cerebrospinal otorrhea
CSF leaking from the ears
Escape of CSF through the ear as a result of trauma to the head
cerebrospinal rhinorrhea
CSF leaking from the nose, Fractures of the sinus bones may cause cerebrospinal fluid to leak from the nose.
Waters View
requires the patient to sit or stand upright and hyperextend the neck.
nose and chin placed against the xray cassette when taken
facial bones viewed: infraorbital rims, frontal and maxillary sinuses, maxillary alveolar arch and zygomos
Caldwell View
nose and forehead placed against the cassette
view shows, the hard palate, nasal septum, orbital floor and zygoma
basal view
shows zygomatic fractures
panoramic X-ray
shows the alveolar process, mandible, posterior maxillary sinuses, and zygomas
CT SCAN hard palate plane
shows entire palate and pterygoid plates
CT SCAN mid maxillary plane
shows the zygomatic arch, temporal bone, nasal septum and turbinates
CT SCAN mid-orbital plane
displays the globe, lens and optic nerve
needles for local (tooth extraction/odontectomy)
10ml syringe w/ 25 gauge 1 1/2 in needle
needles for irrigation (tooth extraction/odontectomy)
20 ml syringe w/ 19 gauge 1 1/2 in blunt needle
Weider
instrument used as tongue and cheek depresser
McGill
an instrument used to aid and facilitate the placement of nasotracheal tubes and nasogastric tubes or to insert pharyngeal packing (throat packing)
periosteal elevator
used to detach the periosteum and gingival tissues form around the tooth prior to the use of extraction forceps.
Minnesota retractor
used to hold and retract the tongue, tissues or cheeks during surgery.
Oral procedures
not considered sterile they are clean procedures
Dry cracked lips
ointment or cream may be used
patient in supine postion with..
arms tucked at sides, headrest for stabilization
always protect the ulnar nerves
throat pack
Included in formal count. Contains a radiopaque sponge. It is moistened and placed in the nasopharynx to reduce risk of aspiration during surgical procedures. protects the airway from becoming lodged with debri or blood. Must be moved before extubation.
the labial
side of tooth closest to the lips
tongue side
lingual
cheek side
buccal
alveolar process
A bony ridge found on the inferior surface of the Maxilla and the superior surface of the Mandible which contains the sockets for the teeth.
incisors
4 front teeth used for tearing food
cuspids
lateral to the incisors;stronger;
used to grasp and shred food
bicuspids
distal to the cuspids
used to break up food into smaller portions
molars
flat topped teeth also used to break up food
three regions of a tooth
crown- portion above the gumline
root- portion below gumline
neck-junction of the crown and root
enamel
Covers the crown, hardest part of the tooth
dentin
forms majority of the crown
harder than bone
encases the pulp
pulp
contains blood vessels, nerves and connective tissue
periodontal ligament
holds root in place,made of collangenous fibers and connects the bony alveolar process and cementum of each tooth.
cementum
bone-like substance that covers the tooth from the termination of the enamel at the neck to the thickest region at the apex of the root
Simple extraction
removal of tooth from the alveolar socket with extraction foceps
Odontectomy
involves resection of the soft tissue and excision of the bone surrounding the tooth prior to removal of the tooth
done for impacted tooth
gingival probe
probe with graduated marks inserted into the gumline to determine the extent of damage to surrounding gingiva
dental drill
may be required to remove any bone preventing exposure of the tooth
osteotome
sometimes used to split tooth so it can be removed in sections if the whole tooth cant be extacted at once. Aaccompanied with a mallet
4-chromic or silk on a cutting needle
to close incision in gumline
malloclusion
abnormal alignment of the teeth
tooth extraction/ odontectomy
class II clean contaminated wound
maxillofacial procedures
surgeon typically stands at the head of the OR bed,
OR bed reversed to create knee room if the surgeon decides to sit
can be lengthy procedures, bony areas padded
can endanger airway
NPO status vital
intubation may be difficult due to distortion of bony a
reduce risk of fire
use closed ventilation system
use fire retardant endotracheal tubes
use caution when ESU in use
dural tear
condition may be treated by covering area with fat, fascia, or muscle graft or by placing a suture
graft materials
may be used to fill defects from bone loss
fill cavities to promote osteogenesis
support a weak reduction
autogenous bone grafts
harvested from iliac crest, ribs, or calvarial bone
homogeneous bone
taken from a cadaver and is obtained from a bone bank
xenograft material
coral is often used
synthetic material
such as Silastic may be used
power equipment
always in " safe" position when not in use
corneal shield
to protect the eyes
several basic techniques used repeatedly in maxillofacial procedures
placement of arch bars, wires, paltes, and screws
placement of graft material if needed
most common repair technique for craniofacial procedures
rigid fixation by plates and screws or plates alone
bone plates shapes and thickness
available in L,Y,H, and T shapes
range in thickness from .5 to .9 mm
screws
come in diameters of 1.0 to 4.0 mm
smaller screws for facial bones
larger screws for the mandible
titanium
used in craniofacial procedures because it is strong, lightweight and noncorrosive metal
Arch Bars
used to immobilize the jaw following mandibular and or maxillary fracture
maxillary bones
meet inferior to the nasal septum to form the upper jaw
point of connection is called the intermaxillary suture
articulate with the following facial bones:
inferior turbinate, lacrimal, nasal, platine, vomer, and zygomatic does not articulate with the man
frontal bones and ethmoid bones
articulate with the maxillary bones
maxillary sinus
cavity with the maxillary bone that is lined with a mucous membrane and opens into the nasal cavity
upper teeth
located in the alveolar process of the maxilla
hard palate
palatine process of the maxilla
roof of mouth
infraorbital foramen
found below the eye and contains the infraorbital nerve and artery
mandible
largest and strongest facial bone
articulates with the glenoid fossa of each temporal bone to form the synovial joint called the TMJ
3 portions of the mandible
the body, the ramus and the angle
mental protuberance
chin
body of the mandible
lies horizontally and contains the alveolar process for the lower teeth
contains the mental foramen located below the first molar tooth.
ramus
project upward at an angle from the posterior part of each mandibular body.
condylar process
posterior projection of the ramus
coronoid process
anterior projection of the ramus
temporalis muscle attaches here
TMJ
contains:
the condylar process
portions of the temporal bone
the mandibular fossa
the auricular tuberacle
the depression between the condylar process and the coronoid process is the
mandibular notch
mandibular foramen
located on the medial surface of the rami
contains the inferior alveolar nerve along with its vessels.
mental foramen
mandibular foramen
used by dentists for the injection of anesthetics
the angle
connects each ramus to the body
4 catorgories of mandibular fractures
symphysis and parasymphyseal fractures
horizontal ramus fractures
mandibular angle fractures
condyle fractures
symphysis and parasymphyseal fractures
occur along the mandible between the bicuspid teeth,
hematomas can form sublingually due to damage along the floor of the mouth.
repaired intraorally by making an incision into the anterior gingivobuccal area for reduction and placement of rigid fixation
horizontal ramus fractures
occur along the lateral portion of the mandible between the bicuspid teeth and molars
the degree of fracture dictates the type of incision
which can be intraorally or transbuccal
mandibular angle fractures
occur from the second molar to the ascending ramus
submandibular incision or preauricular incision is used
submandibular incision
the mandibular branch of the facial nerve must be protected
preauricular incision
requires the preservation of the frontal branch of the facial nerve
condyle fractures
occur within the capsular head of the manible and subcondylar fractures below the capsule.
both approached through submandibular and preauricular incisions or combo of both
Arch bars
wire of 22g, 23g, 24g and 26g
cut into 10cm segments
wire used to attach arch bars
must be precut and prestretched to prevent stretching of wire intra operatively and post operatively ensuring safety of arch bars
preparation of wire
cut segments slightly longer then needed-10cm
place cut ends of wire in jaws of 2 wire twisters and secure
twist each instrument half a turn and pull to stretch
trim the crimped ends
prepare several wires in advance
plan to use 1 wire for each viable toot
v shaped probe
facilitates placement of wires
arch bar placement
place wire
use probe
cut wire
sequence repeated on each the mandible and the maxilla
arch bars are thin strips of metal with small hooks
hooks facing down on lower jaw
hooks facing up on upper jaw
elastic band placed over hooks and tightened to immobilize
scissors or wire cutter
should accompany patient to PACU it may be necessary to open the mouth in case of vomiting or resp distress
plate and screw fixation
1. appropriate plate chosen
2. plates customized if necessary
3. correct diameter drill bit chosen and applied to drill
4. drill guide used
5. depth of hole measured
6. drill hole tapped self tapping screws available
7. screw selected, measured and loaded
7 bones of orbit
frontal, zygoma, maxilla, lacrima, ethmoid, sphenoid, palatine
orbit
contains fat to protect the eye from shock
contains connective structures to retain eyeball and allow for its motion
contains blood vessels and optic nerve
optic nerve
second cranial nerve
orbital floor
separates the eye from the maxillary sinus
thin extension of the maxillary and zygomatic bone
2 classifications of orbital fractures
floor fractures and
blowouts
involving one or more bones of the orbit
trauma to orbital floor
fractures caused by accidents, fights and falls
orbital fractures
can occur unilaterally, bilaterally, or in conjunction with other fractures
characteristics of orbital fractures
diplopia, enophthalamus, periorbital fat and muscles pinched in fracture line or herniated into the maxillary antrum, swelling and bruising
implant material for orbital floor fracture
Teflon or Silastic sheeting
must be washed and sterilized according to manufacturer's instructions
orbital floor fracture incision
with #15 blade made underneath lower eyelid on affected side
cotton swabs or weckcell sponges
used to blot blood and irrigation around incision
traction sutures
sometimes placed between the lower lashes and incision for better exposure during orbital floor fracture repair
to retract the eye
moistened orbital retractor or Teflon coated brain spatula may be placed to gently retract the eye superiorly to expose the orbital floor
freer elevator
the peristeum is incised with a 15 blade and elevated with a Freer
curved tenotomy scissors and adson forceps
used for dissection of infraorbital fat to expose the infraorbital rim
Silastic sheeting
if reduction stable
Used as permanent support on top of the orbital floor following fixation of fracture
sheeting will be prepared,customized, and sterilized
rigid fixation device
if reduction is not stable the device may be implanted followed by insertion of silastic sheeting
LE FORT I FRACTURE REPAIR
transverse maxillary
most common type of mid-facial fracture
the alveolar process of the maxilla is horizontally separated from the base of the skull
the upper jaw can be floating free in the oral cavity
bridge of the nose
where the pair of nasal bones come together
each nasal bone articulates with
the frontal, ethmoid, maxillary and opposite nasal bone
anterior view of the nasal bones
are bordered laterally by the maxilla and superiorly by the frontal bone
tip of the nose
cartilage attaches to anterior portion of the small nasal bones here to form the...
zygomatic bones (malar)
form the prominences of the cheeks and a portion of the inferior and lateral wall of the orbit
L shaped palantine bone
articulates with each other, sphenoid, athmoid, maxillary, inferior tubernate, and vomer
hard palate
separaates th nasal and oral cavities thus forming the floor and lateral wall of the nasal cavity
vomer
contributes to the posterior and inferior portion of the nasal septum
LE FORT II FRACTURES
also called panfacial fractures
may be triangular or pyramidal in shape
the vertical fracture line extends upward to the nasal and ethmoid bones.
can be unilateral or bilateral in nature
LE FORT III FRACTURES
also called panfacial fractures
located high in the mid face
fracture extends transversely from the zygomatic arches, through the orbits, and to the base of the nose.
can be unilaterally, bilaterally, alone or in conjunction with other facial fractures
pretrauma photos and dental records
can aid the surgeon in determining the proper placement of fractured facial bones
several procedures may be needed prior to fracture reduction and stabilization
this includes a tracheotomy, arch bar application, and dental impressions
LE FORT I REPAIR
a gingivobuccal incision provides best exposure of the maxilla
15 blade used on a 7 handle
gingiva injected with local and epi prior to incision
periosteal elevator such as a Freer
may be used to expose the fracture line by dissecting the gingiva from the alveolar process
reducing the fracture
if wire fixation is anticipated:
a drill hole is made on each side of the fracture line
a single wire on a wire twister is passed through each hole and pulled taut
wire is twisted clockwise, cut and the ends of the wire are imbedded in the drill hole
wire technique
can be used to apply traction by simply placing the wires through the holes and pulling the impacted maxilla up and foward
plates and screws can be employed to fixate the maxilla
plate is placed over the fracture line and secured to the bone by the compressive force of the screw. can be utilized with the wire technique or alone, and may be completed several times thru out the procedure
patency or airway
can be compromised due to swelling and hemorrhage
Rowe forceps
maxillary forceps situated intranasally and intraorally to reduce the maxilla
(le fort II and III repair)
LE FORT II AND II FRACTURES
to suspend the maxillary arch to stable bones, the suspension wires aare placed thru holes drilled bilaterally thru the zygomatic process of the frontal bone
to facilitate wire placement in le fort II and III repair
bilateral eyebrow incisions are made
the wires are passed thru behind the zygomatic arches and into to the oral cavity using the Brown needle
polyethylene buttons and foam padding
used in le for II and III repairs
a pullout stainless steel wire is looped thru the suspension wire at the eyebrow incision, pulled thru the skin at the hairline, and tied done over the button and padding
when power tools are not in use
safety is on