Mid Face Fractures#2 (NXPowerLite) / orthodontic courses by Indian dental academy

Part –IIPart –IIManagement Management

of of MIDFACE FRACTURESMIDFACE FRACTURES INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.comwww.indiandentalacademy.com

TreatmentTreatmentGoal is functional & cosmetic restorationGoal is functional & cosmetic restorationReestablish:Reestablish: Mid-facial height and projection (most Mid-facial height and projection (most

important)important) OcclusionOcclusion Integrity of nose and orbitIntegrity of nose and orbit

Provide structural support for proper soft Provide structural support for proper soft tissue contourtissue contour


Treatment must be indivisualisedTreatment must be indivisualised

Factors affecting treatment stratigiesFactors affecting treatment stratigies Multi-traumaMulti-trauma

Concomitant mandibular InjuryConcomitant mandibular Injury


Principles of TreatmentPrinciples of Treatment(Rodrich & Shewmake,1992)(Rodrich & Shewmake,1992)

Early 1 stage repairEarly 1 stage repair

Exposure of all # sitesExposure of all # sites

Precise Anatomic reduction & semirigid Precise Anatomic reduction & semirigid

fixationfixation

Immediate bone grafting if neededImmediate bone grafting if needed

Definitive soft tissue repairDefinitive soft tissue repairwww.indiandentalacademy.comwww.indiandentalacademy.com

Timing of Operative repairTiming of Operative repair

Initial concept - 5Initial concept - 5thth -8 -8th th dayday


Surgical ApproachesSurgical Approaches

Maxillary vestibular incisionMaxillary vestibular incision

Lower eyelid incisionLower eyelid incision

TransconjunctivalTransconjunctival

SubciliarySubciliary

Lower lid incisionLower lid incision

Coronal ApproachCoronal Approach


Reduction of Midface Reduction of Midface FracturesFractures

Most imp step.Most imp step.Universal rule of mechanicsUniversal rule of mechanicsReduction:Reduction: Manual reductionManual reduction : Fresh #, Non impacted : Fresh #, Non impacted

Hand manipulationHand manipulation

Dental compounds (1951)Dental compounds (1951)

Rubber cathaters (1966)Rubber cathaters (1966)

Special instrumentsSpecial instruments


Special InstrumentsSpecial Instruments

Rowe’s Maxillary Rowe’s Maxillary Disimpaction Forceps Disimpaction Forceps




Hayton Williams ForcepsHayton Williams Forceps


Lefort II & IIILefort II & III – –

When inadequate alignment results, When inadequate alignment results,

individual segments are reduced individual segments are reduced

separately. separately.

Direct reductionDirect reduction: Elevator, bone hook or : Elevator, bone hook or

wire inserted through the fragment. wire inserted through the fragment.

Traction using elastic bandsTraction using elastic bands applied to applied to

maxillary and mandibular arch bar can be maxillary and mandibular arch bar can be

used for reducing fraction.used for reducing fraction.


Immobilization of mid-face Immobilization of mid-face fractures:fractures:

A) A) Internal fixationInternal fixationaa..Direct osteosynthesis :..Direct osteosynthesis :

MiniplatesMiniplates

Transosseous wiring.Transosseous wiring.

High level (fronto-zygomatic and fronto-nasal)High level (fronto-zygomatic and fronto-nasal)

Mid level (orbital rim/ zygoma buttress).Mid level (orbital rim/ zygoma buttress).

Low level (Alveolar / midpalatal).Low level (Alveolar / midpalatal).


b..Suspension wires (Skeletal fixation).b..Suspension wires (Skeletal fixation).

A)Frontal :A)Frontal : Central (LeFort II & III ; Unstable mand.)Central (LeFort II & III ; Unstable mand.)

Lateral ( LeFort II & III ; Stable mand)Lateral ( LeFort II & III ; Stable mand)

b) Circum-zygomaticb) Circum-zygomatic

c) Zygomatic-frontoc) Zygomatic-fronto

d) Infra-orbital rim.d) Infra-orbital rim.

e) Pyriform aperture.e) Pyriform aperture.

f) Buttress, transnasalf) Buttress, transnasal

g) Perialveolar wireg) Perialveolar wire


B) External fixation: B) External fixation: 1) Cranio-mandibular1) Cranio-mandibular

Box frameBox frameHalo frame.Halo frame.Plaster of paris head cap.Plaster of paris head cap.

2) Craniomaxillary:2) Craniomaxillary:Supra-orbital pins.Supra-orbital pins.Zygomatic pins.Zygomatic pins.Halo frames.Halo frames.Levant Frames.Levant Frames.


Lateral frontal wire:Lateral frontal wire:


BOX FRAMEBOX FRAME


Central frontal wire:Central frontal wire:


2) Circum zygomatic:2) Circum zygomatic:


3) Zygomatic buttress and pyriform:3) Zygomatic buttress and pyriform:


Infra-orbital wiringInfra-orbital wiring..


Various –Various – Plaster of paris.Plaster of paris.Halo frame.Halo frame.Box frame.Box frame.Levant frame.Levant frame.

IndicationIndication – Presence of anteroposterior instability – Presence of anteroposterior instability of the facial skeleton (i.e. concomitant B/L of the facial skeleton (i.e. concomitant B/L condylar # of mandible).condylar # of mandible).

DisadvantageDisadvantage: Appliances are cumbersome, : Appliances are cumbersome, conspicuous is lead to lengthen the period of conspicuous is lead to lengthen the period of hospitalization.hospitalization.

Contraindicated Contraindicated : Presence of mental confusion, : Presence of mental confusion, cerebral irritation, epilepsy and alcoholism. cerebral irritation, epilepsy and alcoholism.


Halo FrameHalo Frame..


BOX FRAMEBOX FRAME


LEVANT FRAMELEVANT FRAME


Internal FixationInternal Fixation- Michelet first introduced miniplate in - Michelet first introduced miniplate in facial # 1972. facial # 1972. Monocortical semi-rigid fixation with Monocortical semi-rigid fixation with plates or screws:plates or screws: Provides three diamenssional stabilityProvides three diamenssional stability resists antero-posterior and rotatory bony resists antero-posterior and rotatory bony

movements. movements. Allows primary bony healingAllows primary bony healing


Different configuration X,H, L,T and Y Different configuration X,H, L,T and Y shapes. shapes. Various material likeVarious material likeStainless steelStainless steelTitaniumTitaniumVitallium (Cobalt-chromium and Vitallium (Cobalt-chromium and molydenum)molydenum)Resorbable bone plates and screws Resorbable bone plates and screws (Polylactide, polyglycolic copolymer)(Polylactide, polyglycolic copolymer)





MAXILLOFACIAL INJURIESMAXILLOFACIAL INJURIES

ABCDE

Reduction & fixation

Closed v/s Open

MIDFACE FRACTURESManagement



GK / MAXFACGK / MAXFACSDM DHARWADSDM DHARWAD

Le-Fort I fractures ORIF plates

Intra oral approachFixation of plates after reductionPyriform rimZygomatic buttress

MIDFACE FRACTURES




Le-Fort II fractures ORIF plates

Nasal #s

Infra orbital rim

Zygomatic buttress

MIDFACE FRACTURES




Le-Fort III fractures ORIF plates

Fronto-zygomatic

Fronto-nasal

Zygomatic buttress

MIDFACE FRACTURES




Le-Fort I, II & III fractures CLOSED

Reduction & Fixation Suspension wires to mandibleFrontal: Central & lateral Circum zygomatic

MIDFACE FRACTURES




Le-Fort I, II & III fractures CLOSED

External fixationCranio-mandibularBox, Halo frames POP head cap

MIDFACE FRACTURES


Thank youThank you

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Mid Face Fractures#2 (NXPowerLite) / orthodontic courses by Indian dental academy