MAXILLOFACIAL INJURIES MIDFACE FRACTURES Temporal
Frontal
Maxilla
Zygoma
Nasal
Ethmoid
Sphenoid
Vomer
Palatine
Lacrimal
#s are multiple www.indiandenalacademy.com
INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiadentalacademy.com
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Applied surgical anatomy •Link cranial base to occlusal plane •Protect base of skull •Thin lamellar bone •Blood supply
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Applied surgical anatomy Protect base of skull Vertical buttresses (Sicher & Tandler 1928)
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Classification 1886 Alphonse Guerin 1901 Rene Le Fort Le-Fort I, II & III
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES
Le-Fort I Fracture (Guerin # / Low level # / Floating #)
Nasal floor Pyriform rim Zygomatic buttress Pterygoid lamella Lateral wall nose Nasal septum tuberosity
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II Fracture ( Pyramidal # / Subzygomatic # )
Nasal bone Frontal bone Orbit Lacrimal bone Infraorbital foramen Maxillary antrum ZM suture www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort III Fracture
( High transverse/Suprazygomatic/Craniofacial disarticulation)
Fronto-nasal suture Ethmoid cribriform plate Frontal process maxilla Medial wall orbit Optic foramen Inferior orbital fissure Pterygoid lamella Lateral wall of orbit Z-F suture www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Clinical features
Swelling Ecchymosis Mobility Deranged occlusion Loss of function www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I : Clinical features
Swelling Ecchymosis Mobility Deranged occlusion Loss of function cracked pot sound ? mid palatal split
: minimal : intra oral, palate, sulcus : floating # : post gagging, ďƒ› V. D.
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II / III : Clinical features Swelling
: gross; (moon face) eyelids conjunctiva
Ecchymosis : bilateral circum-orbital (panda face/raccoon face) Mobility
: nasal bones, maxilla Infra orbital step (Le Fort II)
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES
Le-Fort II / III : Clinical features Deranged occlusion: post gagging ďƒ› V. D Dish face Loss of function: Diplopia? Anosmia Nares filled with clotted blood Emphysema, Epiphora, CSF Rhinorrhea,Hooding of eye www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES
CSF Rhinorrhea Le-Fort II / III #s Dural tear # cribriform plate Meningitis ?? Diagnosis Clinical
- Tram track, halo effect
Biochemical - Dipstick - ďƒ› glucose levels Radiological CT scan Radio opaque dye - sub arachnoid space www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Bilateral hooding of eyes Le-Fort II / III # Separation of F-Z suture Suspensory ligament of Lockwood Attachment medially - lacrimal bone laterally - below F-Z suture www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Radiographic examination
RADIOGRAPHS PNS view PA skull CT SCANS Axial & Coronal Views
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com
MAXILLOFACIAL INJURIES MIDFACE FRACTURES Management
ABCDE Reduction & fixation Closed v/s Open
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I fractures ORIF plates Intra oral approach Fixation of plates after reduction Pyriform rim Zygomatic buttress
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II fractures ORIF plates Nasal #s Infra orbital rim Zygomatic buttress
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort III fractures ORIF plates Fronto-zygomatic Fronto-nasal Zygomatic buttress
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I, II & III fractures CLOSED Reduction & Fixation Suspension wires to mandible Frontal: Central & lateral Circum zygomatic
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I, II & III fractures CLOSED External fixation Cranio-mandibular Box, Halo frames POP head cap
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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com
Thank You www.indiandenalacademy.com