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Dentoalveolar (teeth and surrounding bone) Mandibular (lower jaw) Maxillary (upper jaw)

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Presentation on theme: "Dentoalveolar (teeth and surrounding bone) Mandibular (lower jaw) Maxillary (upper jaw)"— Presentation transcript:

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2 Dentoalveolar (teeth and surrounding bone) Mandibular (lower jaw) Maxillary (upper jaw)

3 Learning Objectives List the types of orofacial injuries List the types of orofacial injuries List anatomic structures commonly affected by orofacial injuries List anatomic structures commonly affected by orofacial injuries Describe functional impairments resulting from orfacial fractures Describe functional impairments resulting from orfacial fractures Explain the mechanism of injury for orofacial fractures Explain the mechanism of injury for orofacial fractures Become familiar with the diagnostic work up for patients presenting orofacial injury Become familiar with the diagnostic work up for patients presenting orofacial injury List the treatment options and surgical intervention for orofacial fractures List the treatment options and surgical intervention for orofacial fractures Understand the approach to treatment for specific orofacial fractures Understand the approach to treatment for specific orofacial fractures List common early and late complications of orofacial injuries List common early and late complications of orofacial injuries

4 Dentoalveolar Mandibular Maxillary

5 When facial bones break How effective are our attempts to repair?

6 Vehicular Injury » Vehicular Injury » Sports » Falls Assault » Assault »Domestic »Workplace »Associated with Crime »Interpersonal Conflicts » Self Inflicted

7 High Impact » High Impact » Low Impact » Penetrating

8 High Impact Facial Fractures Vehicular high speed deceleration type-injury

9 Sports Related Injuries (low impact)

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11 Rihanna Lucy Newman » Assault »Domestic »Workplace »Associated with Crime »Interpersonal Conflicts

12 Fist blow to face

13 Sports Safety Equipment

14 In spite of our best efforts and millions being spent to protect and ensure safety there are still unexplained injuries

15 Dentoalveolar Mandibular Maxillary

16 Dento alveolar Fractures (Dental / Tooth)(Alveolar Bone) Dental Alveolar Bone

17 Dentoalveolar Fractures Fracture of teeth and adjacent alveolar bone

18 Classification of Tooth Injuries 1.Fracture of tooth crown without pulp involvement 2.Fracture of tooth crown with pulp involvement 3.Crown root fractures 4.Root fractures 5.Concussion injuries 6.Luxation injuries 7.Tooth avulsion (Exarticulation)

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20 Diagnosis – Dentoalveolar injuries 1. Clasic signs of inflammation from injury (Pain, swelling, redness) 2. Mobility 3. Malocclusion (malaligned/displaced teeth)

21 Etiology of Dentoalveolar Injuries 1.Altercations 2.Falls 3.Seizure disorders 4.Sporting activity 5.Vehicular injuries 6.Endoscopic procedures (anesthesia intubation) 7.Abusive behavior 8.Mental health disorders

22 Treatment Objective 1. RESTORE FORM 2. RESTORE FUNCTION

23 RESTORE FORM Place displaced teeth of tooth/bone segment back to their natural position ~ Stabilize repositioned teeth/bone segment RESTORE FORM ~ Place displaced teeth of tooth/bone segment back to their natural position ~ Stabilize repositioned teeth/bone segment

24 ~ Normal bite - Non injured teeth should come together without interference from the displaced/fractured segments. RESTORE FUNCTION ~ Normal bite - Non injured teeth should come together without interference from the displaced/fractured segments. ~ Preserve vitality of dislodged teeth or dentoalveolar segment

25 Prognosis is Dependent on Viability of Pulp and Periodontal Tissues

26 Injuries to the tooth 1.Fracture of tooth crown without pulp involvement 2.Fracture of tooth crown with pulp involvement 3.Crown root fractures 4.Root fractures 5.Concussion injuries 6.Luxation injuries 7.Tooth avulsion (Exarticulation) Root Canal Treatment Likely

27 Injuries to the tooth 1.Fracture of tooth crown without pulp involvement 2.Fracture of tooth crown with pulp involvement 3.Crown root fractures 4.Root fractures 5.Concussion injuries 6.Luxation injuries 7.Tooth avulsion (Exarticulation) Requires reduction and stabilization Requires reimplantation and stabilization

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29 Out of mouth for less than 2 hours 1.Reimplant immediately if possible 2.Transport in Hanks solution, milk, saline or saliva (mouth) 3.Provide local anesthesia 4.Saline irrigation and gentle evacuation of blood from socket 5.Reimplant tooth and stabilize

30 Transport media for the avulsed tooth 1.In the tooth socket 2.Saliva (in the mouth) 3.Milk 4.Hanks balanced salt solution 5.ViaSpan cold storage solution

31 ViaSpan, cold storage solution is currently available as an organ transport solution Hanks balanced salt solution, commercially available as : Save-A-Tooth (Phoenix Lazarus, Inc.) (Save-A-Tooth is a mainstay in many athletic first aid kits)

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33 Simple, non-traumatic stabilization for mobile teeth and dentoalveolar fractures

34 Missing teeth, tooth fragments, broken fillings, appliances must be accounted for ~ Aspirated ~ Ingested ~ Witnessed expelled tooth at the injury location Traumatic occlusion Infection Loss of Teeth and Bone Associated injuries ~ Blunt head trauma ~ Soft tissue injuries ~ Bleeding ~ Infection risk (Tetanus prophylaxis /risk)

35 Ingested Tooth Aspirated Tooth Tongue Bite - Look for Tooth Fragment Tooth Fragment in Lip

36 McQuirter JL, et al. Elevated Blood Lead Resulting from Maxillofacial Gunshot Injuries: Three Case Reports of Ingested Lead Particles after Gunshot Injury to the Face. J Oral Maxillofac Surg 61(5): , 2003.

37 Molar tooth dislodged to mid-tongue area from gunshot injury

38 Infection Ankylosis of Teeth Devitalization/Discoloration of Teeth Loss of Teeth/Dentoalveloar Segment

39 Dentoalveolar segment loss due to periodontal disease compromising interdental blood supply

40 Dentoalveolar Mandibular Maxillary

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42 Diagnosis Clinical/Physical Findings Clinical/Physical Findings Diagnostic Studies Diagnostic Studies

43 Clinical Findings Altered Form Altered Function

44 Altered Form > Swelling > Displacement of Anatomical parts > Decreased Muscle Tone

45 Swelling and bleeding

46 Step / Gap defect in dental arch

47 Displaced anatomy in both jaws

48 Superimposition of other anatomical parts sometimes makes radiographic diagnosis difficult

49 Clinical confirmation of suspected fracture

50 Altered Function > Occlusal Abnormalities > Decrease Range of Motion > Deviation of Jaw with Opening > Altered mental nerve function > Structural Integrity of the Bone > Compromised of Host Defense > Soft Tissue Compromise > Speech > Swallowing > Respiration > Bleeding

51 Bimanual palpation of the mandible in a cephalad position allows excellent evaluation and comparison of the anatomic structures

52 The application of gentle bimanual pressure over the angle regions can unmask a minimally displaced fracture in the anterior region of the mandible.

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56 Treatment Objective 1. RESTORE FORM 2. RESTORE FUNCTION


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