Plastic surgery for facial bones & nose , fractures with Open Reduction & Internal Fixation ORIF скачать в хорошем качестве

Plastic surgery for facial bones & nose , fractures with Open Reduction & Internal Fixation ORIF

A facial fracture is a broken bone in the face. The face has a complex bone structure consisting of Frontal bone (forehead). Zygomas (cheekbones). Orbital bones (eye sockets). Nasal bones. Maxillary bones (upper jaw). Mandible (lower jaw). Multiple facial fractures are more likely to occur during a motor vehicle accident or other high-impact accident. Fractures can be on both sides of the face . Facial fractures lead to functional and esthetical deficits if not treated adequately . Appropriate acute management of facial fractures must be done when indicated. Some fractures are best treated in a delayed fashion; others represent real emergencies and need to be treated within 24 h of trauma. Acute treatment is done within 72 h after trauma. Immediate reconstruction is done within 2 weeks and delayed reconstruction is considered at any time after 2 weeks. The timing for repair relies mostly on surgeon’s preference, hospital resources. Acute reconstruction is indicated in orbital fractures with muscle entrapment to prevent muscle atrophy. Airway compromise and hemorrhage are also indications for acute reduction. In mandibular open fractures, delaying repair may increase bacterial load and osseous devascularization, so early immobilization is recommended . In other fractures such as zygomatic fractures, a short delay in the reconstruction with reduced swelling may be advantageous. Primary repair usually offers best functional recovery as well to “easier” repair. There are several main types of facial fractures. Nasal bones (broken nose): Nasal bone fractures are the most common type of facial fracture. The nasal bone is made up of two prominent thin bones. Hence it takes less force to break the nasal bones than other facial bones. Nosebleeds and bruising around the nose are common symptoms of a nasal fracture. Frontal bone (forehead) fractures: A high-impact injury to the head can cause a fracture of the frontal bone and floor of the sinuses. The fracture is mostly likely to occur in the middle of the forehead. Often other injuries to the face and skull or neurological trauma may be present. Associated problems may include leakage of the cerebrospinal fluid, eye injuries and damage to the sinus ducts. Zygomaticomaxillary fractures (broken cheekbone/upper jaw): These cheekbones are attached at several points to the upper jaw (maxilla). Fractures to the cheekbone might also involve breaks in other facial bones nearby. Orbital fractures (eye socket): There are three main types. Orbital rim fracture: Many other injuries may accompany an orbital rim fracture, such as damage to the optic nerve. Blowout fractures: The orbital rim remains intact in this case, but a crack forms in the thin bone at the lower part of the eye socket. The eye muscles and other structures can become entrapped in the break and prevent the eyeball from moving normally. Direct orbital floor fracture: This is a rim fracture that extends into the lower socket. Mid-face (Le Fort fractures): Blunt force trauma tends to cause fractures along three lines of weakness in the mid-face. One characteristic of all types of Le Fort fractures is the fracture of the pterygoid processes, part of the sphenoid bone. There are three main types of Le Fort fractures, but there may be individual variations. Le Fort I: The fracture extends above the upper jaw (maxilla). Le Fort II: The fracture extends from the lower part of one cheek, below the eye, across the bridge of the nose, and to the lower part of the other cheek. Le Fort III: The fracture extends across the bridge of the nose and the bones surrounding the eyes. Mandible (lower jaw): Fractures of the lower jaw affect the sections of the lower jaw that supports teeth (called the body), the part where the jaw curves upwards into the neck (the angle) or the knob-shaped joint at the top of the jaw bone (the condyle) or the point where the two sides of the lower jaw are joined (the symphysis). Patient may also have broken or loose teeth. Signs of orbital fractures may include differences in the position of the eyeballs or sunken eyes causing diplopia. 3-D reconstructive scans may be required for diagnosis and after surgery to confirm correction of the fracture. plain X-rays done if the nose is broken. How are facial fractures treated? The type of treatment will depend on the location and extent of the injury. The aim of treatment for facial fractures is to restore the normal appearance and function of the injured areas. Life-threatening conditions, such as blockage of the airways, cardiovascular problems, or brain or nervous system injuries, must be treated immediately. Surgical treatment of facial fractures may include Open reduction and internal fixation (ORIF) with refined titanium plates and screws have revolutionized the surgical treatment of complex facial fractures. Some fractures may be treated by performing a closed reduction (resetting the broken bone or bones without surgery)