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Miniseminar: Modern approach to facial fracture repair
OtolaryngologyHead and Neck Surgery Volume 121 Number 2
Scientific Sessions--Wednesday
P179
8:00 to 9:30 AM M C C Rooms 255-257 9
Miniseminar: Modern Approach to Facial Fracture Repair PAUL J DONALD MD (moderator); BRIAN E EMERY MD; JORAM RAVEH MD DMD; SHERARD A TATUM MD; KURTLADRAUCH MD; Sacramento CA; Baltimore MD; Bern Switzerland; Syracuse NY; Bern Switzerland
Educational Objectives: (1) To understand plating and lag screw fixation mandible. (2) To comprehend an algorithm for management of frontal sinus fractures. (3) To know how to manage fractures of the midface using plating on facial stress buttresses. (4) To appreciate a system for reconstructing nonunited facial fractures. Description of Symposium: Facial fractures in the past were traditionally repaired by ligating bony fragments with interosseous wires. The advent of plates, especially those made of titanium, has revolutionized fracture management. Depending on the bone injured, plate size varies from the large plate used for mandibular reconstruction to the microplates used for orbital rim and nasal fractures. The transcutaneous systems have obviated external incisions, and most mandibular, as well as low maxillary, plates can be applied using intraoral incisions only. In many obliquely angled fractures of the mandible, lag screw fixation has evolved as a quick and easy method of securing the fracture. For Le Fort fractures of the
maxilla, the use of suspension wires and head frames has almost entirely been replaced by titanium miniplates and microplates placed along the facial buttresses. Frontal sinus fractures are managed by open reduction and fixation, often with miniplates of a square configuration. Missing bone is supplanted by hydroxyapatite bone cement. Cranialization is still the preferred method of managing through-and-through injuries that penetrate the intracranial cavity. Depressed nasofrontal ethmoidal complex fractures continue to be challenging. Replacement of the avulsed medial canthal tendon and support of the nasal bones by lead plates and hammock wires may need to be supplemented by a cantilevered split calvarial bone graft fixed to the frontal skull by an angled microplate. Delayed management of fractures is often difficult. The use of free grafts or vascularized free flaps of bone supported by plates to replace missing segments lost by a gunshot wound or infection may be necessary. Distraction osteosynthesis may also be employed to replace lost bone.
Scientific Sessions--Wednesday
P179
8:00 to 9:30 AM M C C Rooms 255-257 9
Miniseminar: Modern Approach to Facial Fracture Repair PAUL J DONALD MD (moderator); BRIAN E EMERY MD; JORAM RAVEH MD DMD; SHERARD A TATUM MD; KURTLADRAUCH MD; Sacramento CA; Baltimore MD; Bern Switzerland; Syracuse NY; Bern Switzerland
Educational Objectives: (1) To understand plating and lag screw fixation mandible. (2) To comprehend an algorithm for management of frontal sinus fractures. (3) To know how to manage fractures of the midface using plating on facial stress buttresses. (4) To appreciate a system for reconstructing nonunited facial fractures. Description of Symposium: Facial fractures in the past were traditionally repaired by ligating bony fragments with interosseous wires. The advent of plates, especially those made of titanium, has revolutionized fracture management. Depending on the bone injured, plate size varies from the large plate used for mandibular reconstruction to the microplates used for orbital rim and nasal fractures. The transcutaneous systems have obviated external incisions, and most mandibular, as well as low maxillary, plates can be applied using intraoral incisions only. In many obliquely angled fractures of the mandible, lag screw fixation has evolved as a quick and easy method of securing the fracture. For Le Fort fractures of the
maxilla, the use of suspension wires and head frames has almost entirely been replaced by titanium miniplates and microplates placed along the facial buttresses. Frontal sinus fractures are managed by open reduction and fixation, often with miniplates of a square configuration. Missing bone is supplanted by hydroxyapatite bone cement. Cranialization is still the preferred method of managing through-and-through injuries that penetrate the intracranial cavity. Depressed nasofrontal ethmoidal complex fractures continue to be challenging. Replacement of the avulsed medial canthal tendon and support of the nasal bones by lead plates and hammock wires may need to be supplemented by a cantilevered split calvarial bone graft fixed to the frontal skull by an angled microplate. Delayed management of fractures is often difficult. The use of free grafts or vascularized free flaps of bone supported by plates to replace missing segments lost by a gunshot wound or infection may be necessary. Distraction osteosynthesis may also be employed to replace lost bone.