Dott.re Giuseppe Spinelli

Fractures

FRACTURES

Traumatology Maxillofacial

Fractures of the maxillofacial district represent about 30-40% of all fractures. Most of them are caused by road accidents, followed by those caused by sports accidents, assaults, accidental falls, pathological fractures and are often associated with fractures of other body areas. The diagnosis relies on examination medical history and physical examination, followed instrumental examination.

The gold standard examination for the diagnosis of fractures of the maxillofacial district is the TC, which allows to visualize the possible fracture in the three dimensions, also in relation to the surrounding districts. In association with TC it is also possible to use skull X-rays, such as orthopantomography (OPT). Not all fractures of the bones of the face require surgical intervention and, given that often patients with fractures of the maxillofacial district have lesions in other regions of the body, it is essential to assess the level of risk (vital signs, airway patency ) and the order of priority of any surgical reductions operating in teams with orthopedic surgeons, neurosurgeons, etc.

NOSE FRACTURES

Nose fractures are the most common fractures among those of the bones of the face due to the greater projection in an antero-os direction with respect to the surrounding tissues and due to the fragility of the bones of the nose. Symptoms vary from edema of the surrounding soft tissues to the orbital region, epistaxis, alterations in the shape of the nasal pyramid, difficulty in breathing, pain on palpation.

The physical examination by speculum or probes can highlight the possible dislocation of the septum, while through palpation it is possible to locate the fracture gap. Type of operation: depending on the complexity, the closed reduction of the nose fracture can be sufficient, by manual repositioning of the stumps, under local anesthesia or in sedation. In more complex cases, open reduction is performed under general anesthesia. An acrylic resin disc can be used to protect the nose, which is removed after 7-10 days. Generally, a rigid infill system is not used.

Healing: antibiotic therapy is given to prevent infections. Pain, normal in the first days after surgery, is controlled by prescribed therapy. It will be necessary not to expose oneself to the sun and avoid competitive sports for 30 days.

CHEEKBONE FRACTURE

After fractures of the bones of the nose, the cheekbone fractures represent the most frequent fractures, due to the position of the zygoma more exposed than the other bones of the face. They can be compound or decomposed, simple or comminuted. They are characterized by edema and ecchymoses that can extend to the region of the nose and orbit, pain, sometimes alterations of the position of the eyeball with subcutaneous haemorrhages, epistaxis, subcutaneous emphysema, hypoesthesia in the region of the cheek, limitations in the opening of the mouth.

The characteristic sign of zygomatic fractures is the asymmetry of the knob or zygomatic arch with a sensation of ‘’ sinking ’’ of the region and at the physical examination the fracture rhyme can be perceived by palpation. The therapy depends on the extent of the fracture. In cases of fractures where there is no dislocation of the fragments, reduction is performed under local anesthesia using a specific transcutaneous hook. We will then follow
a radiographic check to evaluate healing.

In the case of zygomatic fractures with dislocation of the fragments, surgery is performed through open reduction. Type of operation: under general anesthesia, the fracture gap is exposed and the abutments are stabilized by means of titanium plates and screws. Depending on the location of the fracture, intraoral access can be used, which has the advantage of not creating skin scars, or skin access in the region of the lower eyelid or eyebrow.

Duration: from 40 minutes to 1 hour, depending on the complexity of the case.

Healing: antibiotic therapy is given to reduce the risk of infections. Pain, normal in the first days after surgery, is controlled with the prescribed therapy.

You will need to avoid competitive sports for 30 days.

MANDIBULAR FRACTURES

They represent the most frequent fractures, after those of the nasal bones and the cheekbone. In addition to fractures resulting from trauma, pathological mandibular fractures linked to atrophy of the jaw itself may also occur. Open and closed fractures can be distinguished, depending on the exposure or not of fracture stumps, complete and incomplete, composed and displaced. They can be located at the level of the condyle, the angle, the body, the symphysis and the parasinfisi, the branch, the alveolar process, the horn process.

Mandibular fractures are often accompanied by pain, edema and hematomas in the region, wounds in the skin or mucous membrane, malocclusion, difficulty in normal movements of opening and closing of the mouth. Surgical reduction of mandibular fractures aims to restore occlusion and facial harmony.

Type of operation: the operation is usually performed under general anesthesia and involves the use of plates and screws to stabilize the fragments. In case of subsequent pain or infection in the area of ​​the osteosynthesis plaques, these can be removed by an operation performed under local anesthesia. Depending on the location of the fracture, the incision is made at the intraoral level, with the advantage of not having skin scars. It is also possible to perform a graft of stem cells, by taking them from the same patient. In general, rigid intermaxillary blocks are not used.

Duration: from 40 minutes to 1 hour, depending on the complexity of the case.

Healing: antibiotic prophylaxis is performed to reduce the risk of infections. Pain, normal in the first days after surgery, is controlled with the prescribed therapy.

You will need to follow a soft diet for a few weeks and avoid competitive sports for 30 days.

MANDIBULAR CONDILE FRACTURES

Among the mandibular fractures, they represent the most frequent ones. They can derive from direct traumas of the condylar region or from indirect traumas, for example from traumas of the chin region.

They may be unilateral or bilateral and may or may not involve the ligamentous structures of the temporomandibular joint (intra or extra articular fractures). They present with limitations and deviations in the opening of the mouth, irradiated pain also in the ear, malocclusion.
Depending on the severity, only one functional therapy can be performed, using specific physiotherapy schemes, or resorting to surgical therapy.
Type of operation: an incision is made at the preauricular or submandibular level and miniplates and screws are used to stabilize the fragments.
Depending on the case, surgery can be performed endoscopically.

Duration: from 40 minutes to 1 hour, depending on the complexity of the case.

Healing: antibiotic therapy is given to reduce the risk of infections. Pain, normal in the first days after surgery, is controlled with the prescribed therapy.

You will need to follow a soft diet for a few weeks and avoid competitive sports for 30 days.

A scheme with physiotherapy exercises to be performed for a few weeks will be recommended.

MAXILLA FRACTURES

They are distinguished, in relation to the location, in fractures of the alveolar process, of the palate, of Le Fort I (horizontal), Le fort II (pyramidal), Le Fort III (craniofacial disjunction). They present themselves with the mobility of the affected segments, pain, edema and hematomas that may involve the region of the nose or eyelids, malocclusion, mucosal wounds, lesions of the dental elements, sometimes alterations in the
position of the eyeball.

Type of operation: the operation is usually performed under general anesthesia and involves the use of plates and screws to stabilize the fragments. In case of subsequent pain or infection in the area of ​​the osteosynthesis plates, these can be removed by a simple operation performed under local anesthesia. Generally the incision is made at the intraoral level, with the advantage of not having skin scars.

Duration: from 40 minutes to 1 hour, depending on the complexity of the case.

Healing: antibiotic therapy is given to reduce the risk of infections. Pain, normal in the first days after surgery, is controlled with the prescribed therapy.

You will need to follow a soft diet for a few weeks and avoid competitive sports for 30 days.

ORBIT FRACTURES

Often associated with fractures of the surrounding districts, they are classified according to the location in fractures of the floor, of the medial wall, of the lateral wall, of the roof of the orbit and can be of the blow in type (from internal burst) or blow out (from outbreak). external). The characteristic symptoms are the alteration of the position of the eyeball (enophthalmos or exophthalmos), alterations of vision, especially diplopia (double vision), alterations of the cutaneous sensitivity of the region. Before the operation it is necessary to perform an ophthalmologic evaluation with recording of the Hess-Lancaster screen, useful for evaluating the extent of diplopia.

Surgery to reduce orbital fractures aims to restore the volume of the orbital cavity and the mobility of extrinsic muscles. Type of operation: under general anesthesia, through minimally invasive incisions at the level of the eyelid, laminae of alloplastic material (for example high density polyethylene) are inserted.

Duration: from 30 minutes to 1 hour depending on the complexity of the case.

Healing: antibiotic therapy is given to reduce the risk of infections. Analgesic therapy is prescribed to reduce pain, normal in the immediate post-operative period.

You will need to avoid sports for 30 days and avoid sun exposure.