A lecture for 5th stage dentistry students

1. Definitive treatment of
midfacial fractures
Dr.Mohamed Rahil
(Maxillofacial surgeon)
Tikrit dentistry college

2. Priority to saving patient life (ABC)

3. Principle of treatment
Reduction
Fixation
Immobilization
Follow up and
rehabilitation

9. Dentoalveolar fracture
I. Fracture of teeth
a. Fracture of teeth without pulp exposure
b. Fracture of teeth with pulp epxosure
c. Subluxation
d. Avultion
II. Fracture of alveolus and maxillary tuberosity

10. Zygomatic complex fracture
Indications for reduction
• Diplopia
• Restriction of mandibular movement
• Restore orbit skeleton
• Restore normal contour of face

11. Reduction
• Time
• Appraoches

12. Gillies approach

15. Keen approach

16. Quinn approach

17. Percutaneous approach

19. fixation
• Trans-osseous wiring

20. plating

21. Fixation with pack in the maxillary sinus
• Comminuted fracture of zygoma
• Comminuted fracture of orbital floor
• Ballon or back can be used

22. Pin fixation
• Excessively mobile zygoma
• Following surgical refractur of badly displaced
zygomatic bone which has been healed

23. Fracture of zygomatic arch
• Reduction through Gillies approach
• Fixation un necessary in recent fracture

24. Fracture of orbital floor

25. Indications for treatment
• Diplopia not resolved after 10 days after injury
• Large herniation of tissue to the antrum
• Restriction of eye globe movment
• Enophthalmus greater than 3 mm

28. Nasal complex fracture
• Reduction
Walsham’s forceps
Asche’s forceps

31. fixation
• POP
• Lead plate splint
• Open reduction

33. LeFort fractures

34. Le Fort I fracture
Rowe’s disimpaction forceps

37. Lefort II

38. Lefort III
Usually multiple fractures
Priority of treatment ;
Reduction of zygomatic bone fracture
Teeth bearing portion
Naso-ethmoidal fracture
And finally nasal complex immobilization

39. Immobilization of lefort fractures
• Extra-oral immobilization
• Immobilization within the tissue

40. Extra oral immobilization
• 1. cranio-mandibular
• A. box frame
• B. halo frame
• C. pop headcap
• 2. craniomaxillary
• a. supra – orbital pins
• B. zygomatic pins
• C. halo fram
• 3. suspension

44. Immobilization within the tissues
1. Direct fixation
• A.Transosseous wiring
• B. K-wire
• C. plating
2. internal wire suscpension
3.support

46. Type of plating
• Minplate
• Compression plate
• Reconstruction plate

54. Rigid fixation VS non rigid fixation

55. Complications of fractures
• Complication from head injury
• Complications from fracture it self
• Complications associated with lacrimal
system
• Ophthalmic complication
• Complications from neural damage
• Non - union

56. Thank you for listening