LR - TRAUMA OF MAXILLARY SINUSSSSSS.pptx

trauma

1. Trauma Of Maxillary Presentant: Guntur Benedict Supervisor: dr. Ifiq Budiyan Nazar , Sp.T.H.T.B.K.L . Department of Otorhinolaryngology - Head & Neck Surgery Faculty of Medicine Padjadjaran University – RSHS Bandung 202 5 Literature Reading

2. INTRODUCTION 2 Trauma is a disruption of the continuity of any bodily tissue due to an external action The face occupies the most prominent position in the human body  vulnerable to injuries Maxillofacial injuries are one of the most common injuries associated with other injuries Yamsani Bhasker, et al. Zygomaticomaxillary Complex Fractures: A Review of 101 Cases. J. Maxillofac . Oral Surg. 2015; 15(4):417–424 Singaram Mohanavalli , et al. Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study. (J Korean Assoc Oral Maxillofac Surg . 2016;42:174–181

3. INTRODUCTION 3 Yamsani Bhasker, et al. Zygomaticomaxillary Complex Fractures: A Review of 101 Cases. J. Maxillofac . Oral Surg. 2015; 15(4):417–424 Singaram Mohanavalli , et al. Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study. (J Korean Assoc Oral Maxillofac Surg . 2016;42:174–181 Nasal: 12.66% Zygomatic: 27.64% Maxilla: 29.85% Maxilla fractures as the most common subtype among midfacial fractures in both children and adults

4. ANATOMY OF MAXILLARY 4 Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13.

5. ANATOMY OF MAXILLARY 5 Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13. Sagittal View

6. ANATOMY OF MAXILLARY SINUS 6 Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13. The largest paranasal sinuses Limit: A pex : extends to the zygomatic bone B ase : forms the inferior portion of the lateral wall of the nasal cavity R oof : formed by floor of orbit F loors : formed by the alveolar portion of the maxilla Drainage to middle nasal meatus

7. 7 MAXILLARY ARTERY Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13. Glick, Y., Bell, D. Maxilla. Reference article, Radiopaedia.org. (accessed on 24 Nov 2021) https://doi.org/10.53347/rID-52768

8. 8 MAXILLARY ARTERY Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13. Glick, Y., Bell, D. Maxilla. Reference article, Radiopaedia.org. (accessed on 24 Nov 2021) https://doi.org/10.53347/rID-52768

9. 9 Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13. Glick, Y., Bell, D. Maxilla. Reference article, Radiopaedia.org. (accessed on 24 Nov 2021) https://doi.org/10.53347/rID-52768 MAXILLARY VEIN

10. 10 Hansen JT. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences; 2017 Dec 13. Glick, Y., Bell, D. Maxilla. Reference article, Radiopaedia.org. (accessed on 24 Nov 2021) https://doi.org/10.53347/rID-52768 System of Facial Buttresses Vertical Buttress

11. 11 Horizontal Buttress Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. System of Facial Buttresses Bailey, Byron J .; Johnson, Jonas T .; Newlands , Shawn D. 2014 . Title: Midfacial Fracture : Head & Neck Surgery - Otolaryngology, 5th Edition Copyright Lippincott Williams & Wilkins

12. Etiology and Mechanism 12 - The etiology of maxillary fractures varies depending on the socio-economic status of countries, sports cultures, motor vehicle regulations, and other laws . - During impact is the transmission of physiological force distributed along the facial buttresses, and these are more likely to give during a fracture Meldrum J, Yousefi Y, Jenzer AC. Maxillary Fracture. [Updated 2021 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

13. CLASSIFICATION OF MAXILLARY FRACTURES 13 Roselló EG, Granado AM, Garcia MA, Martí SJ, Sala GL, Mármol BB, Gutiérrez SP. Facial fractures: classification and highlights for a useful report. Insights into imaging. 2020 Dec;11(1):1-5. Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore Rene Le Fort Classification Killey’s Classification  Rowe and Williams’s Classification Marciani (1993: Modification of Le Fort Fractures) Hendrickson’s classification: of Palate fractures

14. 14 Rene Le Fort Classification : Le Fort III F ractures, which result in complete separation of facial skeleton from the skull base Le Fort II P yramidal NM fragment separate from the upper craniofacial skeleton . Le Fort I T ransverse fractures separating the maxilluy alveolus from the rest of the midfadal skeleton Bailey, Byron J .; Johnson, Jonas T .; Newlands , Shawn D. 2014 . Title: Midfacial Fracture : Head & Neck Surgery - Otolaryngology, 5th Edition Copyright Lippincott Williams & Wilkins

15. 15 Rene Le Fort Fracture Pattern : Roselló EG, Granado AM, Garcia MA, Martí SJ, Sala GL, Mármol BB, Gutiérrez SP. Facial fractures: classification and highlights for a useful report. Insights into imaging. 2020 Dec;11(1):1-5.

16. 16 Classification Killey’s Classification :   Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore.

17. 17 Classification Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Rowe and Williams’s Classification :

18. 18 Classification Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Marciani (1993: Modification of Le Fort Fractures)

19. 19 Classification Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Hendrickson’s classification: of Palate fractures

20. 20 Classification Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Hendrickson’s classification: of Palate fractures

21. 21 Clinical Features Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Le Fort Fractures :

22. 22 Clinical Features Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Le Fort Fractures :

23. 23 Radiographic Examination Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. McGregor-Campbell’s lines These lines were described by McGregor and Campbell for ease of searching on an occipitomental view 10-degree frontal projection. First line across the zygomaticofrontal, the superior margin of the orbit and the frontal sinus Second line across the zygomatic arch, zygomatic body, inferior orbital margin and nasal bone  Third line across the condyles, coronoid process and the maxillary sinus / Zygomatic buttress region  Fourth line across the mandibular ramus, occlusal plane  Fifth line ( Trapnell’s line, added later) across the inferior border of the mandible from angle to angle DIAGNOSIS

24. 24 Radiographic Examination Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. McGregor-Campbell’s lines

25. 25 Radiographic Examination Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Dolan’s lines   Dolan’s lines  are the collective name given to three lines described by Dolan and Jacoby that aid in evaluating for  maxillofacial fractures  on an  occipitomental skull radiograph . They are usually used as an adjunct to McGregor-Campbell lines . Orbital line (line 1)   Zygomatic line (line 2)   Maxillary line   (line 3)

26. 26 Radiographic Examination Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Dolan’s lines  

27. Management of Trauma Basic principles of management of trauma A  airway and cervical spine B  breathing C  circulation and bleeding control D  disability & neurologic status E  exposure & overall evaluation for other injuries For assessing disability  is the AVPU system A = alert V = responds to voice P = responds to pain U = unresponsive All patients should be considered to have a cervical spine injury until proved otherwise. Bailey, Byron J .; Johnson, Jonas T .; Newlands , Shawn D. 2014 . Title: Midfacial Fracture : Head & Neck Surgery - Otolaryngology, 5th Edition Copyright Lippincott Williams & Wilkins 27

28. Basic Principle Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore 28

29. Factor that Influence Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore 29

30. APPROACH TO MAXILLARY Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore 30

31. 31 Treatment Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Suspension Wiring

32. 32 Treatment Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Rigid Internal Fixation Demonstrates fixation of panfacial fractures at Le Fort I, II and III levels in addition to a comminuted fracture of the mandibular symphysis.

33. 33 Fixation of Le Fort I Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. A clinical situation where the defect in the anterior wall maxilla due to comminution of the wall was partly covered by fixing the free segment (red arrow). The long-span plate from the buttress to the anterior maxilla region can also be seen.

34. 34 Fixation of Le Fort I Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Approach to Maxillary Mobilization for Reduction dan Fixation. We can use Rowe disimpaction forceps or bone hooks Placing MMF Rigid Internal Fixation

35. 35 Fixation of Le Fort II Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. Le Fort II fracture lines at the infraorbital rim area may have to be accessed directly, if required, especially with associated zygomatic/orbit fractures. In this case the lateral orbital rim reconstruction is done via combined access from left sub ciliary incision and left supra tarsal incision

36. 36 Fixation of Le Fort III Open reduction internal fixation for Le Fort III . (n.d.). https:// surgeryreference.aofoundation.org / cmf /trauma/midface/le-fort-iii/ open-reduction-internal-fixation#fixation

37. Complication 37 Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore.

38. Complication 38 Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore.

39. CONCLUSION 39 Maxillary fracture is one of the most common emergencies that presents in an acute condition The commonly used classification is Le Fort with specific management based on that classification Visual problems, diplopia, and epiphora are the most common associated problems Jacob O.A., Prathap A. (2021) Maxillary Fractures. In: Bonanthaya K., Panneerselvam E., Manuel S., Kumar V.V., Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore.

40. Thank You