Maxillofacial Injury

新光醫院急診科; 報告者: 梁偉成醫師; 指導者: 張志華醫師

Maxillofacial Injury: Anatomy

Maxillofacial Injury: Radiologic Evaluation

Facial Series
Mandibular Series
Panorex
CT

Standard Facial series

Waters View (occiptomental)
Caldwell View (occiptofrontal)
Lateral View
Submentovertex View
Maxillofacial Injury

Waters View

Most Valuable
Screening Tool
Evaluation Midface
Dolan Evaluation Method
Four Curvilinear To Observing For Asymmetry

Waters View

Normal

Water Views

Blow-Out Fracture

Caldwell View

Evaluation The Upper And Middle Thirds Of The Face

Lateral View

Frontal Sinus
Maxillary Sinus
Pterygoid (Le Fort Fracture)

Submentovertex View

Zygomatic Arch

Standard Mandibular Series

Right Lateral Oblique
Left Lateral Oblique
PA View
Townes View

Standard Mandibular Series: PA View

Lower Ramus
Angle
Body

Standard Mandibular Series: Lateral Oblique Views

Condylar
Coronoid Processes
Ramus
Angle
Body

Standard Mandibular Series: Townes View

Condylar

Standard Mandibular Series: Mandibular Symphysis

Occlusal View
Panoramic View

Standard Mandibular Series: Occlusal View

Special Dental Film
Symphysis
Alveolar Processes
Maxillofacial Injury

Standard Mandibular Series: Panoramic View

Single Most Useful Film In Diagnosis Of Mandibular Fracture

Standard Mandibular Series: Panoramic View

Fracture of Condylar Process, Ramus, Body Of Mandible

Conventional Radiography VS CT

Plain Film
Economic
Diagnostic Base
Screening Tool
Providing Orientation And Direction To CT
Associated Tissue Injury
Comminution And Displacement Of Fracture
Three Dimension
Planning Surgical Treatment
Maxillofacial Injury

CT

Axial
Coronal
Three-Dimensional Reconstruction

Le Fort Fractures

Le Fort I Fracture = Horizontal Fracture
Le Fort II Fracture = Pyramidal Fracture
Le Fort III Fractures = Craniofacial Separation

Le Fort Fractures: History

Mechanism
Does your bite feel normal?
Is your upper lip, side of nose, or upper gingiva numb?
Does your jaw hurt? Where?

Le Fort Fractures: Clinical Examination

Inspection
Palpation
Grasp The Anterior Maxillary teeth With Thumb And Finger

Le Fort Fractures: Management = ATLS

A – Airway And C-spine
B – Breathing
C – Circulation And Stop Bleeding
D – Disability

Le Fort Fractures: Life-Threatening Problems

Airway
Bleeding
Associated Injury

Le Fort Fractures: Airway

Asphyxia
Fractures of the mandible and maxilla can cause compromise by posterior displacement of bony fragments of attached soft tissue into the pharynx
Tonque posterior displacement due to unconsciousness patient
Foreign material obstruction
Such as teeth, denture fragments, glass, or vomitus
Vascular injury (neck)
Edema and hematoma occlude the airway
Orotracheal Intubation
Cricothyreotomy
Tracheostomy

Le Fort Fractures: Bleeding

External compression bleeding wounds
Nasal packing

Le Fort Fractures: Associated Injuries

Head Injury
C-spine Injury
Chest Trauma
Cardiac Trauma
Abdominal Trauma

Thank you