4. mid face fracture ppt for ug students

Midface fracture

1. Fractures of the Midface

2. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Temporal Frontal
Maxilla Zygoma
Nasal Ethmoid
Sphenoid Vomer
Palatine Lacrimal
#s are multiple

3. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management

4. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Applied surgical anatomy
•Link cranial base to occlusal plane
•Protect base of skull
•Thin lamellar bone
•Blood supply

5. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Applied surgical anatomy
Protect base of skull
Vertical buttresses
(Sicher & Tandler 1928)

6. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management

7. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Classification
1886 Alphonse Guerin
1901 Rene Le Fort
Le-Fort I, II & III

8. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Le-FortI Fracture
(Guerin # / Low level # / Floating #)
Nasal floor
Pyriform rim
Zygomatic buttress
Pterygoid lamella
Lateral wall nose
Nasal septum tuberosity

9. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Le-FortII Fracture
( Pyramidal # / Subzygomatic # )
Nasal bone
Frontal bone
Orbit
Lacrimal bone
Infraorbital foramen
Maxillary antrum
ZM suture

10. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Le-Fort IIIFracture
( High transverse/Suprazygomatic/Craniofacial disarticulation)
Fronto-nasal suture
Ethmoid cribriform plate
Frontal process maxilla
Medial wall orbit
Optic foramen
Inferior orbital fissure
Pterygoid lamella
Lateral wall of orbit Z-F
suture

11. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management

12. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Clinical features
Swelling
Ecchymosis
Mobility
Deranged occlusion
Loss of function

13. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Le-Fort I: Clinical features
Swelling : minimal
Ecchymosis : intra oral, palate, sulcus
Mobility : floating #
Deranged occlusion: post gagging, V. D.
Loss of function
cracked pot sound
? mid palatal split

14. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Le-Fort II/ III: Clinical features
Swelling : gross; (moon face) eyelids conjunctiva
Ecchymosis: bilateral circum-orbital
(panda face/raccoon face)
Mobility: nasal bones, maxilla
Infra orbital step (Le Fort II)

15. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Le-Fort II/ III: Clinical features
Deranged occlusion: post gagging V. D
Dish face
Loss of function:
Diplopia? Anosmia
Nares filled with clotted blood
Emphysema, Epiphora,
CSF Rhinorrhea,Hooding of eye

16. Dural tear # cribriform plate Meningitis ??
Diagnosis
Clinical-Tram track, halo effect
Biochemical -Dipstick -glucose levels
Radiological
CT scan
Radio opaque dye
-sub arachnoid space
MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
CSF Rhinorrhea Le-Fort II / III #s

17. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Bilateral hooding of eyes
Le-Fort II / III #
Separation of F-Z suture
Suspensory ligament of Lockwood
Attachment
medially -lacrimal bone
laterally -below F-Z suture

18. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management

19. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
Radiographic examination
RADIOGRAPHS
PNS view
PA skull
CT SCANS
Axial & Coronal Views

20. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management

21. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
ABCDE
Reduction & fixation
Closed v/s Open
MIDFACE FRACTURES
Management

22. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort I fractures ORIF plates
Intra oral approach
Fixation of plates after
reduction
Pyriform rim
Zygomatic buttress
MIDFACE FRACTURES

23. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort II fractures ORIF plates
Nasal #s
Infra orbital rim
Zygomatic buttress
MIDFACE FRACTURES

24. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort III fractures ORIF plates
Fronto-zygomatic
Fronto-nasal
Zygomatic buttress
MIDFACE FRACTURES

25. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort I, II & III fractures CLOSED
Reduction & Fixation
Suspension wires to mandible
Frontal: Central & lateral
Circum zygomatic
MIDFACE FRACTURES

26. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort I, II & III fractures CLOSED
External fixation
Cranio-mandibular
Box, Halo frames
POP head cap
MIDFACE FRACTURES

27. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
MIDFACE FRACTURES
•Applied surgical anatomy
•Classification
•Clinical features
•Radiological features
•Management

28. Thank You