Major Topic Abbreviation

347 Pages·2003·6.94 MB·English

ORAL SURGERYIPAIN CONTROL
LEGEND
Major Topic Abbreviation
Adrenal cortex Adren Cort
Anatomy Anat
Anesthesia Anesth
Biopsy Biopsy
Disorders/Conditions Disord/Cond
Drugs Drugs
Exodontia Exo
Fractures Fractures
General Information Gen Info
Implants/Grafts Impl/Grfts
Miscellaneous Misc.
TMJ TMJ
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Fractures
ORAL SURGERY/PAIN CONTROL
The treatment of a mandibular fracture using only intermaxillary fixation (IMF) is
called:
• Openreduction
• Closedreduction
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• Closed reduction
" 'ItiscalledclosedreductionbecauseitdoesnotInvolvedirectopening,exposure,andmanip
ulationofthefractured area.
Formsof immobilizationofafracture:
1. Abarton bandage is the simplest form of immobilization. Primarily a first aid measure
untildefinitivetherapycanbeinstituted.
2. Intermaxillary fixation (IMF) is establishing a proper occlusal relationship by wiring the
teeth together.This method will successfully treat mostfractures of the mandible.The
main methodsforsuch fixation are wiring,arch bars,and splints.This isthe classical way
to Immobilizethe fractureafterclosed reduction.
3. External skeletal fixation is used in most cases in which the management of a fractured
bonesegmentisnotsatisfactorilyaccomplishedby intermaxillaryfixation.Itinvolvesthe
placement of screws or pins through the skin on each side of the fracture and a cold cure
acrylicbarwhichholdsthescrewsinproper relationshipwiththefractureinthereducedposi
tion.Itiscumbersomeandestheticallydispleasing.
4. Direct intraosseous wiring combinedwithaperiodofIMF isthetraditional methodofbone
stabilizationafteropen reduction.Thismethodofstabilizationcan beaccomplishedthrough
avarietyofdifferentwiringtechniques.Thewireisplaced throughholesoneitherside ofthe
fractureandimmobilizationisaccomplished bytighteningthe wires.
Fractures
ORAL SURGERYIPAIN CONTROL
Zygomatic arch fractures can be nicely demonstrated by which radiographic view?
• Water's view
• Lateralskull view
• Posteroanterior skull view
• Submental vertex view
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• Subment&yerfex view
Thistypeoffracture maynotcauseanyproblemotherthan perhaps aslight sinkingof
thecheekbonearea.There maybe someencroachment and impairment inclosure of
thejaw ifit comesdownand entrapsthe coronoidprocess ofthe mandible.
Possible complications include:
• Paresthesia (mostcommon) - usuallysubsides
• Theantrum (sinus)may befilled with ahematoma, whichusuallyevacuatesitself
• Ocularmusclebalancemay beimpairedbecauseoffractureoftheorbitalprocess
Important: Fractures of the facial bones, particularly the zygomatic complex may
on rareoccasionsbe complicated by damage to the contents of the superior orbital
fissure.
Note: Fractureofthe infraorbital rim presents withthefollowing symptoms:
• Numbnessofthe followingareason theaffected side: upper lip,cheek,andnose.
Remember: TheWater's view isbestto evaluateorbital rimareas.
....
Fractures
ORAL SURGERYIPAIN CONTROL
Which of the following is the most common pathognomonic sign of a mandibular
fracture?
• Nasalbleeding
• Exophthalmos
• Malocclusion
• Numbnessintheinfraorbitalnervedistribution
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• Malocclusion
Othersignsand symptons ofa mandibularbodyoranglefracture include:
• Lowerlipnumbness
• Mobility,pain,or bleedingatthefracture site
Anatomic distribution of mandibularfractures:
• Angle (30%)mostcommon site
• Condylar neck (25%)
• Symphysisarea (22%)
• Body (17%)
• Ramus (2%)
• Coronoidprocess (1%) leastcommon site
Notes:
1. Indicationsforopenreduction includecontinuedgross displacementofthebony segments
andanunfavorablefracture that islikelyto result infurtherdisplacementofthe fractured seg
ments caused by muscle pull,This type of reduction is commonly performed for displaced
angleor bodyfractures. Remember: Condylarneckfracturesare usuallytreated byclosed
reduction.
2. Inafractureinvolvingtheangleof anedentulousmandible,theproximalsegmentisusu
allydisplaced anteriorlyand superiorly.
Fractures
ORAL SURGERYIPAIN CONTROL
Inpatientswhohavea LeFort IIfracture, acommon finding isparesthesia overthe
distribution of the:
• Infraorbitalnerve
• Inferior alveolarnerve
• Mylohyoid nerve
• Hypoglossalnerve
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• Infraorbital nerve
Midfacialfractures includefracturesaffectingthemaxilla,thezygoma,andthenasoorbitaleth
moidcomplex.Midfacialfractures canbeclassified as:
• LeFort I (alsocalleda horizontal fracture) isa horizontal segmented fracture ofthe alveolar
processofthemaxilla,inwhichtheteeth areusuallycontained inthedetached portionofthe
bone.Resultis anopen bite.
• LeFortII(alsocalledapyramidalfracture) isaunilateralorbilateralfractureofthemaxilla,in
whichthebodyofthemaxillaisseparated fromthefacial skeleton andtheseparatedportion
is pyramidal in shape. Signs include periorbital edema, ecchymosis, subconjunctival
hemorrhage, and nose bleeding.
• LeFort III (alsocalledatransverse fracture or craniofacialdysfunction)isafracture inwhich
theentiremaxillaand oneor morefacial bones arecompletely separated from thecraniofa
cialskeleton.These patients will have restriction of mandibular movement.
• Also zygomaticomaxillary complex fractures, zygomatic arch fractures, or nasoorbital eth-
moidfractures.
Important:Thefirststepinthetreatmentofthesefractureswhichaffecttheocclusalrelationship
issimilartothetreatmentofmandibularfractures- toreestablish aproperocclusal relationship
byplacingthemaxillaintoproperocclusionwiththe mandible.
Note: Duetotheslopeofthe sphenoid bonecomprising thefloor ofthecranialvault, blowsto
themaxillawillcausethe maxilla to bedriven backwards and downwards.This may result in
anopen bite or Impingementof the airway.
Fractures
ORAL SURGERY/PAIN CONTROL
All of the following are weak points in the mandible where fractures are most com
monexcept
• Theangle
• Thecoronoidprocess
• Thecondylar neck
• Thesymphysisarea
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