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Fractures of the Middle Third of the Face. Maxillary Fracture Can compromise the airway Commonly transverse Direct trauma to the face. Le Fort Fractures System. 1. Le Fort 1 : The upper alveolus is detached

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Fractures of the Middle Third of the Face

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    1. Fractures of the Middle Thirdof the Face Maxillary Fracture Can compromise the airway Commonly transverse Direct trauma to the face Professor Sameer Bafaqeeh

    2. Le Fort Fractures System 1 • Le Fort 1: The upper alveolus is detached • Le Fort 2: the entire upper jaw is detached • Le Fort 3: the F.S. is separated from the S.B. 2 3 Professor Sameer Bafaqeeh

    3. Fractures of the Middle Thirdof the Face • High-speed injuries (Motor vehicle accidents) • Seatbelt Laws Professor Sameer Bafaqeeh

    4. Fractures of the Middle Thirdof the Face • Careful history &examination • Palpation around the facial structures • Jaw movements &mobility • Eye & eye movements Professor Sameer Bafaqeeh

    5. Types of Central Middle Third Fracture(Le Fort Classes I ) Maxillary FractureClinical presentation*Le Fort Class I– Low max. horizontal fractures– # the upper alveolus– Abnormal occlusion– Hematoma or fracture of the antral wall Professor Sameer Bafaqeeh

    6. Types of Central Middle Third Fracture(Le Fort Classes II ) Maxillary FractureClinical presentation*Le Fort Class II– Pyramid fractures– # the upper jaw– The fracture passes– Dislocation and depression– Ethmoids, orbital, lacrimal involvement– Hypertelorism Professor Sameer Bafaqeeh

    7. Types of Central Middle Third Fracture(Le Fort Classes III ) *Le Fort Class III– F. Sk. and SB are separated– The fracture line: zygomaticofrontal, maxillofrontal, and nasofrontal sutures– All the structures of the central part of the facial skeleton are involved– Massive depression of the middle third of the face– Multiple fractures of the bones (dish face)– Typical symptoms (shock, concussion, cerebral contusion) Professor Sameer Bafaqeeh

    8. Pathogenesis Central Middle-third Fractures # High-speed injuries • Traffic accidents • Occupational injuries Professor Sameer Bafaqeeh

    9. Trauma of the Middle Third of the FaceDiagnosis * History: Type, direction and force * Inspection:– Skeletal (fracture, dislocations,depression)– Symmetry of middle and frontal areas– The nose– The orbit (hematoma, movement, & vision) Professor Sameer Bafaqeeh

    10. Trauma of the Middle Third of the FaceDiagnosis (cont.) * Palpation: Tenderness, upper jaw, facial contour, bony skeleton, orbital rim, trismus, nose root, mandible, occlusion, teeth. * Sensory or motor innervation * CSF Rhinorrhea* Brain tissue 12 Professor Sameer Bafaqeeh Prof.BAFAQEEH

    11. Trauma of the Middle Third of the FaceDiagnosis (cont.) * Radiography: –Skull radiography(Radiopaque F.B.)–Angiography– C.T. scan– Olfactometry* Maxillofacial surgeon, an ophthalmologist a neurologist, a neurosurgeon, general and orthopedic surgeon are consulted. Professor Sameer Bafaqeeh

    12. NOTE: Rapid soft tissue swelling. Bloody effusion. Skeletal assymetryor deformity } concealed concealed Soft tissue injuries. Life-threateningskeletal injuries Professor Sameer Bafaqeeh

    13. Treatment ofMiddle Third Injuries Traumatologic ABC A = Airway (the airway is secured and aspiration is prevented) B = Bleeding (must be controlled) C = Circulation (shock must be treated) Professor Sameer Bafaqeeh

    14. Fracture Middle 1/3 Face •Hospitalization: Traumatologic center •Admission: Extent and type of the skull, thorax, abdomen & extremities •Patient head injury: Special traumatologic teams (A neurosurgeon, a rhinosurgeon, a maxillo-facial surgeon and an ophthalmic surgeon) Professor Sameer Bafaqeeh

    15. Definitive Surgery ofMiddle Third Fractures • Reconstitution (anatomy and function) - Debridement - Ventilation - Drainage• Rhinologic surgeon: I - Soft tissue injury, nose and sinuses II - Assessment of the base skull III- Correction of the F.Sk. and the B.O.•D.S. should be carried out quickly Rapidly heal in wrongposition Formationof callus Fracture Professor Sameer Bafaqeeh

    16. Fractures of the Mandible • Maintain the airway • Stop hemorrhage • Intracranial or other injury • Mouth deformity& malocclusion • Inferior dental nerve • Orthopantamogram [OPG] Professor Sameer Bafaqeeh

    17. Mandible Fractures Treatment • Undisplaced fractures: Analgesia & antibiotics .A simple fracture: Intermaxillary fixation [eyelet wiring] .An irreducible fracture: Open reduction&fixation Wires or an AO Plate. Professor Sameer Bafaqeeh

    18. Key Points: • 1.In orbital trauma, check the eye movements, palpate the bony orbital rim, and record visual acuity. • 2.In patients with facial injury, always check the full range of jaw mov. &determine whether or not the upper jaw is mobile. fractures of the cheek bone [ zygoma ] are often overlooked. • 3.Wear eye protection while playing racquet sports. Professor Sameer Bafaqeeh

    19. Isolated Blowout Fracture –Localized violence --> Orbital contents – A blow (a fist, a tennis ball, a sq. ball, a champagn bottle cork, etc ) – Fractures of the orbital bony floor – Trapping of the orbital contents Professor Sameer Bafaqeeh

    20. Blowout FractureSymptoms – Enophthalmos – Double vision – Limitation of eye movement – Infraorbital nerve sensation disorders Professor Sameer Bafaqeeh

    21. Blowout FractureDiagnosis •Radiographs “tear drop” • Tomograms • Ophthalmologic examination Prof.BAFAQEEH Professor Sameer Bafaqeeh

    22. Blowout FractureTreatment • The antral cavity must be explored: - The bony fragments are exposed - The prolapsed part is replaced - Bridging or stabilization (Lyophilized dura, cartilage or plastic prop) • Alternative or supplementary measures: - Orbital access - Lyophilized dura, silicone sheet, or teflon - Autologous implant to correct enophthalmos Professor Sameer Bafaqeeh

    23. Professor Sameer Bafaqeeh

    24. Nasal trauma in Childhood • Child’s nose - less promineent -more cartilaginous .Nonaccidental injury -[grotesque] .# growth centers N.deformity .Surgical correction :conservative delay .Cart. : repositioned not resected Professor Sameer Bafaqeeh

    25. Mucosal injuries of the MOUTH & Pharynx [ F.B. &Trauma ] • Good healing properties • Mucosal suture in extensive injuries • Antibiotic cover Professor Sameer Bafaqeeh

    26. Penetrating soft tissue injuries of the Mouth and Pharynx • Bullet, stab, and traffic accidents wounds. • Mouth and Pharynx must be assessed with related soft and bony tissues • Structures shoud be debrided, repositioned, fixed, and sutured in layers • Antibiotic • Surgical emphysema Professor Sameer Bafaqeeh

    27. Impalement injuries of the Palate and posterior Pharyngeal wall • Children falling on pointed objects. • Expert examination • Suture of the wound Professor Sameer Bafaqeeh

    28. Tongue Bites • Heal spontaneously • Penetrating bite require suture • Completely divided tongue reimplanted : • -the time of reconstruction • -the condition of the wound • -the bloodsupply Professor Sameer Bafaqeeh

    29. Insect Bites • Swallowing a living insect [bees, etc.] . • Edema of the pharynx respiratory obstruction • I.V. high-dose steroids • Ice packs • Calcium & tracheotomy Professor Sameer Bafaqeeh