p.16
Complications in Mandibular Fracture Treatment
How does surgical technique affect complications in mandibular fractures?
The method of fixation can contribute to the development of complications.
p.2
Hemorrhage Control in Facial Trauma
What is the first step in treating uncontrollable bleeding in facial trauma?
Reduction of fractures or facial compression dressing.
p.2
Hemorrhage Control in Facial Trauma
What are some methods to control uncontrollable bleeding?
Nasal packing, embolization, external carotid ligation.
p.14
Hemorrhage Control in Facial Trauma
What is the primary goal in treating fractures of the maxilla or mandible?
To reestablish the patient's preinjury dental occlusion.
p.12
Classification of Facial Fractures
Which regions are most commonly fractured in the mandible?
Parasymphysis, angle, body, and subcondylar regions.
p.11
Imaging Techniques for Facial Trauma
What views are used for the upper third of the face in plain film evaluation?
Modified Caldwell view and lateral projection.
p.12
Classification of Facial Fractures
Why might figures of regional fracture percentages be misleading?
Because most mandible fractures are multifocal.
p.12
Classification of Facial Fractures
Which types of mandibular fractures may be the most common?
Fractures of the angle and body, with parasymphyseal fractures a close second.
p.16
Complications in Mandibular Fracture Treatment
What factors contribute to complications in craniomaxillofacial surgery?
Delayed treatment, fracture instability, and insufficient antibiotic treatment.
p.11
Imaging Techniques for Facial Trauma
How is a full plain film evaluation of the face divided?
Into upper, middle, and lower thirds.
p.10
Primary Survey in Trauma Protocol
What guidelines should be followed for initial assessment and management of panfacial fractures?
ATLS (Advanced Trauma Life Support) guidelines.
p.2
Aspiration Prevention in Maxillofacial Trauma
What materials can be aspirated in maxillofacial trauma?
Blood, gastric contents, teeth.
p.13
Classification of Facial Fractures
How are most ramus fractures characterized?
They are vertically favorable.
p.13
Classification of Facial Fractures
How are most angle fractures characterized?
They are vertically unfavorable and extend posterior-inferior.
p.16
Complications in Mandibular Fracture Treatment
Which type of plate placement is more advantageous?
Single-plate placement is more advantageous than multiple-plate fixation.
p.14
Airway Management in Facial Injuries
What is the 'first and last' principle for IMF in ORIF cases?
IMF is applied first to secure occlusion and released last to check occlusion.
p.10
Initial Evaluation of Facial Trauma
Why is swift transfer to a hospital necessary for panfacial fractures?
General practice is not equipped to deal with these types of injuries.
p.16
Complications in Mandibular Fracture Treatment
What are common complications of osteosynthesis in the craniomaxillofacial region?
Infection, delayed union, malocclusion, or injury to surrounding structures.
p.13
Classification of Facial Fractures
What causes most symphyseal and parasymphyseal fractures to be vertically unfavorable?
The downward pull of the suprahyoid muscles on the anterior mandible.
p.12
Classification of Facial Fractures
What factors determine the site of mandibular fractures?
The mechanism of injury, not age or inherent characteristics of the mandible.
p.14
Airway Management in Facial Injuries
What does Intermaxillary Fixation (IMF) provide for the jaws?
Stabilization by binding the upper and lower dental occlusal arches together.
p.13
Classification of Facial Fractures
What is the stability characteristic of high condylar fractures?
They tend to be horizontally unstable.
p.13
Classification of Facial Fractures
What muscle exerts a medial pull on the condylar head, affecting fracture stability?
Lateral pterygoid muscle.
p.6
Detailed Physical Examination for Maxillofacial Trauma
What are common symptoms reported by patients with mandibular fractures?
Malocclusion and pain over the fracture site.
p.6
Classification of Facial Fractures
What is the typical location of the second fracture in a mandibular fracture?
In the mandibular condyle or angle on the contralateral side.
p.2
Aspiration Prevention in Maxillofacial Trauma
How can aspiration be prevented in maxillofacial trauma?
By endotracheal intubation.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What systems should be evaluated during a facial trauma assessment?
Intraoral/dental, ocular, and neurologic systems.
p.5
Classification of Facial Fractures
What distinguishes nasoethmoidal (NOE) fractures from simple nasal fractures?
NOE fractures extend into the nose through the ethmoid articulations and often through the orbital floor.
p.5
Complications in Mandibular Fracture Treatment
What sensory issue may occur due to NOE fractures?
Hypesthesia in the distribution of the infraorbital nerve.
p.8
Classification of Facial Fractures
What are Le Fort fractures?
Fractures of the midface that involve separation from the skull base.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What should be checked for in the nose during examination?
Dislocation, telecanthus, tenderness, crepitus, septal hematoma, lacerations, and SF rhinorrhea.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What should be inspected in the tongue and mouth during the examination?
Inspect for any injuries or abnormalities.
p.8
Complications in Mandibular Fracture Treatment
What common symptoms occur with orbital wall fractures?
Subconjunctival and periorbital hematoma, and diplopia.
p.6
Complications in Mandibular Fracture Treatment
What should be considered in children with suspected condylar fractures?
A high index of suspicion, as these injuries are often missed.
p.6
Classification of Facial Fractures
What is the relationship between the orbit and zygomatic fractures?
The majority of zygomatic fractures involve the orbit.
p.8
Detailed Physical Examination for Maxillofacial Trauma
How is maxillary mobility tested in suspected midface fractures?
By stabilizing the head and applying pressure to the maxillary ridge.
p.7
Classification of Facial Fractures
What are the characteristics of isolated orbital fractures?
The medial and inferior walls of the orbital skeleton are very thin.
p.10
Complications in Mandibular Fracture Treatment
What serious injuries may occur with panfacial fractures?
Cervical spine injury, cerebral injury, and cerebrospinal fluid leak.
p.8
Complications in Mandibular Fracture Treatment
What can occur if the orbital floor is fractured?
Infraorbital paraesthesia or anesthesia.
p.10
Imaging Techniques for Facial Trauma
What is the advantage of using CT for diagnosing facial fractures?
It avoids superimposition of structures and can be reformatted for alternate planes.
p.6
Hemorrhage Control in Facial Trauma
When should mandibular fractures be referred?
Within 24 hours due to pain and discomfort.
p.10
Imaging Techniques for Facial Trauma
What does a standard head CT scan cover?
From the vertex of the skull to the mid to upper orbits.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What should be inspected during the examination?
Bruising, swelling, lacerations, missing tissue, foreign bodies, and bleeding.
p.5
Detailed Physical Examination for Maxillofacial Trauma
What can a nasal speculum help localize?
Hemorrhage or hematoma, especially adjacent to the nasal septum.
p.7
Initial Evaluation of Facial Trauma
What are the minimum components of an eye examination in facial trauma?
Visual acuity, pupillary light reflexes, and ocular movements.
p.6
Classification of Facial Fractures
What happens if the impact hits the middle of the mandible?
Additional indirect fractures of both condyles are common.
p.6
Detailed Physical Examination for Maxillofacial Trauma
Why must the mandibular condyles be carefully assessed?
When a patient presents with a blow laceration to the chin.
p.11
Imaging Techniques for Facial Trauma
When is vascular imaging recommended?
For penetrating injuries to Zones I and III of the head and neck, and for fractures of the carotid canal.
p.2
Detailed Physical Examination for Maxillofacial Trauma
What is the significance of obtaining a complete history from the patient?
It guides the examiner to specific injury patterns and helps suspect certain diagnoses before radiographs.
p.10
Imaging Techniques for Facial Trauma
What does a complete CT scan of the craniomaxillofacial region cover?
From the vertex of the skull to the symphysis of the mandible.
p.5
Hemorrhage Control in Facial Trauma
What are some conservative measures to control epistaxis?
Pinching the nasal ale against the septum, topical vasoconstrictors, and chemical cautery with silver nitrate.
p.7
Initial Evaluation of Facial Trauma
What should be done if there is an acute decrease in visual acuity?
Refer immediately to an ophthalmologist or maxillofacial surgeon.
p.10
Detailed Physical Examination for Maxillofacial Trauma
What vital symptoms should not be missed in maxillofacial injuries?
Injuries involving the eye and vision.
p.2
Detailed Physical Examination for Maxillofacial Trauma
What should be included in the patient's history during the secondary survey?
Allergies, medications, previous tetanus immunization, medical conditions, and prior surgeries.
p.2
Detailed Physical Examination for Maxillofacial Trauma
What is the sequence of the craniomaxillofacial physical examination?
Regional examination from cranial to caudal, including inspection and palpation.
p.6
Imaging Techniques for Facial Trauma
What areas can discontinuities in bone be detected radiographically in zygomatic fractures?
Infraorbital rim, frontozygomatic suture, zygomatic arch, zygomaticoalveolar buttress.
p.8
Complications in Mandibular Fracture Treatment
What might patients complain about if they have midface fractures?
Inability to find occlusion with the teeth and mobility of the top jaw.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What specific eye assessments should be performed?
Examine eye movements and assess pupils.
p.14
Hemorrhage Control in Facial Trauma
What should be considered after the final check of IMF?
The decision to re-secure IMF.
p.11
Imaging Techniques for Facial Trauma
What can poorly performed panoramic tomography lead to?
Blurring in the midline and difficulty in visualizing symphyseal and parasymphyseal fractures.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What signs suggest facial trauma?
Edema, ecchymosis, facial asymmetry, bruising lacerations, skeletal contour irregularities, crepitation, pain, and mobility.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What regions should be examined during a regional examination for facial trauma?
Cranium and cranial base, frontal region, orbits, nasal region, maxillary region, and ear region.
p.5
Classification of Facial Fractures
Where do alveolar fractures occur?
Just above the level of the teeth through the alveolar portion of the maxilla.
p.7
Detailed Physical Examination for Maxillofacial Trauma
What may cause impaired upward gaze and diplopia?
Oedema and hemorrhage of the periorbital tissues or rectus muscle entrapment.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What should be palpated during the examination?
Bony injury and crepitus, systematically.
p.5
Complications in Mandibular Fracture Treatment
What is a potential complication of an overlooked septal hematoma?
Cartilage necrosis and significant nasal deformity.
p.2
Secondary Craniomaxillofacial Survey
What is the purpose of the secondary craniomaxillofacial survey?
To identify specific regional injuries after primary survey issues have been addressed.
p.7
Detailed Physical Examination for Maxillofacial Trauma
What is a common finding in orbitozygomatic injuries?
Palpable step at the infraorbital margin or lateral brow area.
p.7
Detailed Physical Examination for Maxillofacial Trauma
What is infraorbital nerve paraesthesia?
A weakness in the facial skeleton affecting the ipsilateral cheek, nose, lip, upper incisor teeth, and gingival tissue.
p.7
Detailed Physical Examination for Maxillofacial Trauma
How is depression of the malar eminence assessed?
By comparing symmetry while standing behind the patient.
p.3
Detailed Physical Examination for Maxillofacial Trauma
Why is a systematic and thorough examination important in facial trauma?
To overcome assumptions and avoid missing unexpected but significant injuries.
p.6
Complications in Mandibular Fracture Treatment
What is always involved in cheekbone fractures?
The orbital floor, which usually compromises the infraorbital nerve.
p.3
Detailed Physical Examination for Maxillofacial Trauma
What should be assessed in the ears during the examination?
Look for lacerations and CSF in the canal, and assess the tympanic membrane.
p.5
Classification of Facial Fractures
Why are mandibular fractures particularly painful?
Because the mandible is a mobile bone.
p.8
Classification of Facial Fractures
Where do midface fractures typically run?
Along bilateral lines of weakness in the midfacial skeleton.
p.8
Detailed Physical Examination for Maxillofacial Trauma
What is the 'raccoon sign' associated with?
Bilateral hematoma due to midface fractures.
p.8
Detailed Physical Examination for Maxillofacial Trauma
What are the clinical signs of midface fractures?
Symmetrical facial swelling, bilateral periorbital ecchymosis, and flattening of the midface.
p.3
Detailed Physical Examination for Maxillofacial Trauma
How can facial asymmetry be assessed?
By standing at the head of the bed and looking down to check the level of the cheekbones.
p.7
Complications in Mandibular Fracture Treatment
What happens if a patient blows their nose after facial trauma?
They may experience an immediate increase in eyelid swelling due to air blown from the maxillary sinus into the orbit.
