Absite Topic Review General Surgery

1. Absite Topic ReviewGeneral Surgery Nir Hus, MD, PhD. Mount Sinai Medical Center Miami Beach Nir Hus

2. Frontal views of LeFort complex fractures I - III Nir Hus

3. Lateral views of LeFort complex fractures I - III Nir Hus

4. LeFort I • The LeFort I, or transmaxillary fracture runs between the maxillary floor and the orbital floor. • It may involve the medial and lateral walls of the maxillary sinuses and invariably involves the pterygoid processes of the sphenoid. • Clinically, the floating fragment will be the lower maxilla with the maxillary teeth. Nir Hus

5. LeFort II • The LeFort II occurs along yet another weak zone in the face, and is sometimes called a pyramidal fracture because of its shape. • A common mechanism is a downward blow to the nasal area. Nir Hus

6. LeFort III • The most severe of the classic LeFort fractures. • The entire face is a Large unstable (floating) fragment. • This fracture is also referred to as craniofacial disassociation. • This is a very severe injury, and is often associated with significant injury to many of the soft tissue structures along the fracture lines. • Considerable force is necessary to produce this injury, and it is uncommon as an isolated injury. • It may also occur in association with severe skull and brain injuries. Nir Hus

7. Blowout Fracture • The arrows point to the fracture fragments and periorbital tissue which have herniated into the maxillary sinus Nir Hus

8. Blowout Fracture • The forces being transmitted by the soft tissues of the orbit downward to the thin floor of the orbit. • The floor is usually the path of least resistance, and fractures downward into the maxillary sinus. • Common clinical signs are enophthalmos and diplopia (especially on upward gaze), and one should remember that about 24 % of these fractures are associated with ocular injury as well. • On a Waters view, one may see a soft tissue mass on the superior margin of the maxillary sinus, representing the herniated periorbital tissues into the sinus. • One may also see a "trapdoor" fragment of bone protruding down into the sinus, often hinged on the ethmoidal side. • CT will, of course, show these fractures and soft tissue mass much better. Nir Hus

9. Common sites of Mandibular fractures Nir Hus

10. Mandibular fractures • Fractures are obvious on clinical exam. • Clinical findings include facial distortion, malocclusion of the teeth, or abnormal mobility of portions of the mandible or teeth. • The mandible is one of those bones covered by the "ring bone rule“. • A fracture or dislocation in a ring bone or ring bone equivalent, should prompt a look for another fracture or dislocation. Nir Hus

11. Mandibular fractures • This tendency of ring bones to break in more than one place can be illustrated by going through a bag of pretzels and trying to break one of them in just one place. Then try it with a bag of bagels. This is called the Lee Rogers‘ "pretzel-bagel spectrum". • The stiffer a ring bone is, the more likely it is to break in more than one place. • The more flexible it is, the more likely it is to break in just one place. • The mandible has some flexibility, due not only to the mobility around the temporomandibular joints (TMJ's) but also to the tendency of the TMJ's to absorb some forces during trauma. Nir Hus