Concluded Case

maxillofacial trauma

22yrs male with a/h/o RTA by two wheeler. GCS 15/15. Presented to us after 3rd day of accident. Ct scans done, films attached. On Examination, there is ClassII malocclusion. No Obvious visual difficulties. Eyeball movements normal. Questions: 1. Approach to the patient. 2. Mode of anesthesia. 3. Surgical plan of fixation for which segments.

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Concluded answer

Any external skin wounds?? Archbars Bicoronal incision Upper GBS incision Submental intubation Spanning plate for frontal bone Nasofrontal bone fixation with X plate Both IOM fixation Both ZM fixation Lt ZF fixation

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There were no significant or rather helpful external cuts or clws over the face. We ignored the frontal fixation as the fracture line was very much near to the right cribriform and there was per se no cosmetic deformity. Fixation of maxilla, left lateral orbital wall, and zygomaticomaxillary buttress was done along with Nasal bone fixation.

Its a frontal bone depressed fracture. If there is no csf leak excise boefragments&cranioplasty. Then or later.

Thank you doctor
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Any external skin wounds?? Archbars Bicoronal incision Upper GBS incision Submental intubation Spanning plate for frontal bone Nasofrontal bone fixation with X plate Both IOM fixation Both ZM fixation Lt ZF fixation

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Approach: Bicoronal- frontal table repair with frontal sinus exploration+externalization with debridement, packing and plating of anterior table and supraorbital rim. Lower eyelid Blepharoplasty- bilateral infraorbital rims ( six holed orbital plate) and orbital floor exploration. Keen's- bilateral priform and bilateral buttress (four holed L shaped plate). Eyebrow approach- left supraorbital rim if you are not planning frontal table repair otherwise bicoronal will be effective. Intubation- submental intubation. Down top fixation, First fix the maxilla with arch bar once you achieve occlusion of jaws, you can go ahead with fixation of Lower, upper and middle face.

Pyriform margin fixation

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