MAXILLARY FRACTURES LEFORT

   Clinical findings

      Facial edema

       Malocclusion of the teeth 
       Motion of the maxilla while the nasal bridge remains stable

        

        Radiographic findings:

       Fracture line which involves

        Nasal aperture

        Inferior maxilla

        Lateral wall of maxilla

        CT of the face and head

        coronal cuts

        3-D reconstruction

ž    Definition: 

       Pyramidal fracture 

    Maxilla

    Nasal bones

    Medial aspect of the orbits

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MAXILLARY FRACTURES

ž     High energy injuries.

ž     Impact 100 times the force of gravity is required .

ž     Patients often have significant multisystem trauma.

ž     Classified as LeFort fractures

 

 MAXILLARY FRACTURES LEFORT

    Definition:  

   Horizontal fracture of the maxilla at the level of the nasal fossa. 

   Allows motion of the maxilla while the nasal bridge remains stable.

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CONDYLAR FRACTURE

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BILETERAL PARASYMPHYSEAL & ANGLE FRACTURE

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Mandible Fractures Pathophysiology

ž   Mandibular fractures are the third most common facial fracture. ž   Assaults and falls on the chin account for most of the injuries. ž   Multiple fractures are seen in greater then 50%. ž   Associated  C-spine injuries – 0.2-6%.

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Mandible Fractures Clinical Findings

         Mandible Fractures Clinical Findings   

ž   Positive tongue blade test. ž   Mandibular pain. ž   Malocclusion of the tooth ž   Separation of teeth with intraoral bleeding ž   Inability to fully open mouth. ž   Preauricular pain with biting.

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Miniplate Osteosynthesis

Type Of Fracture

Type Of Fracture       1. Mandibular fracture - Body , angle, symphysis and            parasymphysis , condylar fracture       2. Maxillary fracture- Le Fort I, II, III fracture       3. Zygomatic fracture       4. Nasal bone fracture       5. Naso – Ethmoidal

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Physical Examination

ž   Inspection of the face for asymmetry. ž   Inspect open wounds for foreign bodies. ž   Palpate the entire face. ¡      Supraorbital and Infraorbital rim ¡      Zygomatic-frontal suture ¡      Zygomatic arches                  Physical Examination ž   Inspect the nose for asymmetry, telecanthus, widening of the nasal bridge. ž   Inspect nasal septum for septal hematoma, CSF or blood. ž   Palpate nose for crepitus, deformity and subcutaneous air. ž   Palpate the zygoma along its arch and its articulations with the maxilla, frontal and temporal bone. ž   Check visual acuity. ž   Check pupils for roundness and reactivity. ž   Examine the eyelids for lacerations. ž   Test extra ocular muscles. ž   Palpate around the entire orbits..      Definitive Treatment ž   Reduction ž   Fixation ž   Immobolization

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Energency Management Airway Control

ž   Control airway: ž   Chin lift. ž   Jaw thrust. ž   Oropharyngeal suctioning. ž   Manually move the tongue forward. ž   Maintain cervical immobilization Energency Management Hemorrhage Control ž   Maxillofacial bleeding: ¡      Direct pressure. ¡      Avoid blind clamping in wounds. ž   Nasal bleeding: ¡      Direct pressure. ¡      Anterior and posterior packing. ž   Pharyngeal bleeding: ¡      Packing  of the pharynx around ET tube.                History ž   Specific Questions: ¡      Is there pain with eye movement? ¡      Are there areas of numbness or tingling on your face? ¡      Is the patient able to bite down without any pain? ¡      Is there pain with moving the jaw?

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According To Direction

Direction of fracture line and effect of muscle action    1. Favorable        Muscle pull in the same direction          minimizing displacement    2. Unfavorable       Muscle pull in different  same direction           displace proximal fragment.       (  Management Protocol ž   Primary Resuscitation ž    Definitive Treatment  )                      (   Primary Resuscitation A.  Airway maintenance with cervical spine control B.   Breathing and adequate ventilation C.   Circulation with control of hemorrhage D.  Discerning neurological status of patient E.   Exposure of patient to facilitate a complete physical examination)

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