximate bony fragments and enhances their
union.union.
23.
24. • It had been proved that force affecting onIt had been proved that force affecting on
bone will produce both tension andbone will produce both tension and
compression, and so; two plates are neededcompression, and so; two plates are needed
one plate to resist compression and the otherone plate to resist compression and the other
to resist tension.to resist tension.
• One plate can be used separately if placed inOne plate can be used separately if placed in
the neutral zonethe neutral zone
25. B. Eccentric dynamic compression plate
• Holes are not directed perpendicular to bone,Holes are not directed perpendicular to bone,
they have several angulations so the screwthey have several angulations so the screw
will take several directions and this willwill take several directions and this will
eliminate the need of another plateeliminate the need of another plate (one plate(one plate
will be enough)will be enough) as the screw is makingas the screw is making
anchorage at higher level to produce tensionanchorage at higher level to produce tension
rather than compressionrather than compression..
26. • Specific for maxillofacial region as maxillary bone isSpecific for maxillofacial region as maxillary bone is
spongy and highly vascularspongy and highly vascular bone.bone.
• Maxilla is not subjected to high stresses as in long bone soMaxilla is not subjected to high stresses as in long bone so
semi-rigid fixation may be used.semi-rigid fixation may be used.
• Types of semi-rigid fixationTypes of semi-rigid fixation
A.A. Miniplates:Miniplates:
The most commonly used plates specially in theThe most commonly used plates specially in the
mandiblemandible (about 1.5 mmthickness)(about 1.5 mmthickness)
A.A. Microplates:Microplates:
used in very thin placesused in very thin places(about 0.6 mmthickness)(about 0.6 mmthickness)
A.A. Resorbable plates:Resorbable plates:
Recently introduced for treatment of fractures.Recently introduced for treatment of fractures.
33 Semi Rigid fixationSemi Rigid fixation
27. • AdvantagesAdvantages ::
Eliminate the need for another surgery as in youngEliminate the need for another surgery as in young
patients (The plate may prevent growth of bone andpatients (The plate may prevent growth of bone and
should be removed after 6 months)should be removed after 6 months)
Provide good esthetic appearanceProvide good esthetic appearance
Prevent pain sensation at the site of plates specially inPrevent pain sensation at the site of plates specially in
cold environment and thin areas.cold environment and thin areas.
• DisadvantagesDisadvantages ::
ExpensiveExpensive
ThickThick
28. • Used without plates.Used without plates.
• A hole is drilled in the fractured bonyA hole is drilled in the fractured bony
segment, the screw is forced through thesegment, the screw is forced through the
hole to penetrate the fixed segment , thehole to penetrate the fixed segment , the
large diameter head of the screw willlarge diameter head of the screw will
prevent its passage through the hole.prevent its passage through the hole.
44 Lag Screws :Lag Screws :
29. Complications associated with maxillary fracture and their
repair:
• Infraorbital nerve paresthesia.Infraorbital nerve paresthesia.
• Enophthalmos.Enophthalmos.
• Infection.Infection.
• Deviated septum.Deviated septum.
• Nasal obstruction.Nasal obstruction.
• Altered vision.Altered vision.
• Nonunion.Nonunion.
• Malunion or malocclusion.Malunion or malocclusion.
• Epiphora.Epiphora.
• Foreign body reaction.Foreign body reaction.
• Scarring.Scarring.
• Sinusitis.Sinusitis.