Maxillofacial Trauma I Flashcards Preview

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Flashcards in Maxillofacial Trauma I Deck (60)
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1
Q

etiology of maxillofacial trauma in pediatric population

A

falls

2
Q

etiology of maxillofacial trauma in children and adolescents

A
  1. sports and playground

2. child abuse

3
Q

what percent of physical trauma from abuse seen on children and adolescents occur in the head and neck?

A

50%

4
Q

etiology of maxillofacial trauma in adult population

A
  1. interpersonal violence
  2. moter vehicle collisions
  3. sports injuries
  4. work-related injuries
5
Q

what percent of MVC (motor vehicle collisions) survivors have facial injuries?

A

50-70%

6
Q

when does maxillofacial examination occur?

A

after Advanced Trauma Life Support (ATLS) has been completed and the patient is stabilized

7
Q

evaluation of maxillofacial trauma

A
  1. immediate assessment
  2. H&P
  3. radiographic exam
  4. assessment
  5. plan
8
Q

extraoral mandibular exam includes what?

A
  1. palpation inferior border and TMJ
  2. ROM and excursive movements
  3. V3 status
9
Q

intraoral mandibular exam includes what?

A
  1. floor of mouth hematoma
  2. malocclusion
  3. alveolus
  4. teeth
10
Q

what is included in the radiographic exam of the mandible?

A
  1. panorex
  2. CT scan

there’s other radiographs you can take but these are the two Dr. Eman wants us to know

11
Q

floor the the mouth hematoma is pathognomonic for what?

A

symphyseal fracture (symphysis of mandible fracture)

12
Q

tx of intrusion

A
  1. compression fracture of alveolus to accommodate new postion
  2. metallic sound upon percussion
  3. allow passive eruption of deciduous teeth
  4. orthodontic traction
  5. stabilize 2-3 months
13
Q

tx of extrusion and lateral displacement

A
  1. reposition tooth fully at socket

2. splint for 1-3 weeks

14
Q

goal of tx for avulsed tooth

A

maintain periodontal attachment

15
Q

T/F: you should scrape or sterilize the roots of an avulsed tooth

A

false

16
Q

physiological movement of avulsed teeth allows what?

A

fibrous instead of osseous attachment of the root to the alveolar bone

17
Q

what can you use to transport avulsed tooth?

A
  1. saliva
  2. saline
  3. milk
  4. Hank’s solution
  5. ViaSpan
18
Q

which dentoalveolar injury has the worst prognosis? 2nd worst?

A

intrusion then lateral displacement

19
Q

tx of avulsed tooth with OPEN apex <2 hours after the the accident

A
  1. replant immediately if possible
  2. transport in Hanks or milk (good for 30 minutes)
  3. doxycycline 1 mg/20ml for 5 minutes
  4. L.A., socket irrigation, tetanus, abx
  5. replant
  6. splint for 7-10 days
  7. apexification (CaOH)
20
Q

tx of avulsed tooth with CLOSED apex <2 hours after the the accident

A
  1. store in Hank’s solution for about 30 minutes
  2. replant
  3. splint for 7-10 days
  4. perform endodontic cleansing and shaping of canal at time of splint removal
  5. fill canal with CaOH (6-12 mo)
  6. perform final gutta-percha obturation (~6-12 mo)
21
Q

tx of avulsed tooth >2 hours after the the accident

A
  1. replant immediately if possible
  2. transport in Hanks or milk (30 minutes)
  3. bathe tooth in sodium hypochlorite for ~30 minutes vs manual debridement of periodontal ligament
  4. perform extra-oral RCT
  5. bathe tooth in citric acid (~3 min)
  6. bathe tooth in 1% stannous fluoride (~5 min)
  7. transfer to 1 mg/20mL doxycycline bathe for 5 min
  8. L.A., socket irrigation, tetanus, abx
  9. replant
  10. splint for 7-10 days
22
Q

how long should you stabilize mobile teeth?

A

3-4 wks

23
Q

how long should you stabilize displaced teeth?

A

3-4 wks

24
Q

how long should you stabilize root fracture?

A

2-4 months

25
Q

how long should you stabilize reimplanted tooth (mature)?

A

7-10 days

26
Q

tx of alveolar fractures

A
  1. reduction
  2. stabilization
  3. RCT within 1-2 wks
27
Q

why must patients with alveolar fractures get a RCT within 1-2 wks of accident?

A

prevent inflammatory root resorption and infection

28
Q

tx of traumatic cutaneous injuries depend on what?

A
  1. circumstances and location

2. time

29
Q

why does tx of traumatic cutaneous injuries depend on time?

A

longer the time, greater will be the bacterial inoculate

30
Q

contusions are what type of trauma?

A

blunt trauma

31
Q

contusions

A

subcutaneous or submucosal hemorrhage without breakage of soft tissue

32
Q

what should you always check when you exam patients with contusions?

A

check underlying structures

33
Q

tx of contusions

A
  1. surgical exploration if aterial involvement suspected

2. abx recommended if it’s a contaminated wount

34
Q

abrasions removes what?

A

epithelial layer and papillary dermis

35
Q

abrasions leave what?

A

raw bleeding reticular dermis exposed

36
Q

why are abrasions painful?

A

owing to exposes nerve endings

37
Q

what is critical when tx’ing abrasions?

A

debridement

38
Q

how should you debride abrasions?

A
  1. scrub with mild soapy solution followed by copious irrigation with balanced saline solution
  2. cover with thin layer abx ointment
39
Q

laceration

A

tear in epithelial and subcutatneous tissue

40
Q

goal when tx’ing patients with laceration

A

return tissues to proper orientation

41
Q

tx of lacerations

A
  1. cleaning
  2. debridement
  3. hemostasis
  4. closure
42
Q

T/F: when cleansing lacerations, you should make sure the soap doesn’t harm the skin

A

true

43
Q

why is it important to use soaps that don’t harm skin when cleaning lacerations?

A

soaps which enter the wound may cause cellular damage and necrosis

44
Q

what should you avoid when cleansing the laceration?

A

direct wound contact with

  1. alcohol
  2. peroxide
  3. providone-iodine
45
Q

if direct contact is made with either alcohol, peroxide, providone-iodine, what should be used around the wound?

A

copious irrigation with BSS (balanced salt solution)

46
Q

how to debride lacerations

A
  1. pulsatile > constant flow

2. scrubbing

47
Q

dead tissue fragments, foreign bodies, hematomas act as physical barriers to what in patients with lacerations?

A

fibroblast penetration

48
Q

T/F: radical excision of tissue in facial area should always be done when tx’ing lacerations

A

false, usually not necessary

49
Q

why do you remove irregular wound margins when debriding lacerations?

A

to improve marginal approximation at closure

50
Q

continuous bleeding when tx’ing a laceration may lead to what?

A

hematoma

51
Q

what should you do once you ID bleeding vessel?

A
  1. clamp
  2. tie
  3. cauterize
52
Q

why should you close in layers?

A
  1. eliminate dead space, hematoma formation
  2. reduces unsupported tissue during healing
  3. restores anatomical orientation
53
Q

T/F: you should approximate not strangulate closure

A

true

54
Q

how should you tackle closure of laceration?

A

work from known to unknown: orient known landmarks first with tack suture

55
Q

where should you start suturing a laceration?

A

vermillion border

56
Q

what must be ruled out with animal bites?

A

facial fractures

57
Q

puncture wounds from animal bites are more likely to become what?

A

infected due to inability to cleanse

58
Q

abx prophylaxis for animal bites

A

augmentin p/o/ 7 days

59
Q

bacteria found in animal bites

A

Pasteurella multocida (gram-negative rod)

60
Q

T/F: chance of infection from animal bites are greater with dogs than cats

A

false, cats > dogs