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A Handbook for Surgical Approaches to Maxillofacial Trauma
Rajesh R Yadav, Prakash V Dhond, Rashu Mittal
CHAPTER 1:
Principles for Surgical Approaches to Maxillofacial Trauma
PRINCIPLES OF INCISION PLACEMENT
Avoid Injury to Important Neurovascular Structure
Use of Long and Adequate Incision as Necessary
Place Incision Perpendicular to the Surface of Non-hair Bearing Skin
Incision Placed in the Line of Mimimum Tension
NEWER TECHNIQUES
CHAPTER 2:
Approaches to Airways
TRACHEOSTOMY (FIG. 1)
Advantages
Disadvantages
SUBMENTAL INTUBATION
Indications
Advantages
Limitations
Disadvantages
Procedure
Complications
RETROMOLAR INTUBATION
Advantages
Limitations and Disadvantages
Anatomical Consideration
Checking Adequacy of Space
CHAPTER 3:
Occlusion and Buttress
WHAT IS OCCLUSION?
Types of Teeth
Identification of Teeth
Tooth Identification System
Surfaces of Teeth
Each Tooth has Five Surfaces
NORMAL OCCLUSION
Malocclusion
Identification of Preexisting Occlusion
Guide to Proper Occlusion
WEAR FACETS
Malocclusions
Open Bite
Cross Bite
Buttresses
Vertical Buttresses
Horizontal Buttresses
CHAPTER 4:
Intermaxillary Fixation
ARCH BARS
Indications
Advantages
Disadvantages
Steps
WIRING TECHNIQUES
Gilmer Method
Advantages
Disadvantages
Steps
Eyelet Method
Advantages
Disadvantages
Steps
Ernst Ligature
Indications
Disadvantages
Steps
INTERMAXILLARY SCREW FIXATION
Advantages
Disadvantages
Steps
CHAPTER 5:
Infiltration Techniques of Interest
LOCAL ANESTHESIA TECHNIQUES
AREA OF INFILTRATION
Upper Jaw Infiltration
Posterior Superior Alveolar Nerve Block
Middle Superior Alveolar Nerve Block (Fig. 4)
Anterior Superior Alveolar Nerve Block (Infraorbital Nerve Block)
Greater Palatine Nerve Block
Lower Jaw Infiltration
Inferior Alveolar Nerve Block (Mandibular Nerve Block)
Mental Nerve Block
CHAPTER 6:
Approaches to Mandibular Fracture
FREQUENCY OF THE FRACTURE (FIG. 1)
APPROACHES TO SYMPHYSIS AND PARASYMPHYSIS FRACTURES
Intraoral Approach
Indications
Advantages
Disadvantage
Infilteration
Incision
Wound Closure
Extraoral Approach
Indications
Advantages
Incision
Infiltration
Dissection
Wound Closure
Surgical Dressing
USE OF EXISTING LACERATION
Advantage
Dissection
Wound Closure
APPROACHES TO BODY AND ANGLE
Intraoral
Conventional Approach
Transbuccal System Approach
Transbuccal System
Extraoral Approach
Submandibular Approach (Risdon Approach)
Infiltration
Precautions
Various Methods to Prevent Injury to the Nerve
Wound Closure
Complications
APPROACHES TO CONDYLAR AND SUBCONDYLAR FRACTURE
Retromandibular Approach
Area Accessed
Incision
Infiltration
Resection
Advantages
Disadvantages
Preauricular Approach
Indications
Advantages
Incision
Infiltration
Dissection
Wound Closure
Alterations in Preauricular Incision
Intraoral Approaches
Incision
Exposure of Fracture
Endoscopic Approaches
Wound Closure
Surgical Dressing
CHAPTER 7:
Approaches to Zygomatic Fracture
APPROACHES TO ZYGOMA
Treatment
Indications of Surgical Management of Zygoma Fractures
Surgical Approaches (Flow chart 1)
OTHER WAYS OF CLASSIFYING THE APPROACHES
Closed Reduction
Gillies Temporal Approach
Dingman's Approach
Percutaneous Approach
Keen Technique
Carroll-Girard Approach
OPEN REDUCTION
ANTERIOR APPROACHES
Zygomaticomaxillary Buttress
Gingivobuccal Incision
Marginal Gingival Incision (Sulcular Incision)
Infraorbital Rim Approach
Skin Incision
Subciliary Incision (See Fig. 18)
Midtarsal Incision (Fig. 20)
Infraorbital Rim Incision
Conjunctival Incision
Special Instruments
BICORONAL APPROACH (BITEMPORAL APPROACH)
Surgical Consideration
Layers of Temporoparietal Region
Incision
Hair Line
Area to be Accessed
Design of Incision
Hair Preparation
Temporary Tarsorrhaphy
Marking of the Incision
Hemostasis
Dissection
Lateral Dissection (Temporal Extension of Skin Incision)
Exposure of Zygoma
Subperiosteal Exposure of Supraorbital Rim
Exposure of Orbital Walls
Pericranial Flap
Indications
Anteriorly-based Pericranial Flaps
Laterally-based Pericranial Flaps
HARVESTING CRANIAL BONE GRAFT (FIG. 37)
CLOSURE
Lateral Canthopexy
Refixation of Temporalis Muscle
Suturing of Temporalis Fascia
Drain Placement
Skin Closure
Dressing
ZYGOMATICOFRONTAL SUTURE
Brow Incision
Advantages
Disadvantages
Steps
UPPER LID BLEPHAROPLASTY APPROACH (FIG. 41)
Advantages
Steps
CHAPTER 8:
Approaches to Maxilla Fracture
MAXILLA FRACTURE
Intraoral Approach (Maxillary Vestibular Approach)
Gingivobuccal Sulcus Incision (Sublabial Incision)
Advantages
Disadvantages
Steps
Marginal Gingival Incision (Sulcular Incision)
Advantages
Steps
Lower Eyelid Approach (Fig. 4)
Upper Lid Blepharoplasty Approach
Advantages
Steps
BROW INCISION
Advantages
Disadvantages
Steps
Dissection
Coronal Approach (Fig. 5)
CHAPTER 9:
Approaches to Orbital Fracture
SURGICAL APPROACHES TO ORBITAL FRACTURES
ORBITAL FLOOR FRACTURE
Options Available for Treatment of Orbital Floor Fracture
Indications for Surgery
Indications for Endoscopic Repair of Orbital Floor Fracture
Preoperative Evaluation
Surgical Steps
Hinge Fracture (Fig. 1A)
Medial Blowout Fracture (Fig. 1B)
Precautions
OPEN METHODS
A. Skin Incision
Anatomic Considerations
Subciliary Incision
Standard Subciliary Incision (Figs 6A to D)
Converse Subciliary Incision (Fig. 7)
Midtarsal Incision (Fig. 8)
Advantages
Disadvantages
Infraorbital Rim Incision (Fig. 9)
Disadvantages
B. Conjunctival Incision (Fig. 10)
Advantages
Disadvantages
Two Types of Conjunctival Approaches
Incision
Dissection
Incision on Inferior Orbital Periosteum
Closure
Approaches to Medial Wall of the Orbit
External
Endoscopic
Indications of Medial Wall Fracture Repair
Direct Medial Canthal Approach
Advantages
Disadvantages
Medial Brow Approach
Disadvantages
Lid Crease Incision
Advantages
Coronal Approach
Disadvantages
ENDOSCOPIC APPROACHES
Transcaruncular
Resection
Surgical Anatomy
Use of Endoscope
Endonasal Endoscopic Techniques
Advantages of Endoscopic Approaches
Disadvantages
Approach to Lateral Orbital Wall
Approaches to Superior Orbital Wall
CHAPTER 10:
Approaches to Frontal Bone Fracture
INTRODUCTION
ANTERIOR WALL FRACTURE
Indications of Open Approaches
Advantages
Disadvantages
BROW INCISION
Steps
Infiltration
Incision
Dissection
Wound Closure (Fig. 6)
CORONAL INCISION
ENDOSCOPIC APPROACHES
Intranasal Endoscopic Approach
Indications
External Endoscopic Approach
Indications
Techniques of External Endoscopic Technique
SURGICAL STEPS
General Treatment of Frontal Sinus Fracture
CHAPTER 11:
Bone Graft Harvesting
BONE GRAFTS
Primary Bone Graft
Contraindications
ILIAC CREST
Advantages
Disadvantages
Anterior Iliac Grafts
Steps
Posterior Iliac Grafts
Complications
CALVARIAL GRAFT
Advantages
Disadvantages
Calvarial Bone can be Harvested at Three Levels
Complications of Calvarial Graft
RIB GRAFT
Advantages
Disadvantages
Steps
Side Effects and Complications
SURGICAL ATLAS
CASE 1: SYMPHYSIS FRACTURE (INTRAORAL APPROACH)
CASE 2: PARASYMPHYSIS FRACTURE (INTRAORAL APPROACH)
CASE 3: BODY MANDIBLE
CASE 4: ANGLE MANDIBLE
CASE 5: SUBCONDYLAR FRACTURE (RETROMANDIBULAR APPROACH)
CASE 6: INFRAORBITAL FRACTURE (SUBCILIARY APPROACH)
CASE 7: THREE POINT FIXATION USING EXISTING WOUND (TRIPOD FRACTURE)
CASE 8: FRONTAL FRACTURE (SUPRAORBITAL APPROACH)
CASE 9: FRONTAL MUCOCELE
CASE 10: TEMPOROMANDIBULAR JOINT ARTHOPLASTY
CASE 11: RECONSTRUCTION PLATE (COMMINUTED FRACTURE BODY MANDIBLE)
CASE 12: RIB GRAFT
CASE 13: SYMPHYSIS FRACTURE (USE OF EXISTING WOUND)
CASE 14: PARASYMPHYSIS FRACTURE (EXTRAORAL APPROACH)
INDEX
TOC
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