FaciaI trauma

DR : RAMI ELIAS SAAB

CONSULTANT OF ORAL &
MAXILLOFACIAL SURGERY
1he term fac|a| trauma means any |n[ury to the face or
upper [aw bone Iac|a| traumas |nc|ude |n[ur|es to the
sk|n cover|ng under|y|ng ske|eton neckear nasa|
(s|nuses) orb|ta| socket or ora| ||n|ng as we|| as the
teeth and denta| structures Sometimes these types of
injuries are caIIed maxiIIofaciaI injury Iac|a| trauma |s
often recogn|zed by |acerat|ons (breaks |n the sk|n)
bru|s|ng around the eyes w|den|ng of the d|stance
between the eyes (wh|ch may |nd|cate |n[ury to the
bones between the eye sockets) movement of the
upper [aw when the head |s stab|||zed (wh|ch may
|nd|cate a fracture |n th|s area) and abnorma|
sensat|ons on the cheek
at is faciaI trauma"
!hoto at time of
admission in
emergency
department, showing
extent of injuries
After reconstructive...
skin covering
3D
Ct /scan
CIassification of Injury
W Contusion
W Abrasion
W AccidentaI Tattoo
W Retained Foreign Bodies
W !uncture Wounds
W SimpIe Laceration
W AvuIsion (fIap)
W AvuIsion (compIete)
Contusions Abrasion
AccidentaI Tattoo
AvuIsion
puncture wound
looss of tissue
case report
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a b
c
SpeciaI regionaI considerations
AII injuries need to be copiousIy irrigated and have aII
foreign bodies removed. 5impIe Iinear Iacerations with
good hemostasis can be cIosed with stapIes. CIose more
extensive Iacerations, Iacerations with profuse bIeeding,
or Iarge avuIsions of the nonabsorbabIe sutures
encompassing aII Iayers of the scaIp. This method
usuaIIy achieves good hemostasis.
Lacerations
BIunt or penetrating trauma can cause injury to the
midface region, which incIudes the upper jaw
(maxiIIa). Common causes of faciaI injury incIude:
AutomobiIe accidents ,Penetrating injuries , VioIence
Causes
Occupation
accident.
AnimaI
bite.
Home
vioIence
Sport
accident
Gunsot wound sustained injury to
te Face, CIosure / Traceostomy
FaciaI X-Ray
Gunsot wound sustained injury to te Face
patoIogicaI truma.
a b
c
Exams and Tests
Te doctor wiII perform a pysicaI exam, wic may sow:
.BIeeding from the nose, ear, eyes, or mout, or nasaI obstruction
.Bruising around the eyes or widening of the distance between the
eyes, which may mean injury to the bones between the eye sockets
.Lacerations (breaks in te skin)
Te foIIowing may suggest bone fractures:
.AbnormaI sensations on the cheek and irreguIarities that can be feIt
.An upper jaw that moves when the head is stiII
.A CT scan of the head may be done .
Diffirent types of x-rays
CIinicaI signs & symptoms
Traumatic teIecanthus
NormaI intercanthaI distance = 33-34 mm
>35 mm may indicate NOE disruption
.Damage to IacrimaI apparatus => (epipora)
.CSF Ieak
BattIe Sign
Racoon sign
train sign
.Depression or anguIation
.!eriorbitaI ecchymosis
.Epistaxis
.Tenderness
.Crepitus
.SeptaI deviation
.SeptaI hematoma
.RuIe out septaI hematoma
.Remove cIots with suction
.incise and drain if present to prevent septaI
necrosis
.CIosed reduction for simpIe fractures
.Open reduction for severeIydispIaced fractures
NasaI Fractures
Treatment
cIinicaI observation
Tis pictures sows a septaI
hematoma on both sides of the
nose. The bIack arrows point to
the Iining of the septum that is
baIIooned up by underIying bIood
ControI epistaxis.
Drain septaI hematomas.
Refer patients to ENT as outpatient
Tis cIinicaI potograp
sows septaI hematoma.
CIinicaI photograph shows deIayed
drainage of septaI hematoma resuIting in
infection. This patient did not present to
the emergency room untiI week
foIIowing sustaining nasaI trauma
Traumatic teIecanthus secondary
to nasoorbitoethmoid fracture.
IntercanthaI distance is( 39 mm).
!ostoperative view of patient, demonstrating
normaI intercanthaI distance (33 mm) after
resuspension of the mediaI canthaI Iigament
and fixation of the nasoorbitoethmoid
component.
NasaI-OrbitaI-Etmoid Fractures
.Epistaxis.
.Severe periorbitaI edema &
Ecchymosis.
.SubconjunctivaI hemorrhage.
.Comminuted With posterior dispIacement.
.Widened nasaI bridge.
.SpIaying of nasaI compIex.
NasaI emorrage
.Epistat
.FoIey cathe
.NasaI packing
.MeroceI sponge
.NasopharyngeaI baIIon
y is faciaI trauma different in ciIdren tan aduIts?
FaciaI trauma can range between minor injury to
disfigurement that Iasts a Iifetime. The face is criticaI in
communicating with others, so it is important to get the
best treatment possibIe. !ediatric faciaI trauma differs
from aduIt injury because the face is not fuIIy formed and
future growth wiII be a factor in how the chiId heaIs and
recovers. (Certain types of trauma may cause a deIay in
te growt or furter compIicate recover) . DifficuIt
cases require physicians with great skiII to make a repair
that wiII grow with your chiId.
trauma
Pediatric
faciaI
Certain
types of
trauma may
cause a
deIay in te
growt or
furter
compIicate
recovery
a b c
d e f
Treatments
Surgery is needed if the person cannot function normaIIy
or if there is significant deformity.
.ControI bIeeding
.Create a cIear airway
.Fix broken bone segments with titanium pIates
and screws
.Leave the fewest scars possibIe
.RuIe out other injuries
.Treat the fracture
.Treatment shouId be immediate, as Iong as the
person is stabIe and there a no neck fractures
or Iife-treatening injuries
Te goaI of treatment is to:
NECK FRACTURES
Neck coIIar
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c
!atients generaIIy do very weII with proper treatment. The
patient shouId gentIy be toId that they wiII probabIy Iook
different than they did before their injury, and that additionaI
surgeries may be needed 6-12 months Iater.
Prognosis
GeneraI compIications incIude, but are not Iimited to:
.BIeeding
.FaciaI asymmetry
.Infection
.NeuroIogic compIications
PossibIe CompIications
en to contact a medicaI professionaI
Go to the emergency room or caII the IocaI emergency
number if you have a severe injury to your face.
MAXILLARY FRACTURES
(Low MaxiIIary) (PyramidaI) (CraniofaciaI Dysjunction)
Rene Le Fort : Frenc surgeon (9-95)
PrevaIence of mid-face fractures
Fracture Type Fracture Type PrevaIence PrevaIence
ZygomaticomaxiIIary ZygomaticomaxiIIary compIex (tripod compIex (tripod
fracture) fracture)
40 % 40 %
LeFort LeFort
5 % 5 %
0 % 0 %
0 % 0 %
Zygomatic Zygomatic arc arc 0 % 0 %
AIveoIar process of maxiIIa AIveoIar process of maxiIIa 5 % 5 %
Smas fractures Smas fractures 5 % 5 %
Oter Oter 5 % 5 %
ZYGOMATICOMAXILLARY & ORBITAL FRACTURES
MUSCLE ENTRAPMENT
W This chiId presented with dipIopia foIIowing bIunt
trauma to the right eye. On exam, he was unabIe to
move his right eyebaII up on upward gaze.
The faciaI skeIeton is one of the most compIex arrangements of
curving bony surfaces in the body. Today, faciaI imaging is most
successfuIIy performed with CT.
a b
C d e
CT: BIowout Fracture of Orbit
A: OrbitaI bIowout fracture with dispIacement of the
fIoor (arrow), distortion of the inferior rectus, and
herniation of orbitaI fat through defect. Arrowhead
indicates mediaI fracture.
B: Note opacified Ieft anterior ethmoid air ceIIs and
dispIaced mediaI orbitaI fracture (arrowheads).
A B
IsoIated injuries to teeth are quite common and may
require the expertise of various dentaI speciaIists.
Because of the specific needs of the dentaI
structures, certain actions and precautions shouId
be taken if a chiId has received an injury to his or
her teeth or surrounding dentaI structures.
W If a tooth is " knocked out , it shouId be pIaced
in saIt water or miIk. The sooner the tooth is re-
inserted into the dentaI socket, the better chance it
wiII survive. Therefore, the patient shouId see a
dentist or oraI surgeon as soon as possibIe.
W Never attempt to " wipe te toot off since
remnants of the Iigament which hoId the tooth in the
jaw are attached and are vitaI to the success of
repIanting the tooth
Injuries to te teet and surrounding dentaI structures styIe
!anfaciaI fracture showing
characteristic anterior open
bite deformity which is
commonIy associated with
Le Fort fractures. MuItipIe
dentoaIveoIar injuries are
present.
CIinicaI photographs show paIataI
dispIacement of an aIveoIar
fracture comprising right centraI
and IateraI maxiIIary incisors.
case report
DentoaIveoIar
a b
c
CIinicaI photographs showing extrusion of the coronaI fragment
IntraoraI fiIms wiII show the root fracture usuaIIy diagonaI and
Iocated in the apicaI, middIe, or cervicaI third of the root, or
combinations of these (middIe cervicaI).
The tooth is out of its socket, and
radiographic examination has
excIuded intrusive Iuxation. The
patient frequentIy presents the
tooth exhibiting with varying
degree of contamination,
periodontaI Iigament injury, and/or
dryness, unIess kept moist.
InhaIed tooth SwaIIowed tooth
FrontaI and paIataI view of
Ieft centraI maxiIIary incisor
with IateraI Iuxation. The
tooth is onIy attached to the
paIataI mucosa, and it is
dispIaced in paIataI direction.
IntraoraI fiIms wiII show the tooth
axiaIIy disIocated out of its socket
with partiaI or totaI Ioss of bony
attachment. In this case, there is a
totaI Ioss of periodontaI attachment
to the bone, and the tooth is
retained soIeIy by the paIataI
mucosaI attachment.
The Ieft centraI maxiIIary incisor is intruded in haIf its crown
Iength in apicaI direction.
. X-ray shows the same patient case report
case report
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d f e
3/mont Iater
case report
a
b
c
case report
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c d
case report
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c d
/mont post operative
case report
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d c
direct post operative
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c
One week
post operative
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c d
3 / week post operative
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c
d
case report
a b c
d
a b c
d e f
Intraoperative vision
case report
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c
Intraoperative vision
a b c
d e f f
!ostoperative frontaI view
of patient, demonstrating
good faciaI symmetry
InitiaI cIinicaI presentation
of a patient with panfaciaI
fracture
Large steIIate upper Iip
Iaceration demonstrating
comminution of anterior
a b
c
case report
CoronaI access to nasaI and
mediaI orbitaI components.
Fixation of zygoma and
zygomatic arch.
Fixation of nasoorbitoethmoid
component.
Comminuted zygomatic arch.
a b
c
d
Intraoperative vision
case report
Pre operativer Post operative
/ mont postoperative
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b
c
Tree-dimensionaI post operative
case report
FaciaI trauma can range between minor injury
to disfigurement that Iasts a Iifetime. The face
is criticaI in communicating with others, so it
is important to get the best treatment possibIe.
Te End
FaciaI Iacerations, oraI trauma and dentaI
trauma are the most common injuries. The
majority of patients are deaIt with ,without
admission or referraI to another speciaIity.
ConcIusions
THANK YOU
DR : RAMI