The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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Mid Face Fracture / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
www.indiandentalacademy.com Oral and Maxillofacial Surgery
www.indiandentalacademy.com Mid-face Definition: The area between a superior plane drawn through the zygomatico- frontal sutures tangential to the base of the skull and inferior plane at the level of the maxillary dental occlussal surface. www.indiandentalacademy.com Structures connection (structures in relation) Orbit Maxillary sinus Nasal bone Naso-orbital ethmoid (NOE) complex Zygomatic complex Frontal bone and sinus www.indiandentalacademy.com Vertical and horizontal pillars Area of strength Vertical and horizontal pillars Muscular attachment Area of weakness Sutures Lining tissues and air-filled cavities www.indiandentalacademy.com Pattern of fractures of mid-face skeleton
Alveolar fracture and dental fracture
Le Fort s fracture ((french surgeon Rane Le Fort 1901)
Naso-orbital ethmoid fracture
Zygomatic complex and arch fracture
Frontal sinus and bone fracture www.indiandentalacademy.com Alveolar bone fracture Involve block of alveolar bone with or without Intrusion of teeth Extrusion of teeth Luxation of teeth Fracture of teeth www.indiandentalacademy.com Le Forts fractures Le Fort I (low level or Guerian fracture) Unilateral/ bilateral Horizontal fracture through the maxilla above the level of the nasasl floor and alveolar process
www.indiandentalacademy.com Signs and symptoms Slight swelling of upper lip
Ecchymosis in upper lip sulcus
Hematoma intra-orally over zygoma and in palate
Disturbed occlusion
Mobility of teeth of the involved segment of maxilla
Combination of soft tissue laceration
Exposure of nares and the maxillary antra in case of gross injury
Impacted type of fracture is oftenly not mobile and teeth cusps may be damaged
Cracked-pot percussion of upper teeth www.indiandentalacademy.com Le Forts fractures Le Fort II (pyramidal or subzygomatic) Separation of NF suture, medial orbital walls (lacrimal bone), inferior orbital floor and rim (adjacent to infrorbital canal and foramen), anterior maxilla below zygomatic buttress and ptrygoid laminae about halfway up.
Separation of the block from the base of skull is completed via the nasal septum and may involve the floor of the anterior cranial fossa www.indiandentalacademy.com LeForts fractures LeFort III (cranifacial dysjunction, high transverse, suprazygomatic) Separation of NF suture, medial orbital walls (involve the depth of the ethmoid bone and cribriform plate, pass below optic foramen and cross the inferior orbital fissur), inferior orbital floor, lateral orbital wall, ZF suture, zygomatic arch, suprazygomatic to the root of ptrygoid plate.
www.indiandentalacademy.com Signs and symptoms although it is possible to distinguish between le fort II and III, the signs and symptoms are almost similar Gross edema of soft tissue Bilateral circumorbital ecchymosis Bilateral subconjunctival hemorrahge Obvious deformity of the nose Nasal bleeding and obstruction CSF leak rhinorrhea Dish-face deformity Limitation of ocular movement Possible diplopia and enophthalmous Retropostioning of the maxilla with anterior open bite Lengthening of the face Difficulty in mouth opening Mobility of the upper jaw Occusional hematoma of the palate Cracked-pot sound on percussion Step deformity at infra- orbiatal margin Anasthesia of midface Nasal bone moves with mid-face as a whole Tenderness and sepration at FZ suture Tenderness and deformity of zygomatic arch Depression of occular level and pseudoptosis
www.indiandentalacademy.com Bowerman classification of midface-fracture (1994) Fracture not involving the occlusion Central region Nasal bone/ septum (lateral, anterior injuries) Frontal process of the maxilla Nasoethmoid Fronto-orbito-nasal dislocation
Lateral region (zygomatic complex EX dento alveolar frcature
Fracture involving the occlusion Dento alveolar
Subzygomatic: Le Forts (I, II)
Supra zygomatic: Le Fort III These fractures may occur unilaterally or bilaterally, with separation of maxillary midline and or extension to frontal or temporal bone www.indiandentalacademy.com Prevalence of mid-face fractures Fracture Type Prevalence Zygomaticomaxillary complex (tripod fracture) 40 % LeFort I 15 % II 10 % III 10 % Zygomatic arch 10 % Alveolar process of maxilla 5 % Smash fractures 5 % Other 5 % www.indiandentalacademy.com Diagnosis Inspection Extra-oral (e.g. swelling, deformity, asymmetry Leaks) Intra-oral (e.g. hematoma, occlusion)
Palpation Step deformity, criptation, cracked pot sound, mobility
Occipitomental (10 or 30 degree) Waters view Suitable for isolated orbital fracture Search line (Campbells line 1977) www.indiandentalacademy.com Radiographical examination Lateral skull view OPG Occlusal view of the maxilla Perapical views of damaged teeth www.indiandentalacademy.com Radiographical examination CT scan 3-D CT imaging
Coronal sections Axial sections
1. Whenever intracranial damage and frontal sinus are suspected 2. Extensive fracture that involves nasoethmoid complex or orbital region 3. Orbital trauma to evaluate the degree of orbital injury and enophthalmos www.indiandentalacademy.com www.indiandentalacademy.com Indications for treatment
Physical signs of a fracture of the maxilla.
Evidence of a fractured maxilla on imaging.
Disruption of the occlusion of the teeth.
Displacement of the maxilla.
Post traumatic facial deformity.
www.indiandentalacademy.com Indications for treatment Fractured or displaced teeth.
Cerebrospinal fluid leak.
Abnormal eye movement or restriction of eye movement.
Occlusion of the nasolacrimal duct.
Sensory or motor nerve deficit.
Other evidence of loss of function www.indiandentalacademy.com Aims of treatment Relieve pain
Restore function.
Restore bone anatomy.
Prevent infection
Restore the dental occlusion
Restore jaw movement at the earliest possible stage
Restore normal nerve function www.indiandentalacademy.com Factors affecting the risk
Association with multiple injuries.
Presence of uncontrolled haemorrhage
Impairment of the airway.
Presence of bone comminution
Association with a dural tear.
Association with a base of skull fracture.
www.indiandentalacademy.com Factors affecting the risk Presence of a pre-existing dentofacial deformity.
Time elapsed since the injury.
Presence of a medical or surgical factor which would delay general anesthesia
Presence of any factor which would delay healing. (eg nutritional deficiency or alcoholism)
Stage of dental development (deciduous, mixed or permanent dentition) www.indiandentalacademy.com Factors affecting the risk Presence of fractured teeth.
Total absence of teeth (edentulous)
Inability of the patient to co-operate with treatment.
Association with fractures of the mandible especially bilateral fractures of the condyles.
www.indiandentalacademy.com Principles of treatment Closed reduction may be appropriate in cases
Simple uncomplicated fractures
Complex or comminuted fractures
Medical or surgical contraindications to open reduction
Maxillary fractures in children
www.indiandentalacademy.com Open reduction may be appropriate where
www.indiandentalacademy.com Fixation and immobilization
Extraoral fixation
Craniomandibular fixation Box-frame (pin fixation) Halo-frame Plaster of paries headcap
Craniomaxillary fixation Supra-orbital pins Zygomatic pins Halo-frame www.indiandentalacademy.com Immobilization within the tissue
Direct fixation
Transosseous wiring at fracture sites Frontozygomatic sutures Infrorbital margin Midline of the palate
www.indiandentalacademy.com Immobilization within the tissue Internal-wire suspension
Circumzygomatico-mandibular
Infraorbital border-mandibular
Frontomandibular
Pyriform fossa-mandibular www.indiandentalacademy.com Immobilization within the tissue Support via the maxillary sinus by filling materials Ribbon gauze Balloon Folly catheter Polyethylene material
www.indiandentalacademy.com Length of the hospital stay will depend on a number of factors including:
Presence of other injuries
Age and medical status of the patient
Severity of the injury
Technique employed in the reduction and fixation of the fracture
Presence or absence of medical or surgical complications
www.indiandentalacademy.com References Maxillofacial Injuries - Rowe and Williams. Oral and Maxillofacial Trauma - Raymond J.Fonseca. Maxillofacial Surgery - Peter Ward Booth. Killey's fracture of middle third of facial skeleton. Maxillofacial trauma by Robert H.Mathog. Pediatric Maxillofacial Surgery- Kaban Management Of Midfacial Fractures Joms (1993)51;960-968
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