Trauma and Maxillofacial Injuries
Trauma and Maxillofacial Injuries
This domain covers the assessment and management of maxillofacial trauma, including soft tissue injuries, dental trauma, mandibular fractures, midface fractures (Le Fort I, II, III), zygomatic complex fractures, and orbital fractures. You must know the ATLS protocol (primary survey: airway, breathing, circulation, disability, exposure) and the principles of rigid internal fixation (mini-plates, screws). Understand the classification of fractures (e.g., Le Fort, mandibular by location) and the clinical signs (malocclusion, step deformity, paresthesia, diplopia, enophthalmos).
Traps: Questions often test the most common mandibular fracture site (angle, followed by condyle). Another trap is the Le Fort classification: Le Fort I is a horizontal fracture above the roots of the teeth; Le Fort II is pyramidal; Le Fort III is craniofacial disjunction. Also, know that orbital floor fractures may cause entrapment of the inferior rectus muscle, leading to diplopia and restricted upward gaze. Zygomatic complex fractures may cause trismus due to impingement on the coronoid process.
Rule of thumb: For any facial trauma, first rule out cervical spine injury and airway compromise. For mandibular fractures, treat with closed reduction (IMF) or open reduction (ORIF) depending on displacement and patient factors.
Worked example: A patient with a blow to the chin presents with malocclusion and numbness of the lower lip. Likely diagnosis: bilateral condylar or angle fracture. Imaging: CT scan. Management: ORIF if displaced.