Facial Trauma

Question 1

define fracture and displacement

Answer 1

a break in the continuity of bone

the extent to which the two sides of the fracture have moved from their original position

Question 2

define compound fracture

Answer 2

a fracture which is open to external environment through a tear/laceration

Question 3

define comminuted fracture.

Answer 3

a complex fracture with more than 2 bone fragments at the site

Question 4

define pathological fracture

Answer 4

a fracture occurring in bone that has been critically weakened by disease

Question 5

define trismus

Answer 5

the inability to open the mouth fully

Question 6

why can losing teeth lead to mandibular fracture prone sites?

Answer 6

mandiblular ridge resorption occurs when you lose teeth

= thin mandible
= bone is susceptible to fracture

Question 7

what is easier to access - a closed or compound fracture?

Answer 7

compound fracture

closed - harder to access from the mouth

Question 8

where does the zygomatic usually fracture? (tripod fracture)

Answer 8

orbital floor
- impacts the vision
- cause cheek flattening, lose volume

zygomatic arch

maxillary arch

Question 9

how do you describe mid face fractures?

Answer 9

Le Fort I - above apices of upper teeth

Le Fort II - maxilla and nose

Le Fort III - maxilla, zygomas and orbital floor

Question 10

describe the structure of the mandible.

Answer 10

condyle
ramus
angle
body
symphis
parasymphis

Question 11

which fractures affect the occlusion?

Answer 11

mandible and le fort fractures

Question 12

describe this picture.

Answer 12

black eye
subconjunctival haematoma (bloodshot)

Question 13

what does a subconjunctival haematoma mean when it has posterior limit and without?

Answer 13

posterior limit
- blood is confined and has a clear posterior boundary
- small trauma

without a posterior limit
- no posterior boundary and can go towards the orbit
- usually significant trauma

Question 14

what is surgical emphysema?

Answer 14

air is trapped within the subcutaneous space under the skin

Question 15

how would you assess the eye?

Answer 15

check for any zygomatic swellings or flattenings
check for double vision
check eye movements

Question 16

how would you assess the skin?

Answer 16

check the trigeminal nerve
check for asymmetries

Question 17

how would you assess IO?

Answer 17

count and chart the teeth
check the gingiva
check the occlusion

Question 18

when taking radiographs why you would take 2 at different angles?

Answer 18

• you may miss a fracture
• accurately assess the displacement

Question 19

if you dont have a CT scanner and want to see the condyle, how is this done?

Answer 19

Towne’s View

• tilt the head forward for x-ray imaging

Question 20

what are the 4 stages of fracture healing?

Answer 20

1. inflammatory
2. proliferative - fibroblasts and macrophages remove dead cells
3. bone callus
4. remodelling

Question 21

what is required for bone to heal?

Answer 21

• reduce the fracture - try replace back to OG position
• restore the length of bone
• restore the angulation

Question 22

4 types of fracture management in oral surgery

Answer 22

1. conservative
   - doing nothing and allowing itself to heal
2. MUA (manipulation under anaesthesia)
   - moving the bone into OG position
3. intermaxillary fixation
   - wire the teeth together
4. plating
   - metal plate and screws

Question 23

you can allow bone to heal via splinting, what is this, what are the benefits and requirements?

Answer 23

splinting - putting a cast or plate on the bone
- avoid surgery

• stabilisation - for 6 weeks - a cast or plate
• needs to be held it in the correct position
• prevent excessive movement
• allows physiological stress and remodelling

Question 24

what are the priorities in treating facial fractures?

Answer 24

• restore the function (occlusion and eyesight)
• restore appearance as much as possible

Question 25

4 principles of fracture management.

Answer 25

speed - how fast can the patient recover safety - is the technique safe to recover stability - how well will the fracture heal in the correct position mobility - need to be able to move the joints

Question 26

why can atrophic mandibles be hard to manage when they fracture?

Answer 26

no place to put the plate lack of stability

Question 27

how can you help stabilise a fracture if the patient is edentulous?

Answer 27

use a gunning splint

Question 28

what is a gunning splint?

Answer 28

2 dentures with a hole in the middle to eat/drink the dentures are wired closed aims to stabilise the jaw and hold the patient in occlusion

Question 29

what is external fixation?

Answer 29

holds the fracture in place on the mandible

Question 30

what is a retrobulbar haematoma?

Answer 30

collection of blood behind the eyeball = an opthalmic emergency - increases orbital pressure and affect vision can arise from zygomatic fracture

Question 31

why is limited mouth opening bad for a patient?

Answer 31

diet - will have reduced nutrition

Question 32

what are the complications of facial fractures?

Answer 32

- cosmetic - eyesight - nerve damage - scarring - infection

Question 33

what is fracture union? what problems can you have?

Answer 33

broken bone heals and regains structural continuity can have: - malunion - bone heals not in the right length or angulation - delayed union - hasn't healed after 6 weeks - non-union