facial fractures classification
TRANSCRIPT
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CLASSIFICATION OF FACIAL
FRACTURES
Dr ARJUN SHENOY
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INDEX
• MANDIBULAR FRACTURE CLASSIFICATION
• MIDFACE FRACTURE CLASSIFICATION
• ZMC FRACTURE CLASSIFICATION
• NOE FRACTURE CLASSIFICATION
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CLASSIFICATION OFMANDIBULAR FRACTURES
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KRUGER’S GENERALCLASSIFICATION
• SIMPLE / CLOSED
• COMPOUND / OPEN
• COMMUNITED
• COMPLICATED / COMPLEX
• IMPACTED
• GREENSTICK
• PATHOLOGICAL
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KRUGER’S GENERAL CLASSIFICATION
SIMPLE- no communication withexteio o inteio
COMPOUND- communication thou!h "#in
extena$$% thou!h muco"a o PDL
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KRUGER’S GENERAL CLASSIFICATION
COMMUNITED - splintering
crushed multiple pieces
&io$ent 'oce" ( hi!h &e$ocit% - )e am ( mi""i$e"
COMPLICATED / COMPLEX- *ama!e to &ita$ "tuctue"
com+$icate" teatment
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KRUGER’S GENERAL CLASSIFICATION
• IMPACTED – ae
one 'a!ment *i&en )m$% into theothe
c$inica$ mo&ement not a++ecia,$e• GREENSTICK -
one cotex ,o#en an* othe ,ent
incom+$ete 'actue- common chi$*en-
e"i$ience
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KRUGER’S GENERAL CLASSIFICATION
PATHOLOGICAL
GENERALISED SKELETAL DISEASELOCALISED SKELETAL DISEASE
Oste!rs"s# !$%ets# ste&$'$("$ste&)e'"t"s# ()sts# ORN
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ANATOMICAL CLASSIFICATION
• R*e + K"''e) C'$ss",($t"
• A Fractures not involving basal bone
• E!- *entoa$&eo$a
• Fr$(t.res "'"% t0e 1$s$' 1e
i Sin!$e uni$atea$
ii Dou,$e uni$atea$
iii Bi$atea$
i& mu$ti+$e
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DINGMAN + NAT2IG CLASSIFICATION
A S.MP/.SIS 0
B CANINE RE1ION 0
C BOD. OF MANDIBLE 0
D AN1LE RE1ION 0
E RAMUS RE1ION 0
F CORONOID RE1ION 0
1 COND.LAR 0
/ DENTOAL2EOLAR 0
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RELATION OF FRACTURE TO THE SITE OF INJURY
DIRECT FRACTURESINDIRECT FRACTURES
3COUNTERCOUP4
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COMPLETENESS
• Complete versus incomplete
56 C&!'ete 7r$(t.res
A*u$t" - u"ua$$% com+$ete - inteu+t entie$% the continuit% o'the ach
U"ua$$% mo,i$e an* ha&e &aiou" *e!ee o' *i"+$acement
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COMPLETENESS
• INCOMPLETE FRACTURES
• Do not exten* thou!h ,oth the 1.(($' an* the '"%.$' (rt"(es a" we$$ a" the a$&eo$a an* ,a"a$ ,o*e"
• Occa"iona$$% in a*u$t" 3 moe o'ten in (0"'8re
• 8"s!'$(e8 an* &1"'e
• Mi!ht not e4uie "u!ica$ teatment
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Direction & favorability of treatment
/oi5onta$$% Fa&oua,$eFactue $ine un"
*ownwa* 6 'owa* "o
u+wa* *i"+$acement
a&oi*e*
/oi5onta$$% Un'a&oua,$e
Factue $ine un" Down
7a*" an* Bac# 7a*" "o
u+wa* Di"+$acement
Une"ticte*
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VERTICALLY FAVORABLE VERTICALLY UNFAVORABLE
FRACTURE LINE RUNS FROM T/E
OUTER BUCCAL PLATE OBLI8UEL.
BAC97ARDS AND LIN1UALL. 3 MEDIAL
MO2EMENT RESTRICTED
FRACTURE LINE RUNS FROM T/E
INNER LIN1UAL PLATE OBLI8UEL.
BAC97ARDS AND BUCCALL. 3 MEDIAL
MO2EMENT UNRESTRICTED
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DEPENDING UPON THE MECHANISM
I A2ULSION FRACTURE
II BENDIN1 FRACTURE
III BURST FRACTURE
I2 COUNTERCOUP FRACTURE
2 TORSIONAL FRACTURE
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DEPENDING ON NUMBER OFFRAGMENTS
SIN1LE
MULTIPLE
COMMINUTED
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ACCORDING TO SHAPE OF FRACTURE
TRANS2ERSE
OBLI8UE
BUTTERFL.
OBLI8UE SURFACED
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Presence or absence of teeth
Kazanjian V.H. & Converse J.M.
CLASS 1 TEETH ON BOTH
SIDES OF FRACTURE
LINE
MONOMAXILLA RY
CLASS II TEETH ONLY ON ONESIDE OF THE
FRACTURE LINE
INTERMAXILLAR Y FIXATION
CLASS III EDENTULOUS PATIENT OPENREDUCTION /PROSTHESIS
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AO Classification
F NO OF FRACTURE OR FRA1MENTS
L LOCATION OF T/E FRACTURE
O STATUS OF OCCLUSION
S SOFT TISSUE IN2OL2EMENT
A ASSOCIATED FRACTURES
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F: NO. OF FRACTURES
F0 Incomplete !"ct#!e$
F1 S%n&le !"ct#!e$
F' M#lt%ple !"ct#!e$
F( Comm%n#te) !"ct#!e$
F* F!"ct#!e +%t, -one )eect
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L: Location of fracture
L1 P!e.c"n%neL' C"n%ne
L( Po$t.c"n%ne
L* An&le
L S#p!"."nl"!
L Con)le
L2 Co!ono%)
L3 Al4eol"! p!oce$$
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O: Status of occlusion
O 0 No m"loccl#$%on
O 1 M"loccl#$%on
O ' E)ent#lo#$ m"n)%-le
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A: Associated fracture
A 0 None
A 1 Dento"l4eol"! !"ct#!e
A ' N"$"l -one !"ct#!e
A ( 5&om" !"ct#!e
A * Leo!t I
A Leo!t II
A Leo!t III
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According to WHO/1997, 2003//3/ the international classification
S :;< - Factua man*i,u$ae
S :;
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LEFORT CLASSIFICATION
FRACTURES OF THE MIDFACE
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6I7EN BY THE FRENCH SUR6EON RENE LE.FORTIN 1801 AS
LEFORT I 9 II : III FRACTURES
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Provides uniform method to describe thelevel of major fracture lines .
Allows references regarding the probablepoints of stability for surgical treatment .
Does not incorporate vertical orsegmental fractures, comminution or
bone loss .
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ALSO CALLED ;• 6UERINS FRACTURE
• FLOATIN6 FRACTURE
• PTERY6OMAXILLARY
DYS
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LEFORT l
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ALSO CALLED;• PYRAMIDAL >•SUB5Y6OMATIC >
LEFORT II FRACTURE HAS A
PYRAMIDAL APPEARANCE ON THE
PA S?ULL = MAXILLA IS
SEPERATED FROM THE S?ULLBASE =
LEFORT IIFRACTURES
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LEFORT ll
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ALSO CALLED ;
• TRANS7ERSE FRACTURE• SUPRA5Y6OMATIC >• HI6H LE7EL >
•CRANIO.FACIAL DYS
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LEFORT lll
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ROWE AND WILLIAMS CLASSIFICATION -1985
A6 FRACTURES NOT IN9OL9ING OCCLUSION
I6 Cetr$' Re%"
aFactue" o' the na"a$ ,one"(na"a$ "e+tum
- Latea$ na"a$ inuie"
- Anteio na"a$ inuie"
, Factue" o' 'onta$ +oce"" o' maxi$$a
c Na"oethmoi*a$ 'actue"
* Factue" o' t%+e a3 , an* c exten*in! into
the 'onta$,one 'ontoo,itona"a$ *i"$ocation
II6 L$ter$' re%"
Factue" in&o$&in! the 5%!omatic ,one3 ach an*maxi$$a exc$u*in! *entoa$&eo$a com+onent
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ROWE AND WILLIAMS CLASSIFICATION -1985
B FRACTURES IN9OL9ING OCCLUSION
Det$'e'$r
S.1:)%&$t"(
- Le'ot I $ow $e&e$ o 1uein
- Le'ot II P%ami*a$ Factue
S.!r$:)%&$t"(
- Le'ot III /i!h $e&e$
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RELATIONSHIP OF # LINE TO ZYGOMATIC BONE
= BELO7 Z.1OMATIC
subzygomatic fracture
; ABO2E Z.1OMATIC3. Suprazygomatic fracture
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ERICH CLASSIFICATION - 1942
/ORIZONTAL
P.RAMIDAL
TRANS2ERSE
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Modified LeFort FractureClassification - 1993
Le-Fort Level Description I L* &$;"''$r) 7r$(t.re
$a Low maxi$$a% 'actue with mu$ti+$e "e!ment"
II P)r$&"8$' 7r$(t.re
IIa P%ami*a$ 'actue an* na"a$ 'actue II, P%ami*a$ an* NOE 'actue
III Cr$"7$("$' 8)s
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FRACTURE ZMCCLASSIFICATION
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SCHIELDERUP 35>?@4
TYPE 1 : Fractured zygoma hinged on maillary ! frontal attachment.
TYPE " : Fractured and hinged on maillary attachment
TYPE 3 : Fractured and hinged on frontal attachment
TYPE # : Fractured and detached enbloc.
TYPE $ : %omminuted fracture.
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KNIGHT AND NORTH’S CLASSIFICATION 5>5
1ou+ I Un*i"+$ace* 'actue"
1ou+ II Ach 'actue"
1ou+ III Unotate* ,o*% 'actue"
1ou+ I2 Me*ia$$% otate* ,o*% 'actue"
1ou+ 2 Latea$$% otate* ,o*% 'actue"
1ou+ 2I Com+$ex 'actue"
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R*e + K"''e) 35>4
T%+e I No "i!ni)cant *i"+$acement
T%+e II Factue o' the 5%!omatic ach
T%+e III Rotation aoun* &etica$ axi"
- Inwa* *i"+$acement o' o,ita$ im
- Outwa* *i"+$acement o' o,ita$ im T%+e I2 Rotation aoun* $on!itu*ina$ axi"
- Me*ia$ *i"+$acement o' 'onta$ +oce""
- Latea$ *i"+$acement o' 'onta$ +oce""
T%+e 2 Di"+$acement o' the com+$ex en ,$oc - Me*ia$
- In'eio
- $atea$ Rae
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Rowe & Killey (1968)
T%+e 2I Di"+$acement o' o,itoanta$ +atition - In'eio$%
- Su+eio$%
T%+e 2II Di"+$acement o' o,ita$ im "e!ment"
T%+e 2III Com+$ex comminute* 'actue"
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T%+e I no "i!ni)cant
*i"+$acement
T%+e II Factue o' the 5%!omatic
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%+ %!ach
T%+e III Rotation aoun* &etica$ axi"
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O.t*$r8D"s!'$(e&et
I*$r8D"s!'$(e&et
T%+e III Rotation aoun* &etica$ axi"
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T%+e I2 Rotation aoun* $on!itu*ina$ axi"
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T%+e 2 Di"+$acement o' the com+$ex en,$oc
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T%+e 2I Di"+$acement o' o,itoanta$+atition
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T%+e 2II Di"+$acement o' o,ita$ im"e!ment"
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T%+e 2III Com+$ex comminute* 'actue"
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MANSON AND COLLEAGUES (1990) :
Ba"e* on amount o' ene!% *i""i+ate* 6&ndings in %.T. Scan'
a /i!h ene!% 'actue"
, Mo*eate ene!% 'actue"c Low ene!%
'actue"
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MAR9US ZIN1 =HH;
T%+e A Incom+$ete 5%!omatic 'actue
T%+e B Com+$ete mono'a!ment 5%!omatic'actue teta*+o* 'actue
T%+e C Mu$ti'a!ment 5%!omatic 'actue
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RO2E’S + 2ILLIAM’S CLASSIFICATION
1) Fractures stable after ele*ationa. +rch only ,medially displaced)
b. -otation around the *ertical ais.
edially
/aterally
") Fracture unstable after ele*ation.
a. +rch only ,inferiorly displaced).
b. -otation around the horizontal ais.
edially
/aterally
.
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ROWE’S & WILLIAM’S CLASSIFICATION :
c Di"$ocation" en,$oc#
In'eio
Me*ia$$%
Po"teio-$atea$$% * Comminute* 'actue
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1. Group A : Stable fracture – Showing minimal or no displacement and
requires no intervention.
2. Group B : nstable fracture – !ith great displacement and distruption at
the fronto"#gomatic suture and comminuted fracture. $equires reduction
as well as fi%ation.&. Group ' : Stable fracture – (ther t#pes of "#gomatic fractures) which
requires reduction) but no fi%ation.
*. +ractures of the "#gomatic arch alone
•
,inimum or no displacement.• - t#pe in fracture.
• 'omminuted fracture.
LARSEN 6T/OMSEN CLASSIFICATION
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MALAR CLASSIFICATION
TYPE 1 : 0ndisplaced fracture.
TYPE " : +rch fracture only.
TYPE 3 : Tripod malar fracture , F intact ).
TYPE # : Tripod malar fracture ,F distracted ).
TYPE $ : Pure blo2'out fracture..
TYPE : 4rbital rim fracture.
TYPE 5 : %omminuted and other fractures
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SPIESSEL AND SCHROLL’S CLASSIFICATION:
T.PE = I"o$ate* 5%!omatic ach 'actue
T.PE ; Factue with no "i!ni)cant*i"+$acement
T.PE > Patia$$% *i"+$ace* me*ia$$% T.PE ? Tota$$% *i"+$ace* me*ia$$%
T.PE @ Tho"e with *o"a$ *i"+$acement
T.PE < Tho"e with in'eio *i"+$acement T.PE Comminute* an* othe 'actue"
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FRONTO-NASOETHMOIDAL REGION
• NOE complex fractures involve the medial vertical (nasomaxillary) buttresses of the facial skeleton
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• NOE fractures are most commonly classified according to Markowit !"# Manson$N# %argent "# et al (&''&)
• ype • ype
• ype
• hese can be unilateral or bilateral in*uries+
• $last ,econstr %urg+ -.(/)0-123/20
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Type I
• n unilateral Markowit type fractures# there is a single large NOEfragment bearing the medial canthal tendon+
• he nasal bone may also be involved and# in cases of comminution#
may not provide ade4uate dorsal support to the nasal bridge+
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Unilateral Type II
• n unilateral type fractures# there is often comminution of theNOE area# but the canthal tendon remains attached to a fragment of bone# allowing the canthus to be stabilied with wires or a smallplate on the fractured segment
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Unilateral Type II + Involvement of te na!al "one
• he nasal bone may also be involved and# in cases of comminution#may not provide ade4uate dorsal support to the nasal bridge+
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#ilateral type II fra$t%re &it na!al "one
involvement
• bone grafting of the nasal dorsum may be necessary
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Type III
• n type fractures# there is often comminution of the NOE area (asin type fractures) and a detachment of the medial canthal tendonfrom the bone+
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Type III + Involvement of te na!al "one
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#ilateral type III fra$t%re &it na!al "one
involvement
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REFERENCES
FONSECA 2OL = >* EDITION 9ILLE.S >* EDITION
RO7 AND 7ILLIAMS 2OL = PETER 7ARD BOOT/ 2OL = COMPLICATION IN ORAL AND MAJILLOFACIAL
SUR1ER.-9ABBAN
CONTEMPORAR. ORAL AND MAJILLOFACIALSUR1ER.3?th EDITION-LARR.KPETERSON3KAMESR/UPP3M.RON
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