This document provides an overview of Lefort fractures of the maxilla, including:
- The classification system described by Rene Lefort in 1901 which divides maxillary fractures into Types I, II, and III.
- The anatomical features and clinical findings associated with each Lefort fracture type.
- The epidemiology, causes, and management of Lefort fractures from the initial emergency response through definitive surgical treatment.
- Surgical approaches and fixation methods for addressing Lefort fractures, including plates, screws, and wiring techniques.
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Links the pharynx to the middle ear
Eustachius (1562) termed it as Pharyngotympanic tube and Antonio Valsalva as the Eustachian tube. It
Develops from tubotympanic recess which is derived from endoderm of 1st pharyngeal pouch It is
36 mm long in adults .It is
Directed anteriorly, inferiorly and medially from anterior wall of middle ear forming an angle of 45degrees with horizontal and sagittal planes
It enters the lateral wall of nasopharynx 1.25 cm behind posterior end of inferior turbinate.
Lateral 1/3 - bony
Medial 2/3 - fibro-cartilaginous
Junction between 2 parts -- isthmus, narrowest part of Eustachian tube
Frontal sinus fractures are currently managed by various medical specialists, including otolaryngologists/head and neck surgeons, maxillofacial surgeons, plastic surgeons, and neurosurgeons. As a result, consensus does not exist regarding the timing, indications, and treatment modality of these injuries.
Award-winning New CT grading system for preoperative Endoscopic Frontal sinus...Heitham Gheriani
Proud to share this recently presented at BCOS and award-winning new concept and new FOG grading system to help planning your Endoscopic sinus surgery and most importantly to help to identify patients at higher operative risk of intracranial and orbital complication
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Its a Clinical Presentation of Midface fractures-specifically, Lefort fractures. Classification, Anatomical Landmarks, Clinical Features, Diagnosis & Management protocols are discussed.
Links the pharynx to the middle ear
Eustachius (1562) termed it as Pharyngotympanic tube and Antonio Valsalva as the Eustachian tube. It
Develops from tubotympanic recess which is derived from endoderm of 1st pharyngeal pouch It is
36 mm long in adults .It is
Directed anteriorly, inferiorly and medially from anterior wall of middle ear forming an angle of 45degrees with horizontal and sagittal planes
It enters the lateral wall of nasopharynx 1.25 cm behind posterior end of inferior turbinate.
Lateral 1/3 - bony
Medial 2/3 - fibro-cartilaginous
Junction between 2 parts -- isthmus, narrowest part of Eustachian tube
Frontal sinus fractures are currently managed by various medical specialists, including otolaryngologists/head and neck surgeons, maxillofacial surgeons, plastic surgeons, and neurosurgeons. As a result, consensus does not exist regarding the timing, indications, and treatment modality of these injuries.
Award-winning New CT grading system for preoperative Endoscopic Frontal sinus...Heitham Gheriani
Proud to share this recently presented at BCOS and award-winning new concept and new FOG grading system to help planning your Endoscopic sinus surgery and most importantly to help to identify patients at higher operative risk of intracranial and orbital complication
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Its a Clinical Presentation of Midface fractures-specifically, Lefort fractures. Classification, Anatomical Landmarks, Clinical Features, Diagnosis & Management protocols are discussed.
Area between a superior plane drawn through the FZ sutures tangential to the skull base and inferior plane at the level of maxillary occlusal surface
Triangular region with widest dimension facing anterior
Definition:
Middle third of the facial skeleton may be defined as that area bounded superiorly by a transverse line connecting the 2 zygomaticofrontal sutures & inferiorly by occlusal plane of the maxillary teeth, or alveolar ridge in edentulous patient.
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Emergency Department presentation by Dr Conor Dalby. Signs and symptoms to be aware of when assessing a patient following facial injury. Common types of fractures and their management. UK.
Le fort fracture by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, 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.
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!
introduction to orthodontics....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- 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
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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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. *
*Introduction
*History
*Surgical Anatomy of Maxilla
*Etiology of Lefort fractures
*Epidemiology
*Classification & LeFort fracture lines
*Clinical examination
*Clinical features
*Diagnostic radiography
3. • Management
* - Emergency care
* - Early care
* - Definitive care
• Complications
• Controversies
• Conclusion.
4. *
The maxilla represents the bridge between the cranial
base superiorly and the dentition inferiorly. Its
intimate association with the oral cavity, nasal cavity,
and orbits and the important structures adjacent to it
make the maxilla a functionally and cosmetically
important structure.
5. *Fracture of these bones is potentially life-
threatening as well as disfiguring. Hence we
being maxillofacial surgeons need to do
systematic and timely repair of these fractures
to correct deformity and prevent unfavorable
sequalae.
6. *
*The first clinical examination of a maxillary fracture was recorded in
2500 BC.
*In 1822 Charles Fredrick William Reiche provided the first detailed
description of maxillary fractures.
*In 1823 Carl Ferdinand van Graefe described the use of a head frame for
treating a maxillary fracture.
7. *In 1901 , Rene Le Fort published his landmark work,
a three-part experiment using 32 cadavers.
*The heads of the cadavers were subjected to low
velocity forces; the soft tissue were then removed
and the bones were examined.
9. *
*Lacrimal fossa is partially formed by maxilla .Hence fracture can
cause injury to nasolacrimal duct.
*Damage to infraorbital nerve can occur unilaterally or bilaterally
in fracture of maxilla.
*Fracture involving orbital walls may give rise the change in the
ocular level due to separation above the attachment of
suspensory ligament of lockwood. (LeFort III)
*If orbital floor is fractured, there will be herniation of orbital
content into maxillary sinus.
11. *
*It is the second largest bone of the face
*It forms the upper jaw with the fellow of the
opposite side
*It also contributes to the formation of
1. Floor of the nose and the orbit
2. Roof of the mouth
3. Lateral wall of the nose
4. Pterigopalatine and infratemporal fossae
5. Pterigomaxillary and infraorbital fissures
12. *The anatomy of the maxilla has two main parts:
1. Body(pyramidal shape)
* Anterior surface
* Posterior surface
* Orbital surface
* Nasal surface
2. Processes
* Zygomatic
* Frontal
* Alveolar
* Palatine
17. *Rene LeFort (1901) discovered the complex
fracture patterns of Maxilla which is broadly
classified as
1. Lefort I
2. Lefort II
3. Lefort III
18. *
*The LeFort classification has proven to be less
satisfactory to describe more complex fracture
patterns, comminuted, incomplete, combination
maxillary fractures or to describe fractures of the
part bearing the occlusal segment.
19. *
*A more precise system of describing fracture patterns
is necessary to establish an accurate diagnosis &
determine potential surgical approaches.
20. *
*Le Fort I Low maxillary fracture
Ia Low maxillary fracture/multiple segments
*Le Fort II Pyramidal fracture
IIa Pyramidal and nasal fracture
IIb Pyramidal and NOE fracture
* Le Fort III Craniofacial disjunction
IIIa Craniofacial disjunction and nasal fracture
IIIb Craniofacial disjunction and NOE fracture.
21. * Le Fort IV LeFort II or III fracture and
cranial base fracture
IV a + Supraorbital rim fracture
IV b + Anterior cranial fossa and
supraorbital rim
fracture
IV c + Anterior cranial fossa and
orbital wall
fracture
23. *
*There is separation of complete dentoalveolar part of
maxilla (Pterygomaxillary dysjunction) and the fractured
fragment is held only by means of soft tissues.
*Cause -
A violent force applied over more extensive area of
maxilla above the level of maxillary teeth results in Lefort
I fracture.
24. *
*The fracture line commences at the point on the
lateral margin of the anterior nasal aperture, passes
above the nasal floor, passes laterally above the
canine fossa and traverses the lateral antral wall, dips
down below the zygomatic buttress and then inclines
upward and posteriorly across the pterygomaxillary
fissure to fracture the pterygoid laminae at the
junction of their lower third and upper 2/3 rd
25.
26. *
Cause –
Violent force, usually from an anterior
direction, sustained by the central region of
the middle third of the facial skeleton over an
area extending from glabella to the alveolar
margins results in fracture of pyramidal shape
.
27. *It may or may not involve infraorbital foramen. Then
fracture line now extends downward, forward and
laterally to traverse the lateral wall of antrum, just
medial zygomaticomaxillary suture line.
28. As in Lefort I , this fracture line
passes beneath the Zygomatic
buttress, inclines abruptly traversing
the pterygomaxillary fissure at a
higher level and fracturing
the pterygoid laminae approximately
midway from its base. Seperation of
entire pyramidal block from the base
of the skull is completed via nasal
Septum.
42. *
Clinical features -
*Slight swelling of the upper lip is seen.
*Ecchymosis present in the buccal sulcus beneath each
zygomatic arch.
*Disturbance in occlusion with variable amount of mobility in
the tooth bearing segment of the maxilla.
43. *The patient may develop open bite if the fractured segment is
mobile , due to posterior gagging of occlusion.
*Sometimes fracture of the palate can also be associated with
Le Fort I fracture.
44. *In Le Fort I, the teeth and maxilla are mobile, but the
nose and upper face is fixed.
*Percussion of the maxillary teeth results in
distinctive 'cracked-pot sound',
* No tenderness and mobility of the zygomatic arch
and bones
45. *
Clinical features -
* The resulting gross edema of the middle third gives an appearance of "moon
face" to the patient.
*On intraoral examination, retropositioning of the whole maxilla and gagging of
the occlusion are seen.
*When maxillary teeth are grasped, the mid-facial skeleton moves as a pyramid
and the movement can be detected at the infraorbital margin and the nasal
bridge.
46. * Hematoma formation is seen in the buccal sulcus opposite to the maxillary
first and second molar teeth as a result of fracture of the zygomatic buttress.
* Step deformity at the infraorbital rims or frontonasal junction is noticed.
* Orbital wall fractures can cause entrapment with limitation of ocular
movement.
47. *CSF rhinorrhoea is possible and should be looked for.
*Bilateral circumorbital ecchymosis giving an appearance of
'raccoon eyes' is invariably seen in the fractures of both Le
Fort II and Le Fort III.
*Subconjunctival hemorrhage develops rapidly in the area
adjacent to the site of injury.(mostly in medial half )
48. * Diplopia may be seen in cases of orbital floor injury.
* Pupils are at level unless there is gross unilateral enophthalmos.
* Anaesthesia or paraesthesia of the cheek as a result of injury to the
infraorbital nerve due to the fracture of the inferior orbital rim.
* Obvious deformity of nose with epistaxis.
50. *
* LE FORT FRACTURES - Treatment STAGES
1. Emergency care & Stabilization -
( First aid and resuscitation )
2. Initial Assessment and Early care-
3. Definitive Treatment-
4. Rehabilitation -
51. STAGE I - Emergency care & Stabilization
1. Maintenance of airway.
2. Control of hemorrhage.
3. Prevent or control shock.
4. C-Spine stabilization.
5. Control of life-threatening injuries.
6. Head injuries, chest injuries, compound limb
fractures, intra abdominal bleeding.
52. *Evaluate the airway -
*Existence & identification of obstruction.
*Manually clear fractured teeth, blood clots, dentures.
*Endotracheal intubation if needed.
NOTE:
*Altered level of consciousness is the most common
cause of upper airway obstruction
53. * Treatment of Blood Loss & Shock
*Hemorrhage is most common cause of shock
after injury.
*Multiple injury patients have hypovolemia.
Monitor vital signs closely.
*Goal is to restore organ perfusion
54. *External bleeding controlled by direct
pressure over bleeding site.
*Gain prompt access to vascular system
with IV catheters.
*Fluid replacement:
*Ringer’s Lactate
*Normal saline
*Transfusion.
55. * Stabilization of associated injuries
*C-spine injury is primary concern with all maxillofacial
trauma victims.
*Signs/symptoms of C-Spine injury
*Neurologic deficit.
*Neck pain.
56. *Stabilization of associated injuries
*C-spine injury suspected:
*Avoid any movement of neck
*Establish & maintain proper immobilization until
vertebral fractures or spinal cord injuries ruled out
*Lateral C-spine radiographs
*CT of C-spine
*Neurologic exam
57. *
*Emergency care has stabilized patient.
*Initial stabilization of fractures.
*Debridement & dressing of soft tissues.
*Physical exam & history.
*Laboratory tests.
*Clinical & Radiographic Assessment of Patient.
Diagnosis of maxillofacial injuries.
* Pre-operative planning.
59. * STAGE II. Initial Assessment
Pre-operative planning
1. Need for Tracheostomy
2. Surgical Approaches to Midface
3. Whether ‘Open’ or ‘Closed’ methods of reduction
are to be employed.
4. Necessity for & type of Maxillary fracture
Fixation.
60. *
1. Supraorbital eyebrow incision (Lefort
III)
2. Subciliary incision (LeFort II & III)
3. Median lower lid (LeFort II & III)
4. Infraorbital incision (LeFort II & III)
5. Transconjunctival (LeFort II )
6. Zygomatic arch
7. Transverse nasal (LeFort II & III)
8. Vertical nasal incision (LeFort II &
III)
9. Medial orbital incision.
10. Intra-oral vestibular incision. (LeFort
I
61. *
A ) Internal Fixation-
1. Suspension Wires
2. Direct Osteosynthesis
B) External Fixation-
1. Craniomandibular
2. Craniomaxillary
65. *
*Incomplete fixation of fractured fragments
*Insufficient visualization of fractures by closed
reduction
*Compression against the cranial base
*No 3-dimensional stability
*Patients dislike intra-oral splints as it hinders oral
hygiene maintainence.
67. *
. Plates & Screws for midface
fractures -
Stainless steel mini-plating system
Titanium mini-plating system
Vitallium, Cobalt chromium, molybdenum alloy plates
Bioresorbable plating system
68. *
Advantages –
1. Simple & less intraoperative time
2. Intraoral approach is sufficient
3. Postoperative IMF is not needed or period of
IMF is reduced.
4. Three dimensional stability and early return
of function.