Chapter 27: Oral and Maxillofacial Surgery Study Notes

Chapter 27: Oral and Maxillofacial Surgery

Terminology

  • Oral and Maxillofacial Surgery: Focuses on the reconstruction and repairs of facial bones and can include structures of the oral cavity.

  • Key Terms:

    • Bicortical screw

    • Dentition

    • Le Fort Fractures

    • Oromaxillofacial surgery

Anatomy Review

  • The face is predominantly divided into three major sections:

    • Upper Face:

    • Frontal bone with upper orbit

    • Midface:

    • Ethmoid, nasal bone, zygoma, maxilla

    • Lower Face:

    • Mandible (only movable bone)

  • Bony Orbit:

    • Comprises of the following bones:

    • Frontal

    • Zygoma (helps to form the lateral wall and part of the orbital floor)

    • Maxilla

    • Lacrimal

    • Ethmoid (helps to form the "bridge" of the nose; fractures in this area can damage lacrimal ducts and occasionally the dura)

      • Important Note: Remember cerebrospinal fluid (CSF) leakage from the nose!

    • Sphenoid

Additional Craniofacial Bones

  • Face Components:

    • Glabella

    • Nasal bone

    • Ethmoid bone

    • Lacrimal bone

    • Frontal bone

    • Parietal bone

    • Supraorbital foramen

    • Sphenoid bone

    • Optic foramen

    • Zygomatic (malar) bone

    • Infraorbital foramen

    • Maxilla

    • Mandible

    • Mental foramen

    • Middle concha of ethmoid

    • Perpendicular plate of ethmoid

    • Inferior concha

    • Vomer

Instrumentation

  • Types of Instruments:

    • Consists of fine orthopedic instruments, implants, and grafting materials:

    • Plates & Screws: Primary necessities for repairing facial fractures!

    • Specialty Rep Instruments

    • Metal Mesh

    • Depth Guides

Overview of Oral and Maxillofacial Surgery

  • Physiological Effects:

    • Speech

    • Mastication

    • Tooth development

  • Psychological Effects:

    • Malocclusion (misalignment of teeth)

    • Disfigurement

    • Emotional isolation

  • Surgical Practitioners: Performed by oral maxillofacial (OM), plastic or ENT (ear, nose, throat) surgeons; if extensive frontal damage is present, a neurosurgeon may be included.

Facial Fractures

  • Classification of Fractures:

    • LeFort I:

    • Horizontal

    • Palate separates from the maxilla

    • LeFort II:

    • Pyramidal

    • Maxilla fracture through orbits

    • Possible CSF leakage

    • LeFort III:

    • Separation of all facial bones from the cranial base.

    • Symptoms include facial flattening and swelling.

    • Historical Context: Developed by Rene Le Fort in 1901.

Orbital Floor Fractures

  • Commonly called “blowout” fractures,

  • Complications resulting from orbital fractures include:

    • Enophthalmus: Globe of the eye becomes pushed posteriorly into the nasal cavity and sinus.

    • Entrapment (inferior rectus muscle): can lead to issues with eye movement.

    • Diplopia: Double vision.

  • Surgical Approach: Subciliary incisions can be made below the eyelashes for repair.

Repair of Facial Fractures

  • Methods of Repair:

    • Maxillomandibular Fixation (MMF):

    • Involves the use of arch bars (malleable stainless steel straps with smooth hooks) for maintaining proper alignment of patient's bite and stability while facial fractures heal.

    • Techniques used:

      • Implanted to realign dentition of the mandible and midface.

      • Utilize 24-26 gauge wire to loop through arch bars for stability, tightened in a clockwise manner.

      • Rosebuds:

      • Wire cutters kept with the patient at all times due to airway occlusion risks!

Panfacial Fractures

  • Definition: Involve all three maxillofacial segments:

    • FRONTAL BONE

    • MIDFACE

    • MANDIBLE

  • Common Causes: Frequently associated with gunshot wounds or explosive injuries.

  • Additional Procedures: Odontectomy (tooth extraction) may be performed during treatment.