Orbital and mid facial fractures

hmmm nice Concord in this video I'll be talking about orbit and mid-face drama coming to the first point which is very important the most common type of orbital fracture is blowout type of fracture and the most common wall involved in the orbit fracture is the floor of the orbit and the thinnest wall of the orbit is the medial wall and its thickness is around 0.2 - 0.4 mm in the shortest of all of the orbitals are lower and the characteristic sign of orbital fracture is post-traumatic diplopia all these five points are very important every point can come as an MC Q so most common type of orbit fracture is blue out most common wall involved in the fracture is slower and the thinnest wall is the medial wall and whose thickness is 0.2 to 0.4 mm in the shortest wall of the orbit is floor and the characteristic sign of the orbital fracture is forced to Matic diplopia so this picture is showing blue out type of fracture how does this globe type of fracture occur when in larger object larger than the size of the orbit hits the orbit causes blowout type of fracture see here the floor is gone in the orbital content is herniating down into the maxillary sinus so two theories which are associated with blowout type of fracture is Rhett repulsion theory and buckling theory that repulsion theory is also known as hydraulic theory so you need to remember this the theories associated with a blowout type of fracture this picture is showing it is an Emma and sorry it isn't ct-scan coronal section showing hanging drop sign which is in characteristic feature of the blowout fracture of the orbit see there is in communication between the orbit and the maxillary sinus the orbital contains our herniating down the radiolucency of the maxillary sinus is lost so there are other names for blow or type of fracture it is also called as white eye or trapdoor type of fracture at this point is very important that is the other names for blowout type of fracture this white eye or trapdoor type of fracture what is this test this can come as an image-based question this is for seduction test to check for the entrapment of the muscle what is done here here the tendon of inferior rectus is grasped and the eyeball is moved in all direction to check for the entrapment so most common muscle that is entrapped into a floor fracture that is lower type of fracture is inferior rectus which can cause diplopia that is post-traumatic diplopia the classical Trier of blow or type of fracture is diplopia intravital numbness due to injury to the infraorbital nerve and peri ocular ecchymosis so you have to buy hardware that is classical triad of blow or type of fracture is diplopia intravital numbness and parry ocular ecchymosis what is diplopia diplopia is double vision so there are two types of diplopia monocular and binocular in case of moon or killer diplopia diplopia is seen when one eye is covered so what happens in this case when both eyes are open the diplopia doesn't seem when one eye is covered the diplopia is seen in case of binocular diplopia in diplopia disappears when one eye is covered so with both the eyes the patient can see normally but when when one eye is closed diplopia seen in case of binocular diplopia what is this OCD it is an outer candle distance normal is 100 mm in the pupillary distance normally 60 mm and inter candle distance normal is 30 mm okay now we'll see the tele candles in hyper Taylorism difference between Delhi cancels in hyper terrorism in case of tele candle there is an increase in their candle distance so the inter cancel distance is increased and there will be smaller palpebral fissure length in case of orbital hyperthyroidism there will be increased inter candle distance increases outer candle distance increased interpupillary distance but there will be normally palpebral fissure length so dramatic Pelican is caused due to ligaments paying and the how orbital hyper Taylorism is due to the walls playing a part that is the medium walls of orbits playing a part causes hyperthyroidism and the ligaments that is medium can the ligaments on both sides playing a part causes daily canthus what are the indication for surgical treatment of orbital fracture when the end of thermos is greater than 3 mm when there is an herniation of tissue into the antrum when there is an tissue entrapment or limited mobility if the developer is not resolving after two weeks of observation in the orbital fractures involving more than half of the floor and when there is an increase in the orbital volume so all these are indication for surgical intervention of the orbital fracture all these points you need to remember approaches to enthrall vital region various incisions like infraorbital incision sub cellar incision sub tarsal incision transconjunctival or through pre-existing laceration so in this picture the see is showing intra orbital incision and the B is showing the subtitle incision and a is subsidary incision and her D is an extension of subsidiary incision transconjunctival incision here in this picture it is showing transconductor an incision that is placed in the palpable injectable for aesthetic purpose so this can come as an image-based question the subsidiary and transconjunctival are commonly used because of their superior aesthetic vision so this is an important point so which incision are most commonly used for superior if the tigress L that is subsidiary and transconjunctival what are the materials that are used for reconstruction of orbital floor the autogenous materials like calvarium iliac crest rib graft zygomatic buttress and mandibular symphysis so they can ask which autogenous material is used for reconstruction of orbital floor so they can be calvarium iliac crest rib grafts zygomatic buttress mandibular symphysis what are the alo plastic materials that are used for the construction of floor of the orbit like Teflon silicon methyl methacrylate metal alloys titanium white ilium and medpor so among autogenous alo plastic material autogenous bone grafting is the first line of choice so these can be picture based question this is in med poor showing porous polyethylene implant which helps in the reconstruction of the floor of the orbit this is an preformed titanium mesh available in the market which can be used for reconstruction of floor of the orbit so this is an custom-made titanium mesh which can be customized according to the patient's Anatomy 2 buttresses of facial skeleton they are vertical buttress transverse buttress and sagittal buttress what does this buttress represent buttress represents the pillars of the face here the red arrows are showing vertical buttresses that is names of maxillary buttress zygomatic of maxillary buttress and there you go maxillary buttress and the blue arrows are showing transverse buttress that is horizontal buttress that is so p-orbital them I can is in fee orbital rim third is annular process of the maxilla the fourth is a little process of the mandible ends of this lower border of the mandible in the green arrows are showing the sagittal buttress of the facial skeleton that is the earlier process of the posterior maxilla in the zygomatic arch what is the importance of buttress they provide adequate bone stock for reduction they are the stable bone for Anchorage so whatever we are doing that is during management during plating the plates are placed in this buttress region because they have thick bone in case of mid frac mid-face fracture the primary fracture treatment is limited to two weeks after two weeks the treatment is regarded as delayed so these two points are very important so primary treatment of the mid-face fracture is limited to two weeks that it should be done before two weeks if the fracture comes after two weeks the treatment is considered as delayed what are the goals in the management of mid-face fracture to restore the anatomy in all the three direction so you need to remember these goals they can ask your than MCQ the goals in the management of mid-face fracture to restore the anatomy in all the three dimensions that is the horizontal dimension vertical dimension and the anterior posterior dimension and plating of all the maxillary buttress if possible restore the vertical dimension and horizontal projection and restoration of play morbid occlusion so there are four goals that you need to remember restoring the three dimensions of a face and plating of all the maxillary buttresses if possible and restoration of the premorbid occlusion so classification of leave for which was modified by Marcion is very important which was given in the year 1993 this year also you need to remember so they can ask you the type of fracture they can ask you what is type 1 what is type 2 what is type 3 type 3a or 3b they can ask you in an MC cube what is type 1 - is low maxillary fracture when low maxillary fracture is into multiple segments it is 1 a type 2 is pyramidal fracture - a is pyramidal fracture placed nasal fracture type 2b is primitive fracture and any fracture and the type 3 is craniofacial disjunction type 3 a is craniofacial disjunction plus nasal fracture type 3 P is craniofacial disjunction and knee so orbital at model fracture and type 4 is pyramidal fracture or cranial facial disjunction with the skull base fracture in for a supraorbital rim is involved in 4b is supraorbital grim place and deer cranial fossa is involved in 4c disappear orbital rim and here cranial fossa as well as the orbital balls are involved so all these types you need to by heart the classically fault lines the first line 3/4 line is low maxillary line and the leave foot toe line is a pyramidal shaped line and the leave for 3 line is craniofacial disjunction extending from FZ 2 FZ FZ is fronto psycho Matic suture what is this identify it is impaired little ecchymosis which is in classical feature of leave for one fracture it is also called as Guren sign what are the characteristic feature of Lee for to fracture moon phase or ballooning by latent circum orbital atom or ecchymosis that is black eye and dish face the characteristic of Lee for 3 fracture includes panda faces and raccoons eye in Sycamore vital or periorbital acai muscles by literally in hooding of the eyes so all these characteristic features only for 2 only for 3 fractures you guys need to remember what is the sensation this is a mid-face lead loving incision it provides access to the nasal dorsum at the model area nasal dorsum ethmoidal area zygomatic body and lower orbital rim as well this is an intraoral incision intra vestibular incision called as mid-face degloving incision so any fracture in this area can be approached intra orally through this mid-face 11 incision what is this sensation this is an maxillary vestibular incision in case of mid-face fracture when there is only for one fracture and butlers need to be assessed this incision is used that is maxillary vegetable incision what is the sensation this is a globular incision this incision is given men you need to see medial orbit needs a frontal suture in nasal bridge so in case of leaf or to fracture this incision can be placed leaf or three fracture to suture the needs of frontal area or the nasal bridge this question can come as an diagram based question identifies in this picture the a shows lateral eyebrow approach that is little eyebrow incision for approaching the frontal a grammatic suture and the B that is upper eyelid approach also called as upper blepharoplasty incision this incision can also be used to assess the front o cyclomatic suture as well as the supraorbital trim management of LeFort fracture through mini plates plating it the buttress region in case of this is a picture showing management of the only afford one fracture and you see the leave for one line low maxillary fracture for hanging maxilla two plates are place at the buttress region in case of leave for two three plates I place that one one is at the nasal frontal suture and one is a in draw by pilgrim and the other is at the zygomatic alikes lady buttress in case of leaf or three fracture three plates are placed first plated the mezzo frontal suture and one plated the absurd suture and one bladed the zygomatic arch what are these pictures showing these pictures are showing suspension wiring of the mandible this is most commonly employed in cases of LeFort fracture to sandwich the maxilla between the mandible and the skull so there are various types of suspension wirings like frontal succumbs I go Matic zygomatic aims of orbital suspension wiring piriform aperture suspension wiring so this is enzymatic our suspension why sorry this is an intra orbital rim suspension wiring this is one side romantic art suspension wiring because the wire is hanging from the zygomatic arch this is a beautiful upper chest expansion wiring this is a frontal suspension wiring thank you guys this is all for the orbit and the mid-face fracture thank you all for your love will be soon coming up with more informative stuff till then keep working hard keep motivating yourself because trust me guys no one is going to do it for you unless and until you do it for yourself see you soon signing off dr. love