facial fractures classification

8/19/2019 facial fractures classification

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CLASSIFICATION OF FACIAL

FRACTURES

Dr ARJUN SHENOY


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INDEX

• MANDIBULAR FRACTURE CLASSIFICATION

• MIDFACE FRACTURE CLASSIFICATION

• ZMC FRACTURE CLASSIFICATION

• NOE FRACTURE CLASSIFICATION


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CLASSIFICATION OFMANDIBULAR FRACTURES


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KRUGER’S GENERALCLASSIFICATION

• SIMPLE / CLOSED

• COMPOUND / OPEN

• COMMUNITED

• COMPLICATED / COMPLEX

• IMPACTED

• GREENSTICK

• PATHOLOGICAL


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KRUGER’S GENERAL CLASSIFICATION

SIMPLE- no communication withexteio o inteio

COMPOUND- communication thou!h "#in

extena$$% thou!h muco"a o PDL


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COMMUNITED - splintering

crushed multiple pieces

&io$ent 'oce" ( hi!h &e$ocit% - )e am ( mi""i$e"

COMPLICATED / COMPLEX- *ama!e to &ita$ "tuctue"

com+$icate" teatment


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• IMPACTED – ae

one 'a!ment *i&en )m$% into theothe

c$inica$ mo&ement not a++ecia,$e• GREENSTICK -

one cotex ,o#en an* othe ,ent

incom+$ete 'actue- common chi$*en-

e"i$ience


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PATHOLOGICAL

GENERALISED SKELETAL DISEASELOCALISED SKELETAL DISEASE

Oste!rs"s# !$%ets# ste&$'$("$ste&)e'"t"s# ()sts# ORN


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ANATOMICAL CLASSIFICATION

• R*e + K"''e) C'$ss",($t"

• A Fractures not involving basal bone

• E!- *entoa$&eo$a

• Fr$(t.res "'"% t0e 1$s$' 1e

i Sin!$e uni$atea$

ii Dou,$e uni$atea$

iii Bi$atea$

i& mu$ti+$e


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DINGMAN + NAT2IG CLASSIFICATION

A S.MP/.SIS 0

B CANINE RE1ION 0

C BOD. OF MANDIBLE 0

D AN1LE RE1ION 0

E RAMUS RE1ION 0

F CORONOID RE1ION 0

1 COND.LAR 0

/ DENTOAL2EOLAR 0


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RELATION OF FRACTURE TO THE SITE OF INJURY

DIRECT FRACTURESINDIRECT FRACTURES

3COUNTERCOUP4


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COMPLETENESS

• Complete versus incomplete

56 C&!'ete 7r$(t.res

A*u$t" - u"ua$$% com+$ete - inteu+t entie$% the continuit% o'the ach

U"ua$$% mo,i$e an* ha&e &aiou" *e!ee o' *i"+$acement


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COMPLETENESS

• INCOMPLETE FRACTURES

• Do not exten* thou!h ,oth the 1.(($' an* the '"%.$' (rt"(es a" we$$ a" the a$&eo$a an* ,a"a$ ,o*e"

• Occa"iona$$% in a*u$t" 3 moe o'ten in (0"'8re

• 8"s!'$(e8 an* &1"'e

• Mi!ht not e4uie "u!ica$ teatment


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Direction & favorability of treatment

/oi5onta$$% Fa&oua,$eFactue $ine un"

*ownwa* 6 'owa* "o

u+wa* *i"+$acement

a&oi*e*

/oi5onta$$% Un'a&oua,$e

Factue $ine un" Down

7a*" an* Bac# 7a*" "o

u+wa* Di"+$acement

Une"ticte*


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VERTICALLY FAVORABLE VERTICALLY UNFAVORABLE

FRACTURE LINE RUNS FROM T/E

OUTER BUCCAL PLATE OBLI8UEL.

BAC97ARDS AND LIN1UALL. 3 MEDIAL

MO2EMENT RESTRICTED

FRACTURE LINE RUNS FROM T/E

INNER LIN1UAL PLATE OBLI8UEL.

BAC97ARDS AND BUCCALL. 3 MEDIAL

MO2EMENT UNRESTRICTED


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DEPENDING UPON THE MECHANISM

I A2ULSION FRACTURE

II BENDIN1 FRACTURE

III BURST FRACTURE

I2 COUNTERCOUP FRACTURE

2 TORSIONAL FRACTURE


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DEPENDING ON NUMBER OFFRAGMENTS

SIN1LE

MULTIPLE

COMMINUTED


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ACCORDING TO SHAPE OF FRACTURE

TRANS2ERSE

OBLI8UE

BUTTERFL.

OBLI8UE SURFACED


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Presence or absence of teeth

Kazanjian V.H. & Converse J.M.

CLASS 1 TEETH ON BOTH

SIDES OF FRACTURE

LINE

MONOMAXILLA RY

CLASS II TEETH ONLY ON ONESIDE OF THE

FRACTURE LINE

INTERMAXILLAR Y FIXATION

CLASS III EDENTULOUS PATIENT OPENREDUCTION /PROSTHESIS


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AO Classification

F NO OF FRACTURE OR FRA1MENTS

L LOCATION OF T/E FRACTURE

O STATUS OF OCCLUSION

S SOFT TISSUE IN2OL2EMENT

A ASSOCIATED FRACTURES


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F: NO. OF FRACTURES

F0 Incomplete !"ct#!e$

F1 S%n&le !"ct#!e$

F' M#lt%ple !"ct#!e$

F( Comm%n#te) !"ct#!e$

F* F!"ct#!e +%t, -one )eect


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L: Location of fracture

L1 P!e.c"n%neL' C"n%ne

L( Po$t.c"n%ne

L* An&le

L S#p!"."nl"!

L Con)le

L2 Co!ono%)

L3 Al4eol"! p!oce$$


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O: Status of occlusion

O 0 No m"loccl#$%on

O 1 M"loccl#$%on

O ' E)ent#lo#$ m"n)%-le


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A: Associated fracture

A 0 None

A 1 Dento"l4eol"! !"ct#!e

A ' N"$"l -one !"ct#!e

A ( 5&om" !"ct#!e

A * Leo!t I

A Leo!t II

A Leo!t III


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According to WHO/1997, 2003//3/ the international classification

S :;< - Factua man*i,u$ae

S :;


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LEFORT CLASSIFICATION

FRACTURES OF THE MIDFACE


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6I7EN BY THE FRENCH SUR6EON RENE LE.FORTIN 1801 AS

LEFORT I 9 II : III FRACTURES


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Provides uniform method to describe thelevel of major fracture lines .

Allows references regarding the probablepoints of stability for surgical treatment .

Does not incorporate vertical orsegmental fractures, comminution or

bone loss .


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ALSO CALLED ;• 6UERINS FRACTURE

• FLOATIN6 FRACTURE

• PTERY6OMAXILLARY

DYS


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LEFORT l


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ALSO CALLED;• PYRAMIDAL >•SUB5Y6OMATIC >

LEFORT II FRACTURE HAS A

PYRAMIDAL APPEARANCE ON THE

PA S?ULL = MAXILLA IS

SEPERATED FROM THE S?ULLBASE =

LEFORT IIFRACTURES


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LEFORT ll


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ALSO CALLED ;

• TRANS7ERSE FRACTURE• SUPRA5Y6OMATIC >• HI6H LE7EL >

•CRANIO.FACIAL DYS


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LEFORT lll


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ROWE AND WILLIAMS CLASSIFICATION -1985

A6 FRACTURES NOT IN9OL9ING OCCLUSION

I6 Cetr$' Re%"

aFactue" o' the na"a$ ,one"(na"a$ "e+tum

- Latea$ na"a$ inuie"

- Anteio na"a$ inuie"

, Factue" o' 'onta$ +oce"" o' maxi$$a

c Na"oethmoi*a$ 'actue"

* Factue" o' t%+e a3 , an* c exten*in! into

the 'onta$,one 'ontoo,itona"a$ *i"$ocation

II6 L$ter$' re%"

Factue" in&o$&in! the 5%!omatic ,one3 ach an*maxi$$a exc$u*in! *entoa$&eo$a com+onent


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ROWE AND WILLIAMS CLASSIFICATION -1985

B FRACTURES IN9OL9ING OCCLUSION

Det$'e'$r

S.1:)%&$t"(

- Le'ot I $ow $e&e$ o 1uein

- Le'ot II P%ami*a$ Factue

S.!r$:)%&$t"(

- Le'ot III /i!h $e&e$


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RELATIONSHIP OF # LINE TO ZYGOMATIC BONE

= BELO7 Z.1OMATIC

subzygomatic fracture

; ABO2E Z.1OMATIC3. Suprazygomatic fracture


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ERICH CLASSIFICATION - 1942

/ORIZONTAL

P.RAMIDAL

TRANS2ERSE


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Modified LeFort FractureClassification - 1993

Le-Fort Level Description I L* &$;"''$r) 7r$(t.re

$a Low maxi$$a% 'actue with mu$ti+$e "e!ment"

II P)r$&"8$' 7r$(t.re

IIa P%ami*a$ 'actue an* na"a$ 'actue II, P%ami*a$ an* NOE 'actue

III Cr$"7$("$' 8)s


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FRACTURE ZMCCLASSIFICATION


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SCHIELDERUP 35>?@4

TYPE 1 : Fractured zygoma hinged on maillary ! frontal attachment.

TYPE " : Fractured and hinged on maillary attachment

TYPE 3 : Fractured and hinged on frontal attachment

TYPE # : Fractured and detached enbloc.

TYPE $ : %omminuted fracture.


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KNIGHT AND NORTH’S CLASSIFICATION 5>5

1ou+ I Un*i"+$ace* 'actue"

1ou+ II Ach 'actue"

1ou+ III Unotate* ,o*% 'actue"

1ou+ I2 Me*ia$$% otate* ,o*% 'actue"

1ou+ 2 Latea$$% otate* ,o*% 'actue"

1ou+ 2I Com+$ex 'actue"


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R*e + K"''e) 35>4

T%+e I No "i!ni)cant *i"+$acement

T%+e II Factue o' the 5%!omatic ach

T%+e III Rotation aoun* &etica$ axi"

- Inwa* *i"+$acement o' o,ita$ im

- Outwa* *i"+$acement o' o,ita$ im T%+e I2 Rotation aoun* $on!itu*ina$ axi"

- Me*ia$ *i"+$acement o' 'onta$ +oce""

- Latea$ *i"+$acement o' 'onta$ +oce""

T%+e 2 Di"+$acement o' the com+$ex en ,$oc - Me*ia$

- In'eio

- $atea$ Rae


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Rowe & Killey (1968)

T%+e 2I Di"+$acement o' o,itoanta$ +atition - In'eio$%

- Su+eio$%

T%+e 2II Di"+$acement o' o,ita$ im "e!ment"

T%+e 2III Com+$ex comminute* 'actue"


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T%+e I no "i!ni)cant

*i"+$acement

T%+e II Factue o' the 5%!omatic


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%+ %!ach



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O.t*$r8D"s!'$(e&et

I*$r8D"s!'$(e&et



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T%+e I2 Rotation aoun* $on!itu*ina$ axi"


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T%+e 2 Di"+$acement o' the com+$ex en,$oc


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T%+e 2I Di"+$acement o' o,itoanta$+atition


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T%+e 2II Di"+$acement o' o,ita$ im"e!ment"


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T%+e 2III Com+$ex comminute* 'actue"


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MANSON AND COLLEAGUES (1990) :

Ba"e* on amount o' ene!% *i""i+ate* 6&ndings in %.T. Scan'

a /i!h ene!% 'actue"

, Mo*eate ene!% 'actue"c Low ene!%

'actue"


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MAR9US ZIN1 =HH;

T%+e A Incom+$ete 5%!omatic 'actue

T%+e B Com+$ete mono'a!ment 5%!omatic'actue teta*+o* 'actue

T%+e C Mu$ti'a!ment 5%!omatic 'actue


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RO2E’S + 2ILLIAM’S CLASSIFICATION

1) Fractures stable after ele*ationa. +rch only ,medially displaced)

b. -otation around the *ertical ais.

edially

/aterally

") Fracture unstable after ele*ation.

a. +rch only ,inferiorly displaced).

b. -otation around the horizontal ais.

edially

/aterally

.


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ROWE’S & WILLIAM’S CLASSIFICATION :

c Di"$ocation" en,$oc#

In'eio

Me*ia$$%

Po"teio-$atea$$% * Comminute* 'actue


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1. Group A : Stable fracture – Showing minimal or no displacement and

requires no intervention.

2. Group B : nstable fracture – !ith great displacement and distruption at

the fronto"#gomatic suture and comminuted fracture. $equires reduction

as well as fi%ation.&. Group ' : Stable fracture – (ther t#pes of "#gomatic fractures) which

requires reduction) but no fi%ation.

*. +ractures of the "#gomatic arch alone

•

,inimum or no displacement.• - t#pe in fracture.

• 'omminuted fracture.

LARSEN 6T/OMSEN CLASSIFICATION


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MALAR CLASSIFICATION

TYPE 1 : 0ndisplaced fracture.

TYPE " : +rch fracture only.

TYPE 3 : Tripod malar fracture , F intact ).

TYPE # : Tripod malar fracture ,F distracted ).

TYPE $ : Pure blo2'out fracture..

TYPE : 4rbital rim fracture.

TYPE 5 : %omminuted and other fractures


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SPIESSEL AND SCHROLL’S CLASSIFICATION:

T.PE = I"o$ate* 5%!omatic ach 'actue

T.PE ; Factue with no "i!ni)cant*i"+$acement

T.PE > Patia$$% *i"+$ace* me*ia$$% T.PE ? Tota$$% *i"+$ace* me*ia$$%

T.PE @ Tho"e with *o"a$ *i"+$acement

T.PE < Tho"e with in'eio *i"+$acement T.PE Comminute* an* othe 'actue"


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FRONTO-NASOETHMOIDAL REGION

• NOE complex fractures involve the medial vertical (nasomaxillary) buttresses of the facial skeleton


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• NOE fractures are most commonly classified according to Markowit !"# Manson$N# %argent "# et al (&''&)

• ype • ype

• ype

• hese can be unilateral or bilateral in*uries+

• $last ,econstr %urg+ -.(/)0-123/20


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Type I

• n unilateral Markowit type fractures# there is a single large NOEfragment bearing the medial canthal tendon+

• he nasal bone may also be involved and# in cases of comminution#

may not provide ade4uate dorsal support to the nasal bridge+


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Unilateral Type II

• n unilateral type fractures# there is often comminution of theNOE area# but the canthal tendon remains attached to a fragment of bone# allowing the canthus to be stabilied with wires or a smallplate on the fractured segment


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Unilateral Type II + Involvement of te na!al "one

• he nasal bone may also be involved and# in cases of comminution#may not provide ade4uate dorsal support to the nasal bridge+


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#ilateral type II fra$t%re &it na!al "one

involvement

• bone grafting of the nasal dorsum may be necessary


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Type III

• n type fractures# there is often comminution of the NOE area (asin type fractures) and a detachment of the medial canthal tendonfrom the bone+


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Type III + Involvement of te na!al "one


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#ilateral type III fra$t%re &it na!al "one

involvement


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REFERENCES

FONSECA 2OL = >* EDITION 9ILLE.S >* EDITION

RO7 AND 7ILLIAMS 2OL = PETER 7ARD BOOT/ 2OL = COMPLICATION IN ORAL AND MAJILLOFACIAL

SUR1ER.-9ABBAN

CONTEMPORAR. ORAL AND MAJILLOFACIALSUR1ER.3?th EDITION-LARR.KPETERSON3KAMESR/UPP3M.RON


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facial fractures classification