小逸文筆記

Maxillary fracture 1. LeFort classification Le Fort I Fracture = Horizontal Fracture Clinical finding: Facial edema Malocclusion of the teeth Motion of the maxilla while the nasal bridge remains stable 2. Le Fort II Fracture = Pyramidal Fracture Clinical finding: Marked facial edema Nasal flattening Traumatic telecanthus Epistaxis or CSF rhinorrhea Movement of the upper jaw and the nose. Le Fort III Fractures = Craniofacial Separation Clinical finding: Dish faced deformity Epistaxis and CSF rhinorrhea Motion of the maxilla, nasal bones and zygoma Severe airway obstruction

Fracture of Zygoma 1. Symptoms Enophthalmos(眼球內陷): avoid compressing infraorbital nerve Malar asymmetry: Palpable bony defect over the arch Diplopia Trismus: Pain in cheek and jaw movement Impingement on coronoid process Flame sign: Intraoral hematoma, ecchymosis Epistaxis Inferior displacement of globe Inferior displacement of lateral canthus Infra-orbital never injury: numbness 2. Diagnosis: CT scan 3. Classification Group 1. No significant displacement. Group 2. Arch fractures. Group 3. Unrotated body fractures. Group 4. Medially rotated body fractures. Group 5. Laterally rotated body fractures. Group 6. Include all cases with fracture lines cross the main fragment. 4. Five places to align the zygoma 1) zygomatico‐maxillary buttress 2) lateral wall of the orbit 3) infraorbital rim 4) zygomatic arch 5) zygomatico‐frontal suture 5. Treatment 1) Isolated arch fracture Gillies approach 2) Displaced zygomatic fracture: ORIF(open reduction internal f...