Middle third fractures

Dr. Mohamed Rahil(Maxillofacial surgeon)

Tikrit dentistry college

Etiology

1.RTA2. Fall from hight 3.occupational accident4.fighting5.Sport injury6.War injury

Physical characteristics of midfacial skeleton

1.middle third consist from multiple bones which is rarely fractured in isolation

2.this type of structures able to withstand considerable force from below but early fractured from other directions

3. it act as a cushion for trauma directed to the cranium

Classification of mid face fractures

• Dentoalveolar fractures• Zygomatic complex fracture• Orbital floor fracture• Nasal complex fracture• Le Fort I• Le Fort II• Le Fort III

CLINICAL PRESENTATIONS

Dentoalveolar fractures

• Damage to the teeth• Damage to the lip• Alveolar fracture

Fracture of zygomatic ((complex))

Classification of zygomatic complex fractureI . Fracture of the bodya. Minimal or no displacementb. Inward and downward displacementc. Inward and posterior displacementd. Outward displacemente. Comminution

II. Fracture of zygomatic arch a. Minimal or no displacement b. V-type fracturec. comminuted

Signs and symptoms I. Extra oral Inspectiona. Circumorbital ecchymosisb. Subconjunctival heamorrhagec. Edemad. Flattening zygoma regione. Limitation of ocular movementf. Diplopiag. Strabismush. Enophthalmosi. Limitation of mouth openingj. Unilateral epistaxis

Palpationa. Tenderness over the cheek bonesb. Tenderness and separartion at frontozygomatic

suturec. Step at inferior orbital rimd. Parasthesia of the cheek

Intra oral examination By inspectiona. Ecchymosis at the buccal vestibule in the region of

zygomatico-maxillary suture

b. Possible of occlusion gagging in molar region

By palpation

TendernessAnasthesia at the upper lip

Classificationa. Minimal or no displacement b. V- shaped displacementc. Comminuted fracture

Orbital floor fracture

Signs and symptoms

• Edema , COE , SCE , Emphysema• Unilateral epistaxis• Parasthesia within the

distribution of infra-orbital nerve

• Limitation of eye movement• Enophthalmus,diplopia,ptosis• proptosis

Invesigations

• Forced duction test• Cardinal position of the gaze• Hess chart

Forced duction test:

This test use to differentiate betweenMuscle entrapment and muscle paralysis

Radiologya. Opacity of sinusisb. Hanging drop sign

Nasal complex fracture

• Edema , SCH, COE ,lacerations• Epistaxis• Deviation of the nose• Mobility of bone• epiphoria

Signs and symptoms

LEFORT FRACTURES

Lefort I

• Clinical findings:– Facial edema– Malocclusion of the teeth– Motion of the maxilla while the

nasal bridge remains stable

LeFort II

• Clinical findings:– Marked facial edema– Nasal flattening– Traumatic telecanthus– Epistaxis or CSF

rhinorrhea – Movement of the upper

jaw and the nose.

LeFort III– Fractures through:• Maxilla• Zygoma• Nasal bones• Ethmoid bones• Base of the skull

LeFort III• Clinical findings:– Dish faced deformity– Epistaxis and CSF rhinorrhea – Motion of the maxilla, nasal

bones and zygoma– Severe airway obstruction

CSF leak

Radiograph for maxillofacial trauma

Occipitomental view

Sub-mentovertex view

Thank you for listening