mid face fractures#2 (nxpowerlite) / orthodontic courses by indian dental academy
TRANSCRIPT
Part –IIPart –IIManagement Management
of of MIDFACE FRACTURESMIDFACE FRACTURES INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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TreatmentTreatmentGoal is functional & cosmetic restorationGoal is functional & cosmetic restorationReestablish:Reestablish: Mid-facial height and projection (most Mid-facial height and projection (most
important)important) OcclusionOcclusion Integrity of nose and orbitIntegrity of nose and orbit
Provide structural support for proper soft Provide structural support for proper soft tissue contourtissue contour
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Treatment must be indivisualisedTreatment must be indivisualised
Factors affecting treatment stratigiesFactors affecting treatment stratigies Multi-traumaMulti-trauma
Concomitant mandibular InjuryConcomitant mandibular Injury
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Principles of TreatmentPrinciples of Treatment(Rodrich & Shewmake,1992)(Rodrich & Shewmake,1992)
Early 1 stage repairEarly 1 stage repair
Exposure of all # sitesExposure of all # sites
Precise Anatomic reduction & semirigid Precise Anatomic reduction & semirigid
fixationfixation
Immediate bone grafting if neededImmediate bone grafting if needed
Definitive soft tissue repairDefinitive soft tissue repairwww.indiandentalacademy.comwww.indiandentalacademy.com
Timing of Operative repairTiming of Operative repair
Initial concept - 5Initial concept - 5thth -8 -8th th dayday
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Surgical ApproachesSurgical Approaches
Maxillary vestibular incisionMaxillary vestibular incision
Lower eyelid incisionLower eyelid incision
TransconjunctivalTransconjunctival
SubciliarySubciliary
Lower lid incisionLower lid incision
Coronal ApproachCoronal Approach
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Reduction of Midface Reduction of Midface FracturesFractures
Most imp step.Most imp step.Universal rule of mechanicsUniversal rule of mechanicsReduction:Reduction: Manual reductionManual reduction : Fresh #, Non impacted : Fresh #, Non impacted
Hand manipulationHand manipulation
Dental compounds (1951)Dental compounds (1951)
Rubber cathaters (1966)Rubber cathaters (1966)
Special instrumentsSpecial instruments
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Special InstrumentsSpecial Instruments
Rowe’s Maxillary Rowe’s Maxillary Disimpaction Forceps Disimpaction Forceps
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Hayton Williams ForcepsHayton Williams Forceps
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Lefort II & IIILefort II & III – –
When inadequate alignment results, When inadequate alignment results,
individual segments are reduced individual segments are reduced
separately. separately.
Direct reductionDirect reduction: Elevator, bone hook or : Elevator, bone hook or
wire inserted through the fragment. wire inserted through the fragment.
Traction using elastic bandsTraction using elastic bands applied to applied to
maxillary and mandibular arch bar can be maxillary and mandibular arch bar can be
used for reducing fraction.used for reducing fraction.
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Immobilization of mid-face Immobilization of mid-face fractures:fractures:
A) A) Internal fixationInternal fixationaa..Direct osteosynthesis :..Direct osteosynthesis :
MiniplatesMiniplates
Transosseous wiring.Transosseous wiring.
High level (fronto-zygomatic and fronto-nasal)High level (fronto-zygomatic and fronto-nasal)
Mid level (orbital rim/ zygoma buttress).Mid level (orbital rim/ zygoma buttress).
Low level (Alveolar / midpalatal).Low level (Alveolar / midpalatal).
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b..Suspension wires (Skeletal fixation).b..Suspension wires (Skeletal fixation).
A)Frontal :A)Frontal : Central (LeFort II & III ; Unstable mand.)Central (LeFort II & III ; Unstable mand.)
Lateral ( LeFort II & III ; Stable mand)Lateral ( LeFort II & III ; Stable mand)
b) Circum-zygomaticb) Circum-zygomatic
c) Zygomatic-frontoc) Zygomatic-fronto
d) Infra-orbital rim.d) Infra-orbital rim.
e) Pyriform aperture.e) Pyriform aperture.
f) Buttress, transnasalf) Buttress, transnasal
g) Perialveolar wireg) Perialveolar wire
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B) External fixation: B) External fixation: 1) Cranio-mandibular1) Cranio-mandibular
Box frameBox frameHalo frame.Halo frame.Plaster of paris head cap.Plaster of paris head cap.
2) Craniomaxillary:2) Craniomaxillary:Supra-orbital pins.Supra-orbital pins.Zygomatic pins.Zygomatic pins.Halo frames.Halo frames.Levant Frames.Levant Frames.
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Lateral frontal wire:Lateral frontal wire:
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BOX FRAMEBOX FRAME
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Central frontal wire:Central frontal wire:
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2) Circum zygomatic:2) Circum zygomatic:
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3) Zygomatic buttress and pyriform:3) Zygomatic buttress and pyriform:
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Infra-orbital wiringInfra-orbital wiring..
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Various –Various – Plaster of paris.Plaster of paris.Halo frame.Halo frame.Box frame.Box frame.Levant frame.Levant frame.
IndicationIndication – Presence of anteroposterior instability – Presence of anteroposterior instability of the facial skeleton (i.e. concomitant B/L of the facial skeleton (i.e. concomitant B/L condylar # of mandible).condylar # of mandible).
DisadvantageDisadvantage: Appliances are cumbersome, : Appliances are cumbersome, conspicuous is lead to lengthen the period of conspicuous is lead to lengthen the period of hospitalization.hospitalization.
Contraindicated Contraindicated : Presence of mental confusion, : Presence of mental confusion, cerebral irritation, epilepsy and alcoholism. cerebral irritation, epilepsy and alcoholism.
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Halo FrameHalo Frame..
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BOX FRAMEBOX FRAME
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LEVANT FRAMELEVANT FRAME
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Internal FixationInternal Fixation- Michelet first introduced miniplate in - Michelet first introduced miniplate in facial # 1972. facial # 1972. Monocortical semi-rigid fixation with Monocortical semi-rigid fixation with plates or screws:plates or screws: Provides three diamenssional stabilityProvides three diamenssional stability resists antero-posterior and rotatory bony resists antero-posterior and rotatory bony
movements. movements. Allows primary bony healingAllows primary bony healing
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Different configuration X,H, L,T and Y Different configuration X,H, L,T and Y shapes. shapes. Various material likeVarious material likeStainless steelStainless steelTitaniumTitaniumVitallium (Cobalt-chromium and Vitallium (Cobalt-chromium and molydenum)molydenum)Resorbable bone plates and screws Resorbable bone plates and screws (Polylactide, polyglycolic copolymer)(Polylactide, polyglycolic copolymer)
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MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES
ABCDE
Reduction & fixation
Closed v/s Open
MIDFACE FRACTURESManagement
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MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES
GK / MAXFACGK / MAXFACSDM DHARWADSDM DHARWAD
Le-Fort I fractures ORIF plates
Intra oral approachFixation of plates after reductionPyriform rimZygomatic buttress
MIDFACE FRACTURES
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MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES
GK / MAXFACGK / MAXFACSDM DHARWADSDM DHARWAD
Le-Fort II fractures ORIF plates
Nasal #s
Infra orbital rim
Zygomatic buttress
MIDFACE FRACTURES
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MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES
GK / MAXFACGK / MAXFACSDM DHARWADSDM DHARWAD
Le-Fort III fractures ORIF plates
Fronto-zygomatic
Fronto-nasal
Zygomatic buttress
MIDFACE FRACTURES
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MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES
GK / MAXFACGK / MAXFACSDM DHARWADSDM DHARWAD
Le-Fort I, II & III fractures CLOSED
Reduction & Fixation Suspension wires to mandibleFrontal: Central & lateral Circum zygomatic
MIDFACE FRACTURES
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MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES
GK / MAXFACGK / MAXFACSDM DHARWADSDM DHARWAD
Le-Fort I, II & III fractures CLOSED
External fixationCranio-mandibularBox, Halo frames POP head cap
MIDFACE FRACTURES
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