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30 Cards in this Set

  • Front
  • Back
Vertical Buttresses
1. Naso-maxillary (NM)
2. Zygomatico-maxillary (ZM)
3. Pterygo-maxillary (PM)
4. Nasal septum
Horizontal Beams
1. Frontal bar
2. Inferior orbital rims
3. maxillary alveolus and palate
4. zygomatic process
5. Greater wing of the sphenoid
6. Medial and lateral pterygoid plates
7. Mandible
3 vaults of nose
Upper: nasal bones, ethmoid, superior edge of septum, vomer
Middle: upper lateral cartilage, septum, ascending process of maxilla
Lower: lower lateral cartilages, inferior portion of septum
Nasal Fractures Classification (Stranc & Robertson)
Plane 1: distal ends of nasal bones and septum only

Plane 2: involves entire distal portion of nasal bones and frontal process of maxilla at the piriform aperture. Septum is comminuted and begins to lose height

Plane 3: Involvement of one or both frontal processes of maxilla at the piriform aperture. Fracture extends to frontal bone (NOE)
Normal intercanthal distance
33mm (>35mm = abnormal)
Medial canthal tendon composition
anterior limb:
- superficial head of orbic
- inserts onto frontal process of maxillary bone into anterior lacrimal crest

posterior limb:
- deep head of orbic
- inserts onto posterior lacrimal crest
Markowitz NOE Classification
Type 1:
- single central segment
- no disruption medial canthal tendon (MCT)

Type 2:
- comminuted central segment
- no disruption MCT

Type 3:
- severe comminuted central segment
- disrupted/ avulsed MCT
Type 1:
- single central segment
- no disruption medial canthal tendon (MCT)

Type 2:
- comminuted central segment
- no disruption MCT

Type 3:
- severe comminuted central segment
- disrupted/ avulsed MCT
How is the eyelid traction test (Bowstring sign) useful in NOEs?
Grasp lower lid with forceps and pull laterally (opposite to MCT)

inability to pull lid taut = complete disruption of MCT
4 fractures in an NOE
- frontal process of maxilla
- nasal bones
- medial orbital wall
- inferior orbital wall
Surgical approaches to NOE
1: coronal
2: lower eyelid
3: gingival buccal sulcus incision
4: local incision (vertical, open sky, laceration)
How to repair medial canthal tendon in NOE fracture
- Transnasal wiring (30 gauge wire)
- posterior/superior to lacrimal apparatus
- tendon repaired with 2-0 nonabsorbable suture
What drains into middle meatus?
maxillary sinus, frontal sinus, anterior cells of ethmoid sinus
What drains into inferior meatus?
Nasolacrimal canal
What drains into superior meatus?
posterior ethmoidal cells
What is the Foramina of Breschet?
- site of venous drainage of the frontal sinus mucosa

- potential route of intracranial spread of infection
What is the risk if mucosa of frontal sinus is not completely obliterated in cranialization?
Mucocele formation
What separates frontal sinus from brain?
Cribiform plate
Indications for surgery in frontal sinus fracture
- anterior table displacement with contour change
- nasofrontal duct involvement
- displaced posterior table
When do you obliterate frontal sinus?
if nasofrontal duct involved

*NOE, medial/superior orbital, orbital floor fractures assumed to have nasofrontal duct involvement
When do you perform cranialization?
if CSF leak and posterior table is displaced, or if it is non-displaced but leak is persistent > 4-7days

- involves removal of posterior table, obliteration of nasofrontal duct, reduction of anterior wall
Muscles that attach to zygoma
- masseter
- temporalis
- zygomaticus
- zygomatic head of quadratus labii superioris
Fracture sites of Lefort 1
AKA Guerin or transverse Fracture

1: Pterygoid plates
2: Pyriform aperture (inferior medial maxillary buttress)
3: alveolar maxilla (inferior lateral maxillary buttress)
Fracture sites of Lefort 2
AKA Pyramidal fracture

1: pterygoid plates
2: nasofrontal junction
3: medial aspect of inferior orbital rim (transverse maxillary buttress)
4: lateral maxillary buttress
Fracture sites of Lefort 3
1: pterygoid plates
2: nasofrontal junction
3: entire orbital floor
4: zygomaticofrontal suture (upper transverse maxillary buttress)
5: zygomaticosphenoid suture
Hendrickson palate fracture classification
Type I Anterior and posterolateral alveolar
Type II Sagittal
Type III Para-sagittal
Type IV Para-alveolar
Type V Complex
Type VI Transverse
How common is CSF leak in Lefort 2 and 3?
25-50%
Most common facial fractures
1. Mandible
2. zygoma
3. orbit
Percentage of facial fractures with C-spine injury
7% (14% of c-spine injuries have facial fractures)
Percentage of facial fractures with brain injury
68%
Percentage of ocular injury
25%