BILETERAL PARASYMPHYSEAL & ANGLE FRACTURE

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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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TYPRS OF FRCTURE

1.Simple fracture : Fracture does not communicate to exterior . 2.Compound fracture Fracture communicate to exterior. 3.Communited fracture Two or more fracture line that communicated with each another. 4. GreenstickOne cortex is broken and other cortex being   bend. 5. Pathological Fracture due to preexisting bone disease. 6. Impacted One fragment is firmly driven into other                       ACCORDING TO SITE 1. Symphyseal Midline fracture between central incisor 2. Parasymphyseal fracture Within the area of canines 3. Body Between canine and angle of mandible 4. Angle In the angle of mandible 5. Ramus Between ramus and sigmoid notch 6. Condular fractureIn the condylar process 7. Cononoid fracture In the coronoid process 8. Alveolar fracture The region that would normally contain teeth

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ETIOLOGY OF FRACTURE

ž   Road traffic accident ž    Fall from height ž    Occupational hazards – Athletic injury,       industrial mishaps ž    Physical assaults - Fist fight, blow due     to stick etc ž   Iatrogenic .       [OVER CROWDING         TRAFFIC INDISCIPLINERTA         MAXILLOFACIAL TRAUMA.] ž   Maxillofacial Trauma represented about 20% of all trauma ž   60% of patients with severe facial trauma have multisystem trauma and the potential for airway compromise. ž   20-50% concurrent brain injury. ž   1-4% cervical spine injuries. ž   Blindness occurs in 0.5-3% .

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MAXILLOFACIAL TRAUMA

trauma reconstruction  Reconstruction of  maxillofacial trauma is important to maintain         function and aesthetic. Soft tissue reconstruction of maxillofacial trauma is carried our by local closure and advancement flap. Hard tissue  reconstruction is performed by  miniplate osteosynthesis .                        PATHOPHYSILOGY OFFRACTURE ž   Maxillofacial fractures result from either blunt or penetrating trauma. ž   Penetrating injuries are more common in city hospitals.   ž   .  Midfacial and zygomatic injuries. ž   Blunt injuries are more frequently seen in community hospitals. Nose and mandibular injuries.

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Retention

RETENTION •         The essential element of retention is two opposing vertical surfaces of the same preparation. •         These may be external surfaces such as the buccal and lingual walls of a full veneer crown (sleeve retention). •         The opposing surfaces can also be internal, such as the buccal and lingual walls of the proximal box of a inlay. •         An intracoronal restoration resists displacement by wedge retention. •         Many restorations are a combination of the two types.

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RETENTION AND RESISTANCE

RETENTION AND RESISTANCE •         Retention prevents removal of the restoration along the path of insertion or long axis of the tooth preparation. •         Resistance prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces.                             •          Retention and resistance are interrelated and often inseparable qualities.

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