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
12. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Mechanism of Injury
Direct & Indirect
In-bending at area of impact
Out-bending of weak areas (distant)
Dislocation
posterior
inferior
medial
lateral
GK / MAXFAC
SDM DHARWAD
38. MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Management
Diplopia & Enophthalmos
Surgical & surgical only
Create a new floor
Bone
Cartilage
Metal: titanium
GK / MAXFAC
SDM DHARWAD
39. MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Management
Incidence – 2 / 62
Reconstruct floor to prevent
enophthalmos & diplopia
SDM
DHARWAD
Prominent position – frequently fractured
Either alone or in combination with other bones of midface
Fractures include disruption of any of 5 articulations
Articulates with
zygomatic process of maxillary bone: infraorbital rim
Zygomatic process of temporal bone :in front of the glenoid fossa
External angular process of frontal bone:to form fz suture
With in orbit articulates with medially orbital floor & laterally G.W.sphenoid
By virtue of its attachments
Forms floor & lateral wall of orbit & roof and lateral wall of maxillary sinus
Arch: contributions from three bones temporal, zygomatic & maxillary
Muscle attachments
Nerves
Z facial br of zygomatic nerve enters orbit through inferior orbital fissure divides into
Z temporal which supplies area around zf suture & z facial which passes along inferior and lateral surface of the orbit exciting through a foramen on malar eminence to supply that area
Infraorbital nerve through posterior margin of inferior orbital fissure, travels through a in its first 2/3rds of its course obliquely and medially across orbital floor and then through a canal in the infraorbital rim to exit the zygoma @ 1cm below the infraorbital rim grove
Direct violent forces to cotralateral side can cause disruption of zygoma due to reciprocal transfer of forces but not common, bilateral zygoma fracutres are usually in association with other facial bones involved as in lefort 3 and is because of higher energy involvemnt.
Fractures are dislocated posteriorly,inferiorly & medialy are most frequent. Orbital #s are compressed with overlapping # fragments & while reducing, orbital fractures become more severe. These are impacted fractures
More extensive injuries are dislocated posteriorly inferiorly and laterally. The arch and soft tissue attachments must be disrupted to permit this.
Any zygomatic complex fracture should include a discontinuity along the floor of the orbit.
The direction of dislocation involves the rotation of the bone in several planes this has resulted in several classifications
This should be the first slide
Loss of prominence of malar eminence may partially conceled by soft tissue swelling
Proptosis due to swelling with in muscular planes and tissue planes
Echymosis and hematoma usually confined to distribution of orbital septum spectacle hematoma
Epistaxis on ipsilateral nostril secondary to hemorrhage into maxillary sinus
Clinical pictures to be added.
Paresthesia V2 contusion or compression of nrve by bone fragments within the area of infraorbital foramen specially medially displaced fractures and will resolve only after elevation of fracture.
Limitation in mouth opening due to swelling with in muscular and soft tissue planes, medially displaced arch, and posteriorly displaced body
Difference betwqeen proptosis & exopthalmos
This should be the first slide
Tetanus immunization schedule microbiology of tetanus check with dinesh
Fully immunised : last dose with in 10yrs .5ml toxoid
Partially immunised: more than 10yrs .5ml toxoid
Immediate intervention nessasary
Prevent
Enopthalmos
diplopia
Approach through blepharoplasty incision for floor medial and lateral wall
Sub conjunctival approach with lateral canthplexy alternative
Aim to reconstruct the floor / medial wall
Choice of graft : calvarium