Maxillofacial Trauma

Epidemiology

• Nasal bones is the most common isolated facial boen fracture (largely due to the prominence and central location of the nose on the face and weakness of the nasal cartilage) followed by mandibular fracture which is the second most common
• most common causes of facial fractures are interpersonal violence and motor vehicle accidents
• other causes are falls, sporting injuries, and industrial injuries

Biomechanics of trauma

• injury identification
• injury classification
• injury prevention
• nature of injury - degree of force, resistance to force
• severity of injury, direction of force point of application force
• pattern of injury

Definition

• trauma can be defined as the application of excessive energy to the huma body above its tolerance, resulting in damage

Types of injuries

Blunt

• motor vehicle accidents
• falls

Penetrating

• Stab wounds
• firearm injuries

Falls

Interpersonal violence

• using instruments or fists
• can case fracture of the mandible
  • usually not as dramatic as nasal fractures, lingual hematoma is the classical picture of a fractured mandible
  • other signs include
    • deragned occlusion
    • numbness
• Nasal fracture

Reports of Assault

In your notes you have to specifically put allege assault

• say what your findings are too

Sports Injuries

work related injury

• these guys are elgibile under workers comp so you need to write a good report

Knife wound

• Dont pull out!

Ballistics

• Entry wound might be small but exit wound will cause soft tissue damage

Other

• Dog bites
• Kicked by horse

Types of fracture

• Most likely in the face
  • Communiuted -breaks into many fragments
  • simple/closed - break does not penetrate skin
• compound/open-broken bone penetrates skin
• Compression - bone is crushed
• Depressed bone is broken inwards
• etc

Radiographs

Mandibles

• systematic start from one condyle to the next
• try and get 2 views at 90 degrees, so an OPG and a PA mandible

Maxillary fractures

• In the tooth bareing maxilla
  • tooth may devitalize
• Usually you take a n OM view

Writing a report

• Name
• Practice
• Qualifications
• Ahpra dental number

I, Ayham Qawas , APHRA number, Qualifications are Saw patient X DOB , x was hit on the cheekbone, was treated at x place My findings are : XXX

• you can charge the health fund for writing a report

Isolated zygomatic arch fractures

• If the arch is really depressed it might make it difficult for patient to open mouth , they’ll present with difficulty with function

Base of skull

• Symptoms include bruising behind the ears, bruising around the eyes, or blood behind the ear drum
• A CSF leak occurs in about 20% of cases
• Result in fluid leaking from the nose or ear

Head Injury

Contact (head strike)

• Scalp laceration
• skull fracture
• coup
• epidural haematoma
• SDH (subdural haematoma) Acceleration (violent head motion)
• concussion
• contrecoup
• SDH
• DAI