1. MAX FAC INJURIES - u.g. lecture11.ppt

Maxillofacial injury, maxillofacial trauma,

1. GK / MAXFAC
SDM DHARWAD

2. MAXILLOFACIAL INJURIES
•FUNCTION
•SMELL
•SEE
•TALK
GK / MAXFAC
SDM DHARWAD
“APPEARANCE”
EAT
HEAR
BREATHE
•
•
•

3. MAXILLOFACIAL INJURIES
TRAUMA: PHYSICAL FORCE RESULTS IN INJURY
F = mv
2
ETIOLOGY
•ASSAULTS
•FALL
•INDUSTRIAL ACCIDENTS
•RTA
•SPORTS INJURIES
•WAR INJURIES
GK / MAXFAC
SDM DHARWAD

4. MAXILLOFACIAL INJURIES
SERIOUS TRAUMA: DEATH
TRIMODAL DISTRIBUTION
•SECONDS TO MINUTES
•MINUTES TO HOURS
(GOLDEN HOUR)
•AFTER DAYS
GK / MAXFAC
SDM DHARWAD

5. MAXILLOFACIAL INJURIES
GOLDEN HOUR
COMPLICATIONS
UNRECOGNIZED SERIOUS
AIRWAY
CERVICAL SPINE
HAEMORRHAGE
GK / MAXFAC
SDM DHARWAD

6. MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
BREATHING
CIRCULATION
DEFORMITY
EXPOSURE
GK / MAXFAC
SDM DHARWAD

7. MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
•SUCTION
•CHIN LIFT -JAW THRUST
•AIRWAYS
•CRICO / TRACHY
•OXYGEN
GK / MAXFAC
SDM DHARWAD

8. MAXILLOFACIAL INJURIES
GOLDEN HOUR
BREATHING
CHEST INJURY
•Pneumothorax
•Cardiac tamponade
•Ruptured diaphragm
GK / MAXFAC
SDM DHARWAD

9. MAXILLOFACIAL INJURIES
GOLDEN HOUR
CIRCULATION
I.V. ACCESS
TRANSFUSION
Hypovolemia-SHOCK
GK / MAXFAC
SDM DHARWAD

10. MAXILLOFACIAL INJURIES
GOLDEN HOUR: CIRCULATION
Hypovolemic shock
•Tachycardia
•Hypotension
•Cold clammy skin
•Loss of peripheral pulse
•Falling urinary output
•Confusion & disorientation
GK / MAXFAC
SDM DHARWAD

11. MAXILLOFACIAL INJURIES
GOLDEN HOUR
DISABILITY
Patient’s response ‘AVPU’
Awake
Verbal stimuli
Painful stimuli
Unconscious
GK / MAXFAC
SDM DHARWAD

12. MAXILLOFACIAL INJURIES
DIAGNOSIS & TREATMENT PLAN
Eye witness report
Clinical diagnosis (ABCDE)
Neurological examination
-G.C.S
-Cranial Nerves
GK / MAXFAC
SDM DHARWAD

13. EYE
OPENING
VERBAL RESPONSE
MOTOR
RESPONSE
GK / MAXFAC
SDM DHARWAD

14. MAXILLOFACIAL INJURIES
Secondary survey
ABDOMEN
Occult blood sequestration
Tenderness / acute abdomen
Gastric decompression (N.G tube)
Direct peritoneal lavage
GK / MAXFAC
SDM DHARWAD

15. MAXILLOFACIAL INJURIES
Secondary survey
EXTREMITIES
Reduced perfusion
Traumatic amputation
Compartmental Syndrome
Site for major blood loss
(1-6 units)
GK / MAXFAC
SDM DHARWAD

16. GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
EXTRA-ORAL EXAMINATION
Inspection
•Swelling
•Hematoma
•Skin lacerations / defects
•Facial nerve
•Mouth opening

17. MAXILLOFACIAL INJURIES
EXTRA-ORAL EXAMINATION
Palpation
•Tenderness
•Crepitation
•Contour irregularities (step)
•Depressed / Penetrating
bone
GK / MAXFAC
SDM DHARWAD

18. MAXILLOFACIAL INJURIES
EXTRA-ORAL EXAMINATION
Soft tissues
(contusion tissue loss)
Foreign bodies
Nerves
Ducts
Blood vessels
(remember tetanus)
GK / MAXFAC
SDM DHARWAD
(NOSE / EAR / EYE)

19. MAXILLOFACIAL INJURIES
INTRA-ORAL EXAMINATION
Inspection
•Asymmetry, Swelling
•Bleeding, Hematoma
•Occlusal plane / Step deformity
•Mucosal lacerations
•Teeth: fracture
avulsion
dislocation
GK / MAXFAC
SDM DHARWAD

20. MAXILLOFACIAL INJURIES
INTRA-ORAL EXAMINATION
Palpation
•Bimanual
•Tenderness
•# line / Step deformity
•Crepitation
•Teeth movement, Number
•Missing parts
•Sensory distribution V
1 -V
3
( SALIVARY GLANDS / TONGUE / PALATE )
GK / MAXFAC
SDM DHARWAD

21. MAXILLOFACIAL INJURIES
RADIOGRAPHIC EXAMINATION
(based on clinical examination)
Plain radiographs
Location & Severity of fractures
Radio-opaque foreign bodies
CT scans
Intra-cranial injuries
Orbital & naso-ethmoidal
injuries
GK / MAXFAC
SDM DHARWAD

22. MAXILLOFACIAL INJURIES
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Control of infection
antibiotics
Surgical planning
GK / MAXFAC
SDM DHARWAD

23. MAXILLOFACIAL INJURIES
Classification of fractures
1)Relation to overlying soft tissues
Closed / Simple
Open / Compound
Complicated
2)Type of fracture
Green stick
Single
Multiple
Comminuted
( oblique / transverse / sagittal & degree of dislocation) GK / MAXFAC
SDM DHARWAD

24. MAXILLOFACIAL INJURIES
Classification of fractures
Additional features
•Pathologic
•Atrophic
•Impacted
•Direct / indirect (contra-coup)
•Blow out / in
GK / MAXFAC
SDM DHARWAD
3) Anatomical Location

25. MAXILLOFACIAL INJURIES
MANAGEMENT
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Control of infection
antibiotics
Surgical planning
GK / MAXFAC
SDM DHARWAD

26. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management
-immediate
-definitive
•Complications
GK / MAXFAC
SDM DHARWAD

27. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Applied surgical anatomy
Curved bone
Thickness of cortices
Neurovascular bundle
Dentition
Attachment of Muscles
GK / MAXFAC
SDM DHARWAD

28. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Applied surgical anatomy
Muscle attachments:
Depressors
digastric
geniohyoid
Elevators
temporalis
masseter
medial pterygoid
GK / MAXFAC
SDM DHARWAD

29. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Applied surgical anatomy
Areas of weakness
•teeth
•foramen
•alveolar bone
•angle
•ramus
•Condyle
Blood supply
Nerve supply
GK / MAXFAC
SDM DHARWAD

30. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management
-immediate
-definitive
•Complications
GK / MAXFAC
SDM DHARWAD

31. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
-Anatomical location
-Relation to site of injury
-Condition of fracture fragments
-Type of displacement (angle)
-# with reference to dentition
GK / MAXFAC
SDM DHARWAD

32. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Anatomical site
•symphysis
•parasymphysis
•body
•angle
•ramus
•condyle
•coronoid
GK / MAXFAC
SDM DHARWAD

33. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
-Anatomical location
-Relation to site of injury
-Condition of fracture fragments
-Type of displacement (angle)
-# with reference to dentition
GK / MAXFAC
SDM DHARWAD

34. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Relation to site of injury
-Direct
-Indirect
GK / MAXFAC
SDM DHARWAD

35. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
-Anatomical location
-Relation to site of injury
-Condition of fracture fragments
-Type of displacement (angle)
-# with reference to dentition
GK / MAXFAC
SDM DHARWAD

36. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Condition of fractured fragments
Green Stick
Simple
Compound
Comminuted
GK / MAXFAC
SDM DHARWAD

37. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
-Anatomical location
-Relation to site of injury
-Condition of fracture fragments
-Type of displacement (angle)
-# with reference to dentition
GK / MAXFAC
SDM DHARWAD

38. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification: type of displacement
Angle of mandible
Extraoral:Gonion
Intraoral: Junction of alveolar
bone and ramus
Fracture of angle mandible
Greater fragment :teeth bearing segment
Lesser fragment: ramus
GK / MAXFAC
SDM DHARWAD

39. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Type of displacement (angle)
favorable / unfavorable
horizontal -vertical
GK / MAXFAC
SDM DHARWAD

40. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classificaton
Fracture angle of mandible
Displacement of Ramus
(post edentulous fragment)
Favorable: Minimal displacement
Unfavorable: Gross displacement
Viewed from side: Horizontal
Viewed from above: Vertical
GK / MAXFAC
SDM DHARWAD

41. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
-Anatomical location
-Relation to site of injury
-Condition of fracture fragments
-Type of displacement (angle)
-# with reference to dentition
GK / MAXFAC
SDM DHARWAD

42. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
# with reference to dentition
Dentulous
Child
Adult
Edentulous
Dentulous jaw with a posterior
edentulous fragment
GK / MAXFAC
SDM DHARWAD

45. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Kazanzian & Converse
Class I Teeth on both segments
Class II teeth on one segment
Class III Edentulous
Rowe & Killey
#s involving the basal bone
#s not involving the basal bone
favorable / unfavorable
GK / MAXFAC
SDM DHARWAD

46. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Applied surgical anatomy
Classification
Clinical features
Radiological features
Management
immediate
definitive
Complications
GK / MAXFAC
SDM DHARWAD

47. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Clinical Features
Inspection
Hemorrhage
Pain
Swelling
Altered occlusion
Sublingual echymosis
Halitosis
Paraesthesia
GK / MAXFAC
SDM DHARWAD

48. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Clinical Features
Palpation
Confirm inspectory findings
Tenderness
Fracture line/step
Crepitation
Paraesthesia
Abnormal mobility
GK / MAXFAC
SDM DHARWAD

49. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Applied surgical anatomy
Classification
Clinical features
Radiological features
Management
immediate
definitive
Complications
GK / MAXFAC
SDM DHARWAD

50. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Radiographic features
OPG / Lateral oblique
P A mandible
Intra oral occlusal view
Confirms
Site and severity of #
Direction & displacement of #
Condition of teeth in line of #
Presence of bony pathology
GK / MAXFAC
SDM DHARWAD

51. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Applied surgical anatomy
Classification
Clinical features
Radiological features
Management
immediate
definitive
Complications
GK / MAXFAC
SDM DHARWAD

52. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Objectives
RESTORE FORM & FUNCTION
Remember A B C D E
Precise diagnosis
Early reduction
Adequate fixation and immobilization
Rehabilitation / restoration of function
GK / MAXFAC
SDM DHARWAD

53. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Immediate (Primary)
ABCDE
Temp immobilization
Analgesics
Antibiotics
Diet & OHI
GK / MAXFAC
SDM DHARWAD

54. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Definitive
Reduction
Fixation
Immobilization
Rehabilitation
GK / MAXFAC
SDM DHARWAD

55. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
REDUCTION Closed
Advantages
No need for a G.A
Can be used in comminuted #
Continuity defects
( gun shot injuries)
Disadvantages
Accuracy of reduction ambiguous
Poor fracture alignment
Inadequate reduction
GK / MAXFAC
SDM DHARWAD

56. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
CLOSED REDUCTION
AIM : Immobilization (IMF)
•Direct wiring
GK / MAXFAC
SDM DHARWAD
•Ivy eyelet wiring

57. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
CLOSED REDUCTION
AIM : Immobilization (IMF)
•Arch Bar Wiring
•Extra oral pin fixation
GK / MAXFAC
SDM DHARWAD

58. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
REDUCTION Open
Exposure of fracture skin / mucosa
Direct reduction and fixation
Transoseous Wiring
Plate & Screw Osteosynthesis
GK / MAXFAC
SDM DHARWAD

59. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Open REDUCTION
Plate & Screw Osteosynthesis
(Titanium/Stainless steel)
Compression plates
Mini plates
Lag Screw
GK / MAXFAC
SDM DHARWAD

60. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
REDUCTION Open
Advantages
Accurate reduction &
fixation
Alignment under direct
visualization
Disadvantages
Need for a G.A & Hospitalization
Expenses !!!
GK / MAXFAC
SDM DHARWAD

61. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Open REDUCTION
Miniplate Osteosynthesis (Champy)
Small malleable plate( 2 -2.5 mm thickness)
Trans oral approach
No post op IMF
GK / MAXFAC
SDM DHARWAD

62. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
OPEN REDUCTION MiniplateOsteosynthesis
Symphysis/Parasymphysis/body/angle
Eyelets / Arch bars Temp IMF
Intraoral Approach
Exposure of fracture site(s)
GK / MAXFAC
SDM DHARWAD
Curettage (haematoma)
Reduction of Fracture
Temporary Immobilization
(IMF)

63. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
OPEN REDUCTION MiniplateOsteosynthesis
Clinical applications
Mini plate application & fixation
Debridement & removal of IMF
Recheck occlusion & Closure
GK / MAXFAC
SDM DHARWAD

64. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management
-immediate
-definitive
•Complications
GK / MAXFAC
SDM DHARWAD

65. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Edentulous mandibles
Mostly simple #s
Usually heals with out complications
Displacement of # fragments variable
Classification(Luhr et al)
according to height of bone
Class 1 : 16 -20mm
Class2 : 11-15mm
Class3 : less than 10mm
GK / MAXFAC
SDM DHARWAD

66. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Edentulous mandiblesTreatment Methods
Closed Reduction & Fixation
Intra oral appliances: gunning splints
dentures trimmed & relined
(stabilized with Circumferential wiring)
Extraoral pin fixation
Immobilization period 4-6 weeks
GK / MAXFAC
SDM DHARWAD

67. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management
Edentulous mandiblesTreatment Methods
Open reduction & fixation
Intraosseous wiring
Primary rib grafting
Reconstruction plate
In bilateral body #s ( bucket handle # )
Precautions
Avoid excessive periosteal stripping
GK / MAXFAC
SDM DHARWAD

68. Thank You