Presentation on theme: "Lisa Publicover August 2005"— Presentation transcript:
1 Lisa Publicover August 2005 Facial FracturesLisa PublicoverAugust 2005
2 Outline of Lecture Introduction Skeletal Anatomy Fracture Patterns NasalZygomaticMaxillaBlowoutFrontal Sinus and NasoethmoidalMandibularApproach to a Suspected Facial Fracture
3 Anatomy The face is composed of 14 bones: Mandible (1) Vomer (1) Maxilla (2)Zygomata (2)Nasal (2)Lacrimals (2)Palatines (2)Inferior Nasal Conchae (2)
4 Image from http://face-and-emotion. com/dataface/physiognomy/cranium
5 The Mandible Lower jawbone Strongest facial bone Articulates with the temporal boneContains foramens for the passage of nerves and blood vessels to the face
6 The Volmer A small, narrow bone Forms the inferior part of the nasal septum
7 The Maxilla Paired Form the upper jawbone Articulates will every other facial bone except the mandibleContains the maxillary sinusesForms the inferior floor of the orbitsContains a foramen to allow passage of the maxillary/infraorbital nerve
8 The Zygomata Paired Form the “cheekbones” Articulate with the temporal, frontal, and maxillary bonesTheir prominent position and shape renders them susceptible to injury
9 The Nasal Bones Paired Join in the midline to form the nasal bridge They articulate with the frontal, maxillary, and ethmoid bones.
10 The Lacrimal Bones Paired Small & Fragile Located in the medial wall of each orbitContains a small fossa,which houses the lacrimalapparatus
11 The Palatine Bones Paired Located posterior to the maxilla Form the posterior part of the lateral wall of the nasal cavity
12 The Inferior Nasal Conchae PairedLocated within the nasal cavityProject medially from the lateral walls of the nasal cavity
16 Nasal Fractures II: Other Cause: Anterior forceSigns & Symptoms: Similar to lateral blow fracturesTreatment: Require referral for treatment. Treatment involves adequate reduction, packing (24-48h), and fixation with a plaster cast or splint.
18 Zygomatic Fractures Cause: Blunt Force Signs & Symptoms: PainNumbness of the cheek, infraorbital region & upper teeth on injured sideEyelid swellingInability to close mouth properlySwelling, Edema, EcchymosesFlattened cheekbonePalpable depression at fracture siteTreatment: Reduction & fixation
20 Maxillary FracturesComplex, Bilateral fracture that have an unstable “floating” fragment.Classified as LeFort I, II, or III based on the plane of the fracture.LeFort I – TransmaxillaryLeFort II – Pyramidal/SubzygomaticLeFort III – CraniofacialImage from
21 LeFort I : Transmaxillary The fracture occurs along the nasal and maxillary floorAlmost always involves the pterygoid process of the sphenoid boneMay involve the maxillary sinusesThe resultant “floating” component is the lower part of the maxilla and its teeth
22 LeFort II : Pyramidal/Subzygomatic Result from a downward force on the noseThe fracture runs from the peak of the nasal bone laterally beneath the orbits.
23 LeFort III : Craniofacial Most severeOften associated with extensive soft tissue injuryLarge force is necessary to cause this type of fractureThe resultant “floating” component is virtually the entire face
25 Blowout FractureDownward displacement of the orbital floor with protrusion of orbital contents into the maxillary sinus.Caused by a force applied to the eye, which causes an increased intraorbital pressure.The elevated intraorbital pressure causes a fracture at the weakest point (posterior medial floor)Treatment involves surgical repair of the defect in the orbital floor
27 Frontal Sinus & Nasoethmoid Caused by a force applied to the anterior aspect of the facePotentially dangerous (sharp edges can penetrate dura resulting in leakage of CSF)Treatment is surgical reduction, fixation, and repair of any damaged ligaments.
29 Mandibular Fractures (1) Involved in ~ 2/3 of all facial fracturesFractures are classified as open or closed:Open: With a break in the skin or mucosaClosed: No break in the skin or mucosaDescribed as:ObliqueTransverseComminutedGreenstick
35 ReferencesGrabb, W. & Smith,J. (1979). Plastic Surgery (3rd Ed.). Little, Brown and Company: Boston, MAUniversity of Washington School of Medicine:http://www.rad.washington.edu/mskbook/facialfx.html