4 mid face (nxpowerlite)/ dental implant courses by Indian dental academy

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Temporal

Frontal

Maxilla

Zygoma

Nasal

Ethmoid

Sphenoid

Vomer

Palatine

Lacrimal

#s are multiple www.indiandenalacademy.com

INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiadentalacademy.com

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Applied surgical anatomy •Link cranial base to occlusal plane •Protect base of skull •Thin lamellar bone •Blood supply

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Applied surgical anatomy Protect base of skull Vertical buttresses (Sicher & Tandler 1928)

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Classification 1886 Alphonse Guerin 1901 Rene Le Fort Le-Fort I, II & III

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES

Le-Fort I Fracture (Guerin # / Low level # / Floating #)

Nasal floor Pyriform rim Zygomatic buttress Pterygoid lamella Lateral wall nose Nasal septum tuberosity

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II Fracture ( Pyramidal # / Subzygomatic # )

Nasal bone Frontal bone Orbit Lacrimal bone Infraorbital foramen Maxillary antrum ZM suture www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort III Fracture

( High transverse/Suprazygomatic/Craniofacial disarticulation)

Fronto-nasal suture Ethmoid cribriform plate Frontal process maxilla Medial wall orbit Optic foramen Inferior orbital fissure Pterygoid lamella Lateral wall of orbit Z-F suture www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Clinical features

Swelling Ecchymosis Mobility Deranged occlusion Loss of function www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I : Clinical features

Swelling Ecchymosis Mobility Deranged occlusion Loss of function cracked pot sound ? mid palatal split

: minimal : intra oral, palate, sulcus : floating # : post gagging, ďƒ› V. D.

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II / III : Clinical features Swelling

: gross; (moon face) eyelids conjunctiva

Ecchymosis : bilateral circum-orbital (panda face/raccoon face) Mobility

: nasal bones, maxilla Infra orbital step (Le Fort II)

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES

Le-Fort II / III : Clinical features Deranged occlusion: post gagging ďƒ› V. D Dish face Loss of function: Diplopia? Anosmia Nares filled with clotted blood Emphysema, Epiphora, CSF Rhinorrhea,Hooding of eye www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES

CSF Rhinorrhea Le-Fort II / III #s Dural tear # cribriform plate Meningitis ??

Diagnosis Clinical

- Tram track, halo effect

Biochemical - Dipstick - ďƒ› glucose levels Radiological CT scan Radio opaque dye - sub arachnoid space www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Bilateral hooding of eyes Le-Fort II / III # Separation of F-Z suture Suspensory ligament of Lockwood Attachment medially - lacrimal bone laterally - below F-Z suture www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Radiographic examination

RADIOGRAPHS PNS view PA skull CT SCANS Axial & Coronal Views

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com

MAXILLOFACIAL INJURIES MIDFACE FRACTURES Management

ABCDE Reduction & fixation Closed v/s Open

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I fractures ORIF plates Intra oral approach Fixation of plates after reduction Pyriform rim Zygomatic buttress

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort II fractures ORIF plates Nasal #s Infra orbital rim Zygomatic buttress

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort III fractures ORIF plates Fronto-zygomatic Fronto-nasal Zygomatic buttress

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I, II & III fractures CLOSED Reduction & Fixation Suspension wires to mandible Frontal: Central & lateral Circum zygomatic

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES Le-Fort I, II & III fractures CLOSED External fixation Cranio-mandibular Box, Halo frames POP head cap

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MAXILLOFACIAL INJURIES MIDFACE FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management www.indiandenalacademy.com

Thank You www.indiandenalacademy.com