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2. Treatment
Goal is functional & cosmetic
restoration
Reestablish:
Mid-facial height and projection (most
important)
Occlusion
Integrity of nose and orbit
Provide structural support for proper
soft tissue contour
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3. Treatment must be indivisualised
Factors affecting treatment stratigies
Multi-trauma
Concomitant mandibular Injury
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4. Principles of Treatment
(Rodrich & Shewmake,1992)
Early 1 stage repair
Exposure of all # sites
Precise Anatomic reduction & semirigid
fixation
Immediate bone grafting if needed
Definitive soft tissue repair
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5. Timing of Operative repair
Initial concept - 5th -8th day
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12. Lefort II & III –
When inadequate alignment results,
individual
segments
are
reduced
separately.
Direct reduction: Elevator, bone hook or
wire inserted through the fragment.
Traction using elastic bands applied to
maxillary and mandibular arch bar can be
used for reducing fraction.
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13. Immobilization of mid-face
fractures:
A) Internal fixation
a..Direct osteosynthesis :
Miniplates
Transosseous wiring.
High level (fronto-zygomatic and fronto-nasal)
Mid level (orbital rim/ zygoma buttress).
Low level (Alveolar / midpalatal).
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14. b..Suspension wires (Skeletal fixation).
A)Frontal :
Central (LeFort II & III ; Unstable
mand.)
Lateral ( LeFort II & III ; Stable mand)
b) Circum-zygomatic
c) Zygomatic-fronto
d) Infra-orbital rim.
e) Pyriform aperture.
f) Buttress, transnasal
g) Perialveolar wire www.indiandentalacademy.com
15. B) External fixation:
1) Cranio-mandibular
Box frame
Halo frame.
Plaster of paris head cap.
2) Craniomaxillary:
Supra-orbital pins.
Zygomatic pins.
Halo frames.
Levant Frames.
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22. Various –
Plaster of paris.
Halo frame.
Box frame.
Levant frame.
Indication – Presence of anteroposterior instability
of the facial skeleton (i.e. concomitant B/L
condylar # of mandible).
Disadvantage: Appliances are cumbersome,
conspicuous is lead to lengthen the period of
hospitalization.
Contraindicated : Presence of mental confusion,
cerebral irritation, epilepsy and alcoholism.
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26. Internal Fixation
- Michelet first introduced miniplate in
facial # 1972.
Monocortical semi-rigid fixation with
plates or screws:
Provides three diamenssional stability
resists antero-posterior and rotatory bony
movements.
Allows primary bony healing
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27. Different configuration X,H, L,T and Y
shapes.
Various material like
Stainless steel
Titanium
Vitallium (Cobalt-chromium and
molydenum)
Resorbable bone plates and screws
(Polylactide, polyglycolic copolymer)
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35. MAXILLOFACIAL INJURIES
MIDFACE FRACTURES
Le-Fort I, II & III fractures CLOSED
Reduction & Fixation
Suspension wires to mandible
Frontal: Central & lateral
Circum zygomatic
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GK / MAXFAC
SDM DHARWAD
36. MAXILLOFACIAL INJURIES
MIDFACE FRACTURES
Le-Fort I, II & III fractures CLOSED
External fixation
Cranio-mandibular
Box, Halo frames
POP head cap
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GK / MAXFAC
SDM DHARWAD
37. Thank you
For more details please visit
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www.indiandentalacademy.com