Joseph L. McQuirter, DDS
Oral and Maxillofacial Surgery
Dentoalveolar
(teeth and surrounding bone)
Mandibular
(lower jaw)
Maxillary
(upper jaw)
Learning Objectives

List the types of orofacial injuries

List anatomic structures commonly
affected by orofacial injuries

Describe functional impairments
resulting from orfacial fractures

Explain the mechanism of injury for
orofacial fractures

Become familiar with the diagnostic
work up for patients presenting
orofacial injury

List the treatment options and
surgical intervention for orofacial
fractures

Understand the approach to
treatment for specific orofacial
fractures

List common early and late
complications of orofacial injuries
Dentoalveolar
Mandibular
Maxillary
When facial bones break
How effective are our
attempts to repair?
» Vehicular Injury
» Sports
» Falls
» Assault
»Domestic
»Workplace
»Associated with Crime
»Interpersonal Conflicts
» Self Inflicted
» High Impact
» Low Impact
» Penetrating
High Impact Facial Fractures
Vehicular
high speed
deceleration type-injury
Sports Related Injuries
(low impact)
Rihanna
Lucy Newman
» Assault
»Domestic
»Workplace
»Associated with Crime
»Interpersonal
Conflicts
Fist blow
to face
Sports Safety Equipment
In spite of our best efforts and millions being spent to
protect and ensure safety
there are still unexplained injuries
Dentoalveolar
Mandibular
Maxillary
Dento alveolar Fractures
(Dental / Tooth)
(Alveolar Bone)
Dental
Alveolar Bone
Dentoalveolar Fractures
Fracture of teeth and adjacent alveolar bone
Classification of Tooth Injuries
1. Fracture of tooth crown without pulp involvement
2. Fracture of tooth crown with pulp involvement
3. Crown root fractures
4. Root fractures
4
5. Concussion injuries
6. Luxation injuries
7. Tooth avulsion (Exarticulation)
3
2
1
Diagnosis – Dentoalveolar injuries
1. Clasic signs of inflammation from injury
(Pain, swelling, redness)
2. Mobility
3. Malocclusion (malaligned/displaced teeth)
Etiology of Dentoalveolar Injuries
1.
2.
3.
4.
5.
6.
7.
8.
Altercations
Falls
Seizure disorders
Sporting activity
Vehicular injuries
Endoscopic procedures (anesthesia intubation)
Abusive behavior
Mental health disorders
Treatment Objective
1. RESTORE FORM
2. RESTORE FUNCTION
RESTORE FORM
~ Place displaced teeth of tooth/bone
segment back to their natural position
~ Stabilize repositioned teeth/bone segment
RESTORE FUNCTION
~ Normal bite - Non injured teeth should
come together without interference from
the displaced/fractured segments.
~ Preserve vitality of dislodged teeth
or dentoalveolar segment
Prognosis is Dependent on Viability of
Pulp and Periodontal Tissues
Injuries to the tooth
1.
Fracture of tooth crown without pulp involvement
2.
Fracture of tooth crown with pulp involvement
3.
Crown root fractures
4.
Root fractures
5.
Concussion injuries
6.
Luxation injuries
7.
Tooth avulsion (Exarticulation)
Root
Canal
Treatment
Likely
4
3
2
1
Injuries to the tooth
Requires
reduction and
stabilization
1.
Fracture of tooth crown without pulp involvement
2.
Fracture of tooth crown with pulp involvement
3.
Crown root fractures
4.
Root fractures
5.
Concussion injuries
6. Luxation injuries
Requires
reimplantation
and
stabilization
7. Tooth avulsion (Exarticulation)
TOOTH AVULSION
Out of mouth for
1.
2.
3.
4.
5.
less than 2 hours
Reimplant immediately if possible
Transport in Hank’s solution, milk, saline or saliva (mouth)
Provide local anesthesia
Saline irrigation and gentle evacuation of blood from socket
Reimplant tooth and stabilize
Transport media for the avulsed tooth
1. In the tooth socket
2. Saliva (in the mouth)
3. Milk
4. Hank’s balanced salt solution
5. ViaSpan cold storage solution
PRESERVING THE AVULSED TOOTH
Hank’s balanced salt solution, commercially
available as :
Save-A-Tooth (Phoenix Lazarus, Inc.)
(Save-A-Tooth is a mainstay in many athletic first aid kits)
ViaSpan, cold storage solution is currently
available as an organ transport solution
Simple, non-traumatic stabilization for
mobile teeth and dentoalveolar fractures
COMPLICATIONS OF DENTAL INJURIES
Missing teeth, tooth fragments, broken fillings, appliances must be accounted for
~ Aspirated
~ Ingested
~ Witnessed expelled tooth at the injury location
Traumatic occlusion
Infection
Loss of Teeth and Bone
Associated injuries
~ Blunt head trauma
~ Soft tissue injuries
~ Bleeding
~ Infection risk (Tetanus prophylaxis /risk)
Tongue Bite - Look for Tooth Fragment
Ingested Tooth
Tooth Fragment in Lip
Aspirated Tooth
McQuirter JL, et al.
Elevated Blood Lead
Resulting from Maxillofacial Gunshot Injuries: Three Case
Reports of Ingested Lead Particles after Gunshot Injury to the
Face. J Oral Maxillofac Surg 61(5):593-603, 2003.
Molar tooth dislodged to mid-tongue
area from gunshot injury
LATE COMPLICATIONS
•Infection
•Ankylosis of Teeth
•Devitalization/Discoloration of Teeth
•Loss of Teeth/Dentoalveloar Segment
Dentoalveolar segment loss due to periodontal disease
compromising interdental blood supply
Dentoalveolar
Mandibular
Maxillary
Diagnosis
 Clinical/Physical Findings
 Diagnostic Studies
Clinical
Findings
 Altered Form
 Altered Function
Altered Form
> Swelling
> Displacement of Anatomical parts
> Decreased Muscle Tone
Swelling and bleeding
Step / Gap defect in dental arch
Displaced anatomy in both jaws
Superimposition of other anatomical parts sometimes makes
radiographic diagnosis difficult
Clinical confirmation of suspected fracture
Altered Function
> Occlusal Abnormalities
> Decrease Range of Motion
> Deviation of Jaw with Opening
> Altered mental nerve function
> Structural Integrity of the Bone
> Compromised of Host Defense
> Soft Tissue Compromise
> Speech
> Swallowing
> Respiration
> Bleeding
Bimanual palpation of the
mandible in a cephalad
position allows excellent
evaluation and
comparison of
the anatomic structures
The application of gentle
bimanual pressure over the
angle regions can unmask a
minimally displaced fracture in
the anterior region of the
mandible.
Treatment Objective
1. RESTORE FORM
2. RESTORE FUNCTION