Maxillofacial Trauma

Front 1

Which bones are involved in all of the LeFort fractures?

Back 1

The Pterygoid plates

Front 2

Unlike the LeFort I fracture which is horizontal in shape, what shape is the LeFort II fracture?

Back 2

Pyramidal

Front 3

At what portion of the orbit does the LeFort III fracture extend through?

Back 3

The medial and lateral orbital walls and the superior and the inferior orbital fissures

Front 4

The lateral surface of the maxilla forms what anatomical depression?

Back 4

The infratemporal foxxa

Front 5

What bone forms the majority of the orbital floor?

Back 5

The maxilla

Front 6

When does the maxillary sinus reach full maturity?

Back 6

When the person is ~14 or 15 years old

Front 7

What are the buttresses of the maxilla?

Back 7

1. Lateral piriform
2. zygomatic
3. Greater palatine
4. floor of the nose

Front 8

What bones does nasal septum articulate with?

Back 8

1. maxillae
2. palatine
3. ethmoid

Front 9

Comminution of which bone can tear the dura mater and lead to a Cerebrospinal fluid leak?

Back 9

The Ethmoid bone

Front 10

Branches of which ganglion runs thru the inferior orbital fissure?

Back 10

Pterygopalatine ganglion (parasympathetic to the lacrimal gland, among many other things)

Front 11

What arteries supply blood to the nose?

Back 11

Anterior and posterior ethmoid
Sphenopalatine
Nasopalatine
Greater palatine
Superior labial

Front 12

What is the most frequent cause of hemorrhage in a LeFort I fracture?

Back 12

fracture to the nasal septum

Front 13

Which region of the face should be repaired first when dealing with multiple facial fractures?

Back 13

The mandible should be stabilized first

Front 14

If the maxillary fracture is incomplete and it is difficult to mobilize and restore, what to do?

Back 14

Pull out the chisel and fracture the damn thing completely! Hoorah!

Front 15

What is the more scientific name for 'crocodile tears'

Back 15

epiphora

Front 16

Obstruction of the nasolacrimal ducts may lead to what continuous infective process?

Back 16

Dacrocystitis

Front 17

What are the 4 bones that articulate with the zygoma?

Back 17

1. Maxilla
2. Frontal
3. Temporal
4. Sphenoid

Front 18

Fracture of the zygoma at all 4 articulations is known as a tripod fracture.

Back 18

NO! This was before CT allowed the identification of fracture at the zygomatic-sphenoid suture

Front 19

T/F: all ZMC fractures involve the orbital floor

Back 19

TRUE

Front 20

What is the average length of the orbital floor?

Back 20

47mm

Front 21

The palatine, zygoma, and maxilla bones make up what portion of the orbit?

Back 21

The orbital floor

Front 22

If the lesser wing of the sphenoid makes up a portion of the orbital roof, what portion of the orbit does the greater wing make up?

Back 22

The lateral orbital wall

Front 23

What branches of V2 exit through the body of the zygoma?

Back 23

Zygomaticotemporal
Zygomaticofacial
Zygomatic

Front 24

What maintains the position of the orbital globe in relation to the horizontal axis?

Back 24

Lockwood's suspensory ligament

Front 25

What is the lateral attachment of Lockwood's ligament

Back 25

Whitnall's tubercle

Front 26

What would most often cause trismus with a ZMC fracture?

Back 26

Impingement of the zygomatic arch on the coronoid process

Front 27

Intraorally, where does one most commonly find ecchymosis with a ZMC fracture?

Back 27

In the region of the canine fossa due to disruption at the zygomaticomaxillary suture

Front 28

What nerves must be carefully evaluated with ZMC fractures?

Back 28

II-Optic (can they see?)
III-Oculomotor (are extraocular movements intact?)
IV-Trochlear (superior oblique)
V-Trigeminal (can they feel?)
VI-Abducens (Abduction of the eye)

Front 29

Which view of the CT is best for evaluating the extent of orbital Floor injuries?

Back 29

Sagittal

Front 30

What radiographic views make up a facial bone series (plain film)

Back 30

Caldwell's View
Water's view
Submentovertex view (jug handle)
Lateral skull view

Front 31

Which plain film view is the best for evaluating ZMC fractures?

Back 31

Water's view

Front 32

Which plain film view is best for evaluating zygomatic arch fractures?

Back 32

The submentovertex view

Front 33

With the Gillies approach to the zygomatic arch, what layer is the incision made down to?

Back 33

The layer of the deep temporal fascia. So: Thru
1) skin
2) subcutaneous tissue
3) superficial temporal fascia 4) deep temporal fascia

Front 34

What is the name of the elevator used to reduce the fractured zygomatic arch?

Back 34

Rowe elevator

Front 35

Where is the Rowe elevator placed to elevate the arch?

Back 35

Must pass between the deep temporal fascia and the temporalis muscle

Front 36

To reduce the moderately displaced zygomatic complex fracture, what screw is used to reduce the entire complex?

Back 36

The Carroll-Girard screw

Front 37

How can the globe be protected when accessing the orbital floor for repair?

Back 37

1. scleral shield
2. tarsorrhaphy

Front 38

What is the purpose of a frost stitch postoperatively?

Back 38

A frost stitch is used to re-suspend the lower eyelid and discourage ectropion

Front 39

When doing a coronal (or bicoronal) flap, which layers do you initially go thru?

Back 39

The first 3 of the 5 layers of the SCALP
1. Skin
2. Connective (subcutaneous) tissue
3. Aponeurosis (Galea Aponeurotica)
4. Loose Connective tissue
5. Periosteum

Front 40

T/F: With high energy fractures, you always repair the orbital floor first, and the zygomatic arch last.

Back 40

FALSE

Front 41

What are the 3 clinical indications for surgical exploration of an orbital floor fracture?

Back 41

1. Enophthalmos
2. Limitation of extraocular movements with a forced duction test
3. Persistent diplopia

Front 42

What is the term for bleeding into the anterior chamber of the eye?

Back 42

Hyphema

Front 43

What is the treatment for traumatic hyphema?

Back 43

Nothing. It rarely needs intervention by an ophthamologist, but it can delay surgical repair of an orbital floor fracture

Front 44

What is the main difference between superior orbital fissure syndrome and retrobulbar hematoma?

Back 44

Blindness is found in retrobulbar hematoma and not superior orbital fissure syndrome.

Front 45

What is the emergent treatment for retrobulbar hematoma?

Back 45

Lateral cantholysis and canthotomy for decompression

Front 46

What is the most common cause of trismus in patients with isolated midfacial trauma?

Back 46

Impingement of the zygomatic body on the coronoid process of the mandible.