facial bone fractures injuries and its managements.pptx

Facial injuries, or maxillofacial trauma, encompass a range of damage to the face's soft tissues and bones, including lacerations, bruises, fractures of the jaw and eye socket, and cuts. These injuries are commonly caused by accidents like car crashes and falls, as well as assault and sports. Symptoms vary by injury type but can include bleeding, swelling, pain, changes in facial structure, difficulty with breathing or speaking, and vision problems.

1. FACIAL BONE FRACTURES AND ITS MANAGEMENT

2. ANATOMY SKULL CONSISTS OF 28 BONES 1) CALVARIA 14 BONES -PAIRED : PARIETAL TEMPORAL MALLEUS,INCUS,STAPES -UNPAIRED : FRONTAL, OCCIPITAL,SPHENOID,ETHMOID 2) FACIAL SKELETON 14 BONES -PAIRED : MAXILLA, ZYGOMATIC,NASAL, LACRIMAL,PALATINE, INF.NASAL CONCHA -UNPAIRED : MANDIBLE , VOMER.

3. ANATOMY

4. CLINICAL ASSESSMENT HISTORY- Mechanism of injury Past medical history Post injury events Vaccination status Primary survey Its aimed at Airway, Breathing, Circulation, Disability, Exposure assessment. C-spine should be examined All soft tissue wounds over face to be assessed along with any bony involvements.

5. Secondary survey Total head to toe examination Surface inspection, cranial nerves examination, eye examination. Palpation over bony prominence to rule out fractures. Palpation of supraorbital ridge> lateral orbital wall> inf.orbital rim>zygomatic bones>nasal bones> TMJ> mandible. Examination of oral cavity and to look for loss of tooth, soft tissue injury, hematoma, assessment of occlusion.

6. INVESTIGATIONS Routine haematological and biochemical investigations. Radiological imaging like Facial bones- waters view Skull-Caldwell view Sinuses-lateral view Orthopantomogram – mandible and dental problems Occipitomental view –midface fractures CT face with 3d reconstruction- gold standard

7. CLASSIFICATION OF FACIAL INJURIES BONY INJURY- Maxillofacial bone fractures can be divided into Simple fracture (isolated single) Compound( communicates through skin/mucosa) Comminuted (multiple fragments) Complicated (NVB involvement) Greenstick Pathological

8. Facial skeleton divided into 3 zones Upper face- from the level of canthi upwards. Midface-from maxillary teeth to canthi Lower face- mandible and mandibular teeth Mid face is further divided into medial (orbital-ethmoidal complex)and lateral (zygomaticomaxillary complex). Orbital fractures can be classified into fracture of floor, medial, lateral wall, roof of the orbit fractures. Craniofacial fractures- fracture involving frontal and ethmoid sinuses. Pan facial fracture-bony injury at all levels of face. Most common facial bone to get fracture- nasal bone > zygomatic bone.

9. CLASSIFICATION OF FACIAL INJURIES Soft tissue injuries Lacerations due to crushing injury over the bone. Incised wounds due to sharp objects Through and through injury- if there is communication between skin and mucosa.

10. SOFT TISSUE INJURIES Laceration- Blunt or sharp trauma induced wound should be assessed for nerve/ parotid duct/ underlying bony injuries. Thorough wash of wounds and closure to be done within 24 hours. Lacerations involving eye lids and vermilion border of lips need special attention for closure- for better cosmetic outcome. Primary closure can be done using non resorbable monofilament sutures. Facial nerve- Through facial nerve examination to be done. Usually nerve injuries lying lateral to the line drawn vertically down from the lateral canthus are repairable. Under high magnification and GA, nerve stimulator repair can be done.

11. Parotid duct- Surface marking- line drawn from tragus to mid point of alar base and upper lip. In duct injury we can notice saliva leak. Methylene blue can be used to confirm the duct injury. Repair is done under high magnification and over a cannula inserted through the duct opening under GA. Careful examination is required for buccal branch of facial nerve in duct injury as it runs closely to the duct. Animal bites- Through clean of wound and closed primarily in layers d/t high risk of infection. Human bites to consider testing for serology. Prophylactic antibiotic to be given.

12. BONY INJURIES MANDIBLE FRACTURES- Mandible fractures are quite common, and may involve multiple sites. The commonest pattern –Para symphysis and angle fractures or condylar #. Prone area of # - neck of condyle > angle of mandible > region of mental foramen. Parasthesia in the lower lip and chin – damage to inferior alveolar nerve. Management of mandibular fractures are by ORIF , -titanium mini plates and screws are used. Conservative management for 4 weeks , increasing pain and change in occlusion generally needs ORIF. For comminuted fractures intermaxillary fixation with wires are considered.

13. Monocortical , 2mm screws are used for plate fixation. Load sharing plates. Miniplates are used based on the site of fracture , example- single plate is used for fracture involving angle and body of mandible. two plates with 5mm distance is used for parasymphyseal fractures. Approach –Trans buccal approach (cheek skin) for angle fractures Condylar fractures- undisplaced - intermaxillary fixation elastic guidance, strict soft diet and analgesic regimen. Displaced –ORIF(common approach is transparotid access with retromandibular incision) Optimal timing of surgery for mandibular fracture is 24-48 hrs after injury.

14. ZYGOMATIC FRACTURES- Cheek/ malar bone fractures are due to blunt trauma to midface.(fist trauma) Zygomatic bone appears like a table with 4 legs Zygomatic arch ( anterioposteriorly ) Frontozygomatic process (vertically) Infraorbital rim (horizontally) Maxillary buttress (vertically) Facial swelling post trauma hinders the proper examination of zygomatic bones hence reviewed after one week. Associated with periorbital swelling, bruising, step deformity, subconjunctival hemorrhage .

15. Undisplaced / minimally displaced # treated conservatively. Analgesics, antibiotics,avoiding excessive pressure on affected side for 3 weeks. Asymmetric cheek bone prominence, persistent eye symptoms,orbital deformity, restricted mouth opening. Approach-transcutaneous (upper/lower eye lid),intraoral approach depending upon fracture location.

16. MAXILLARY BONE FRACTURE- These fractures are classified according to their anatomical levels Rene Le Forte described these fractures, Le Forte I- fracture line extends from pterygoid plates through lateral wall of maxillary sinus and piriform aperture of nose. Le Forte II –fracture line extends from pterygoid plates to the inferior orbital rim and across the bridge of the nose. Le Forte III- fracture line runs from pterygoid plates to base of zygomatic arch, lateral walls of orbit and nasal bridge.

17. Undisplaced /minimally discplaced #- conservatively treated. ORIF is done for mobile, unstable maxilla, deranged occlusion, loss of facial projection and width resulting in facial deformity. Plates are fixed mainly on facial buttress. Maxillary fractures are associated with significant bleeding (from pterygoid plexus).