maxillofacial injury kel 1

7/28/2019 Maxillofacial Injury Kel 1

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Alfred H L ToruanNugroho S.S

M. Fatikh Nanda


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Introduction

Common with multisystem trauma

Require coordinated management bythe trauma surgeon and the specialists inotolaryngology, plastic surgery,ophthalmology, and oral andmaxillofacial surgery


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Maxillofacial Region

Upper face:

The frontal sinus

Brain

Upper midface:

Orbits

Nose

Zygomaticomaxillary complex The lower face:

Mandible


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Problems

Life-threatening

Airway

Vision

Nose & nasoethmoidal fractures CSFrhinorrhea

Aesthetics of the face


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Fracture Pathophysiology

Maxillofacial fractures result fromblunt or penetrating trauma.

Blunt injuries are far more common,including vehicular accidents,altercations, sports-related trauma,occupational injuries, and falls.

Penetrating injuries include gunshotwounds, stabbings, and explosions.


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Mass, density, and shape of thestriking object, as well as speed of

impact, directly affect type andseverity of facial injury.

The force required to fracturevarious facial bones may be

classified as high impact (greaterthan 50 times force of gravity [g])or low impact (less than 50 g).


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High-impact kinetic energy fracture:

Frontal sinus 100 g

Orbital rims 200 g Mandible

Angle 70 g

Symphisis 100 g

Low-impact forces injure: Nasal bones 30 g

Zygoma 50 g


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Frontal Fracture

Frontal bone fracture require high-energyimpact

May indicate intracranial injury.

Associated fractures of the supraorbitalridge, nasoethmoidal complex, and otherfacial bones also may occur


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Midface Structure 3 vertical buttresses : nasofrontal-

maxillary

frontozygomaticomaxillary

pterygomaxillary

5 weaker horizontalbuttresses:

the frontal bone

nasal bones upper alveolus

zygomatic arches

infraorbital region


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Midface Fractures Le Fort I Le Fort II

Le Fort III


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Le Fort I FracturesHorizontal maxillary fracture

separates the maxillary process (hard

palate) from the rest of the maxillaExtends through the lower third of theseptum and involves the maxillarysinus

Below the level of the infraorbital

nerve

no hypesthesiaThe palatal vault is mobile while thenasal pyramid and orbital rims arestable


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Le Fort I Fractures


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Le Fort II Fractures

Extends through the nasofrontal buttress,medial wall of the orbit, across the

infraorbital rim, and through thezygomaticomaxillary articulation

The nasal dorsum, palate, and medialpart of the infraorbital rim are mobile


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The inner canthus of the nasalbridge is widened.Extends through the zygoma

(near the exit of theinfraorbital nerve) hypesthesia is often presentBilateral subcutaneous

hematomas are often present.


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Le Fort III Fractures = Craniofacial disjunction

Extends posteriorly through the ethmoid

bones and laterally through the orbits belowthe optic foramen, through thepterygomaxillary suture into thesphenopalatine fossa

The frontozygomaticomaxillary,

frontomaxillary, and frontonasal suture linesare disrupted

The entire face is mobile from the cranium


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Le Fort III Fractures


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Midface FracturesIn reality fractures reflect a combination of

these three types

Signs:

Subconjunctival hemorrhage

Malocclusion

Midface numbness or hypesthesia (maxillarydivision of the trigeminal nerve)

Facial ecchymoses/hematoma

Ocular signs/symptoms

Mobility of the maxillary complex


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Nasal Fracture

Simple nasal fractures are quite commonfacial fractures.

They must be distinguished from the moreserious nasoethmoidal (NOE) fractures.

NOE fractures extend into the nosethrough the ethmoid bones.


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Nasal Fracture


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Zygoma Fractures

Lateral blows to the cheek The zygomais typically displaced inferiorly and

medially with disruption of the suture linesbetween the temporal, frontal, andmaxillary bones and the zygomadepression into the maxillary sinus and

blood in the sinus cavity Often impinges on the temporalis muscle

below causing trismus


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Mandible Fracture

Most common facial bone fracture

Sites:

Angle

Body

Condyle

in most cases 2 sites

Secure the Airway!!!


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Mandible


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Mandible Fracture


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Management

ATLS Algorhitms

Airway obstruction from tissue trauma

and edema, foreign debris, or bleeding

Subcutaneous emphysemapharyngeal, laryngeal, or trachealdisruption

Stridor airway narrowing and possibleimpending obstruction


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Management Foreign material finger-swept Blood and secretions suction

A jaw thrust, even in the setting of mandibular

trauma, and bag-valve mask (BVM) assistancemay temporize an airway, especially in the settingof injury to the brain or spinal cord

Orotracheal intubation possible midfacefractures

Nasotracheal intubation the disrupted skullbase!!!

If intubation proves impossible tracheostomy orcricothyrotomy


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Management

The face is very well vascularizedprofuse hemorrhage

Direct pressure and pressure dressings


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Management

Facial injuries cervical spine and braintrauma

Suspected cervical spine injuryimmobilized on a backboard with a rigidcervical collar

GCS


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Thank You...

maxillofacial injury kel 1

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