颌面部创伤.ppt

Treatment of Lefort II and III Intubation must not interfere with ability to use IMF Exposure visualization of all fractures Approaches to inferior rim Infraorbital Subciliary Transconjunctival Mid lower lid Coronal approach Gingivobuccal incision Fractures Teeth and occlusion are the key to reconstruction and provide the foundation upon which other facial structures are built Treatment of Lefort II and III Severely comminuted fractures preliminary approximation may be performed with wire Establishment of the correct occlusion Correct reconstruction of the outer facial frame for proper facial dimensions Correct position for nasoethmoidal complex Treatment of Lefort II and III Reestablishment of the correct intercanthal distance Infraorbital rim fixated Orbit is reconstructed Occlusion unit with IMF is fixated Lefort II III Reconstruction Lefort II III Reconstruction Nasal-Orbital-Ethmoid (NOE) Fractures Usually not isolated event Frequently associated with multiple midface fractures Secondary to traumatic insult to radix area of nose Low resistance to directional force 35-80 gm necessary to produce fracture Nasal-Orbital-Ethmoid Fractures Diagnosis Ophthalmalogic evaluation Document visual acuity Pupillary response to light Neurologic evaluation Frontal lobe contusion Glasgow coma scale Increase in ICP and need for monitoring Nasal-Orbital-Ethmoid Fractures Nasal fracture Comminuted with posterior displacement Widened nasal bridge Splaying of nasal complex Epistaxis Severe periorbital edema ecchymosis Subconjunctival hemorrhage Nasal-Orbital-Ethmoid Fractures Clinical signs symptoms Traumatic telecanthus Normal intercanthal distance = 33-34 mm 35 mm may indicate NOE disruption Damage to lacrimal apparatus = epiphora CSF leak (Photo courtesy of Col David Smith) Nasal-Orbital-Ethmoid Fractures Radiographic examination CT - definitive imaging modality Axial images supplemented with coronal Plain films to fail demonstrate the degree and location of fractures sec