Fractures and Neurological Assessment
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Fractures and Neurological Assessment

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Questions and Answers

What is emphasized as the best method for assessing zygomatic arch fractures?

  • Physical examination
  • X-ray imaging
  • Computed tomography (CT) (correct)
  • MRI scans

    • What is a critical preoperative consideration before surgery for zygomatic arch fractures?

  • Checking for allergies
  • Consultation with a dentist
  • Monitoring of neurologic function (correct)
  • Assessing for respiratory conditions

    • What should be confirmed regarding the optic nerve before proceeding with surgery for zygomatic arch fractures?

  • That it is intact (correct)
  • That it is swollen
  • That it is detached
  • That it shows signs of damage

    • Which surgical principle is crucial for managing zygomatic arch fractures?

    <p>Restoring normal dental occlusion</p> Signup and view all the answers

    What is the recommended postoperative care for patients with zygomatic arch fractures?

    <p>Feeding soft gruel for 4 weeks</p> Signup and view all the answers

    Which condition should be checked in preoperative considerations for zygomatic fractures?

    <p>Diaphragmatic hernia</p> Signup and view all the answers

    What type of feeding tube may be used for postoperative nutrition?

    <p>Gastrostomy tube</p> Signup and view all the answers

    What is NOT recommended for treating mandibular fractures?

    <p>Intramedullary pinning</p> Signup and view all the answers

    What is the main complication associated with temporomandibular joint issues?

    <p>Malocclusion</p> Signup and view all the answers

    What surgical technique is preferred for mandibular symphyseal separations in cats?

    <p>Wire stabilization</p> Signup and view all the answers

    Which statement about preoperative care for intracranial fractures is true?

    <p>Most intracranial fractures are close fractures.</p> Signup and view all the answers

    What is a recommended postoperative care step for patients with intracranial fractures?

    <p>Monitor neurologic function.</p> Signup and view all the answers

    What is generally true regarding the treatment of mandibular body fractures?

    <p>Conservative management is most commonly used.</p> Signup and view all the answers

    Which option is least likely to be used for postoperative care of fractures?

    <p>Internal fixation</p> Signup and view all the answers

    What is the purpose of performing a neurologic examination as a preoperative consideration?

    <p>To assess central nervous system compromise.</p> Signup and view all the answers

    In the case of surgery for calvarial fractures, what is a necessary step?

    <p>Remove comminuted bone pieces.</p> Signup and view all the answers

    What is a common clinical sign of zygomatic arch fractures?

    <p>Asymmetry of the jaw</p> Signup and view all the answers

    Which imaging technique is most effective for assessing zygomatic arch fractures?

    <p>Computed tomography (CT)</p> Signup and view all the answers

    Which of the following is an important anesthetic consideration for zygomatic arch fractures?

    <p>Endotracheal tube placement through a pharyngotomy incision</p> Signup and view all the answers

    What should be monitored postoperatively in patients who have undergone surgery for zygomatic arch fractures?

    <p>Neurologic function</p> Signup and view all the answers

    What is a significant preoperative consideration when dealing with zygomatic arch fractures?

    <p>Confirming intact optic nerve and vision</p> Signup and view all the answers

    Which feeding option is recommended postoperatively for patients who cannot be fed orally?

    <p>Esophagostomy feeding tube</p> Signup and view all the answers

    Which surgical principle should be adhered to when managing fractures that cause eye compression?

    <p>Restoration of normal dental occlusion</p> Signup and view all the answers

    Which condition should be monitored preoperatively for patients with potential zygomatic arch fractures?

    <p>Diaphragmatic hernia</p> Signup and view all the answers

    Which of the following is considered a rare complication following fractures of the temperomandibular joint?

    <p>Osteomyelitis</p> Signup and view all the answers

    What is the typical management approach for mandibular body fractures?

    <p>Managed conservatively unless severe displacement occurs</p> Signup and view all the answers

    What is an important postoperative care consideration after surgery for intracranial fractures?

    <p>Monitoring neurologic function</p> Signup and view all the answers

    What type of stabilization technique is recommended for mandibular symphyseal separations in cats?

    <p>Wire stabilization</p> Signup and view all the answers

    In cases of calvarial fractures, which surgical action is typically performed?

    <p>Elevating depressed fractures</p> Signup and view all the answers

    What is indicated for postoperative feeding in patients with mandibular fractures?

    <p>Soft gruel</p> Signup and view all the answers

    What is a characteristic of most intracranial fractures?

    <p>They often compromise the central nervous system</p> Signup and view all the answers

    Which method is best for stabilizing open, comminuted fractures that involve bone loss?

    <p>External skeletal fixation</p> Signup and view all the answers

    What should be confirmed regarding the optic nerve before surgery for zygomatic arch fractures?

    <p>That it is intact</p> Signup and view all the answers

    Which imaging method provides a three-dimensional impression for diagnosing zygomatic arch fractures?

    <p>CT scan</p> Signup and view all the answers

    What anesthetic consideration is critical during surgery for zygomatic arch fractures?

    <p>Establishing a pharyngotomy incision</p> Signup and view all the answers

    What is a common postoperative care step following surgery for zygomatic arch fractures?

    <p>Feeding a soft gruel for at least 4 weeks</p> Signup and view all the answers

    Which principle is emphasized for managing fractures that compress the eye?

    <p>Restore normal dental occlusion</p> Signup and view all the answers

    What should be monitored postoperatively in patients undergoing zygomatic arch fracture surgery?

    <p>Neurologic function</p> Signup and view all the answers

    In which situation is intramedullary pinning not recommended for fracture treatment?

    <p>Mandibular fractures</p> Signup and view all the answers

    What is a critical aspect of preoperative care for zygomatic arch fractures?

    <p>Ensuring no concurrent head trauma exists</p> Signup and view all the answers

    What is the primary complication associated with fractures of the temporomandibular joint (TMJ)?

    <p>Malocclusion</p> Signup and view all the answers

    What type of fractures are usually associated with central nervous system (CNS) compromise?

    <p>Intracranial fractures</p> Signup and view all the answers

    Which treatment option is considered the technique of choice for managing mandibular symphyseal separations in cats?

    <p>Wire stabilization</p> Signup and view all the answers

    What is the recommended feeding approach for patients recovering from mandibular fractures?

    <p>Soft gruel</p> Signup and view all the answers

    What postoperative complication can arise from a frontal sinus fracture?

    <p>Subcutaneous emphysema</p> Signup and view all the answers

    Which of the following is a key preoperative consideration before managing extracranial fractures?

    <p>Conducting a neurologic examination</p> Signup and view all the answers

    What is the main goal of elevating depressed calvarial fractures during surgery?

    <p>To ensure proper healing of neural structures</p> Signup and view all the answers

    Which stabilization technique is best suited for fractures that are open and comminuted with bone loss?

    <p>External skeletal fixation</p> Signup and view all the answers

    Which aspect should be monitored postoperatively according to standard care practices for zygomatic arch fracture patients?

    <p>Neurologic function and general recovery</p> Signup and view all the answers

    What is the ideal method for imaging zygomatic arch fractures?

    <p>Computed tomography (CT)</p> Signup and view all the answers

    What is a common preoperative consideration for managing zygomatic arch fractures?

    <p>Evaluating optic nerve integrity</p> Signup and view all the answers

    Which feeding method is preferred for postoperative care in zygomatic arch fracture patients who cannot eat normally?

    <p>Esophagostomy or gastrostomy feeding tube</p> Signup and view all the answers

    Which complication is most often associated with zygomatic arch fractures?

    <p>Eye compression and vision loss</p> Signup and view all the answers

    Which anesthetic consideration is vital during the surgical procedure for zygomatic arch fractures?

    <p>Placement of an endotracheal tube via pharyngotomy</p> Signup and view all the answers

    What is NOT recommended when addressing mandibular fractures?

    <p>Use of intramedullary pinning</p> Signup and view all the answers

    What is a key aspect of postoperative nutrition management for patients recovering from zygomatic arch fractures?

    <p>Offering a soft gruel for 4 weeks</p> Signup and view all the answers

    What is the significance of performing a neurologic examination before surgery for intracranial fractures?

    <p>It detects any central nervous system compromise prior to intervention.</p> Signup and view all the answers

    What is typically done during the surgical procedure for managing depressed calvarial fractures?

    <p>Elevate depressed fragments and remove comminuted pieces.</p> Signup and view all the answers

    Which of the following is a common complication observed with mandibular body fractures?

    <p>Subcutaneous emphysema.</p> Signup and view all the answers

    What is an essential postoperative care consideration for patients who have undergone surgery for intracranial fractures?

    <p>Monitor neurologic function continuously.</p> Signup and view all the answers

    What treatment option should be considered for displaced mandibular fractures?

    <p>Wire stabilization for more predictable outcomes.</p> Signup and view all the answers

    Which complication is the most significant concern following fractures of the temporomandibular joint (TMJ)?

    <p>Chronic malocclusion.</p> Signup and view all the answers

    Which technique is recommended for stabilizing mandibular symphyseal separations in cats?

    <p>Acrylic bonding of the canine teeth.</p> Signup and view all the answers

    What is the typical management approach for most extracranial fractures?

    <p>Conservative management for minor cases with no displacement.</p> Signup and view all the answers

    Study Notes

    Zygomatic Arch Fracture

    • Assess for neurological damage before surgery
    • CT scan provides a 3D view of the fracture
    • Reduce fractures that press on the eye
    • Monitor neurological function during post-operative care
    • Degenerative joint disease (DJD) of the TMJ is a potential long term complication

    Extracranial Fractures

    • Assess for neurological damage
    • Most extracranial fractures are managed conservatively
    • Surgery is indicated for severe displacement
    • Subcutaneous emphysema may occur following surgery for frontal sinus fracture

    Intracranial Fractures

    • Assess for neurological damage
    • Most are closed fractures
    • Calvarial fractures often involve CNS compromise
    • Elevate depressed calvarial fractures and remove bone fragments
    • Prognosis for neurological recovery is guarded

    Mandibular Fractures

    • Assess for neurological damage, diaphragmatic hernia, and pneumothorax
    • Use an endotracheal tube through a pharyngotomy incision
    • Give antibiotics because most mandibular fractures are open
    • Restore normal dental occlusion
    • Maintain nutrition with feeding tubes and soft gruel
    • Complications: Malocclusion, osteomylitis

    Mandibular Symphyseal Separations

    • Wire stabilization is the technique of choice

    Mandibular Body Fractures

    • Use a tape muzzle for minimal displacement
    • Maxillary-mandibular fixation for stable fractures
    • Interfragmentary wiring for stable fractures
    • Intraoral acrylic splint is an option
    • External skeletal fixation for open or comminuted fractures

    Fractures of the Skull

    • Zygomatic Arch Fracture:
      • Preoperative Considerations: Perform a neurologic examination, ensure the optic nerve and vision are intact before surgery.
      • Surgical Procedure: Reduce fractures that cause compression of the eye.
      • Postoperative Care and Complications: Monitor neurologic function. Degenerative joint disease (DJD) of the temporomandibular joint (TMJ) may result long-term. Prognosis is good.
    • Extracranial Fractures: Fractures of the nuchal crest, sagittal crest, or frontal sinus.
      • Preoperative Considerations: Perform a neurologic examination.
      • Treatment: Most are managed conservatively. Surgery is performed if displacement is severe.
      • Postoperative Care and Complications: Monitor neurologic function. Subcutaneous emphysema may occur secondary to frontal sinus fracture.
    • Intracranial Fractures:
      • Preoperative Considerations: Perform a neurologic examination. Most are closed fractures. Calvarial fractures are usually associated with central nervous system (CNS) compromise.
      • Surgical Procedure: Elevate depressed calvarial fractures and remove comminuted pieces.
      • Postoperative Care and Complications: Monitor neurologic function. Prognosis is guarded for neurologic recovery.

    Mandibular Fractures

    • Clinical Signs: Asymmetry of the jaw, oral hemorrhage and pain, crepitus, concurrent head and thoracic trauma.
    • Diagnosis: Based on history and radiographs; CT can provide a three-dimensional (3-D) impression.
    • Surgical Procedures:
      • Preoperative Considerations: Monitor neurologic function and check for diaphragmatic hernia, pneumothorax, and other conditions.
      • Anesthetic Considerations: Place an endotracheal tube through a pharyngotomy incision. Give antibiotics because most mandibular fractures are open.
      • Surgical Principles: Restore normal dental occlusion. Intramedullary pinning is not recommended.
      • Postoperative Care: Maintain nutrition with an esophagostomy or gastrostomy feeding tube. If not using a feeding tube, feed a soft gruel for 4 weeks post surgery. Flush the mouth daily with dilute chlorhexidine solution.
      • Complications: Malocclusion is the most important complication; osteomyelitis occurs rarely.
    • Mandibular Symphyseal Separations:
      • Occurs often in cats.
      • Wire stabilization is the technique of choice.
    • Mandibular Body Fractures:
      • Create a muzzle using tape (Figure 22-1): Can be used if there is minimal displacement of fragments. Difficult to do in cats or brachycephalic breeds. Feed soft gruel.
      • Maxillary-mandibular Fixation: Either wire the maxilla to the mandible or use acrylic bonding of the canine teeth to keep the mouth closed.
      • Interfragmentary Wiring: For fracture fragments that are stable without loss of bone or comminution.
      • Intraoral acrylic splint.
      • External Skeletal Fixation: Best used for fractures that are open, comminuted, or involve bone loss.

    Fractures of the Skull

    • Zygomatic arch fracture:

      • Preoperative considerations:
        • Perform neurologic examination.
        • Confirm optic nerve and vision are intact.
        • Computed tomography (CT) provides the best assessment.
      • Surgical procedure: Reduce fractures causing eye compression.
      • Postoperative care and complications: Monitor neurologic function. Degenerative joint disease (DJD) of the temporomandibular joint (TMJ) may occur long-term. Prognosis is good.

    • Extracranial fractures: Fractures of the nuchal crest, sagittal crest, or frontal sinus.

      • Preoperative considerations: Perform neurologic examination.
      • Treatment: Most are managed conservatively. Surgery is performed if displacement is severe.
      • Postoperative care and complications: Monitor neurologic function. Subcutaneous emphysema may occur secondary to frontal sinus fracture.

    • Intracranial fractures:

      • Preoperative considerations:
        • Perform neurologic examination.
        • Most are closed fractures.
        • Calvarial fractures are usually associated with central nervous system (CNS) compromise.
      • Surgical procedure: Elevate depressed calvarial fractures and remove comminuted pieces.
      • Postoperative care and complications: Monitor neurologic function. Prognosis is guarded for neurologic recovery.

    Mandibular Fractures

    • Clinical Signs: Asymmetry of the jaw, oral hemorrhage and pain, crepitus, concurrent head and thoracic trauma.
    • Diagnosis: Based on history and radiographs, CT can provide a three-dimensional (3-D) impression.
    • Surgical Procedures:
      • Preoperative considerations: Monitor neurologic function and check for diaphragmatic hernia, pneumothorax, and other conditions.
      • Anesthetic considerations: Place an endotracheal tube through a pharyngotomy incision. Give antibiotics because most mandibular fractures are open.
      • Surgical principles: Restore normal dental occlusion. Intramedullary pinning is not recommended.
      • Postoperative care: Maintain nutrition with an esophagostomy or gastrostomy feeding tube. If not using a feeding tube, feed a soft gruel for 4 weeks post-surgery. Flush the mouth daily with dilute chlorhexidine solution.
      • Complications: Malocclusion is the most important complication; osteomyelitis occurs rarely.

    Mandibular Symphyseal Separations

    • Occurs frequently in cats.
    • Wire stabilization is the technique of choice.

    Mandibular Body Fractures

    • Muzzle creation using tape (Figure 22-1):
      • Can be used if there is minimal displacement of fragments.
      • Difficult to do in cats or brachycephalic breeds.
      • Feed soft gruel.
    • Maxillary-mandibular fixation: Either wire the maxilla to the mandible or use acrylic bonding of the canine teeth to keep the mouth closed.
    • Interfragmentary wiring: For fracture fragments that are stable without loss of bone or comminution.
    • Intraoral acrylic splint:
    • External skeletal fixation: Best used for fractures that are open, comminuted, or involve bone loss.

    Zygomatic Arch Fracture

    • Perform a neurologic examination and ensure optic nerve and vision is intact before surgery
    • CT scan provides the best assessment
    • Reduce fractures causing compression of the eye
    • Complications include degenerative joint disease of the TMJ, but prognosis is good

    Extracranial Fractures

    • Include fractures of the nuchal crest, sagittal crest, or frontal sinus
    • Perform neurologic examination
    • Most are managed conservatively, surgery is performed if displacement is severe
    • Complications include subcutaneous emphysema secondary to a frontal sinus fracture

    Intracranial Fractures

    • Perform neurologic examination
    • Usually closed fractures
    • Calvarial fractures are associated with CNS compromise
    • Elevate depressed calvarial fractures and remove comminuted pieces
    • Prognosis for neurologic recovery is guarded

    Mandibular Fractures

    • Asymmetry of the jaw, oral hemorrhage and pain, crepitus, concurrent head and thoracic trauma are clinical signs.
    • Diagnosis is based on history and radiographs, CT can provide a 3D impression
    • Anesthetic considerations involve placing an endotracheal tube through a pharyngotomy incision
    • Monitor neurologic function, diaphragmatic hernia, pneumothorax, and other conditions preoperatively
    • Restore normal dental occlusion, intra-medullary pinning is not recommended
    • Complications include malocclusion and osteomyelitis
    • Maintain nutrition with an esophagostomy or gastrostomy feeding tube, or a soft gruel for four weeks post-surgery
    • Flush mouth daily with dilute chlorhexidine solution

    Mandibular Symphyseal Separations

    • Occurs often in cats
    • Wire stabilization is the preferred technique

    Mandibular Body Fractures

    • Use a muzzle with tape for minimal displacement of fragments
    • Maxillary-mandibular fixation uses wire or acrylic bonding of the canine teeth to keep the mouth closed
    • Interfragmentary wiring is used when fragments are stable without bone loss or comminution
    • Intraoral acrylic splint is another option
    • External skeletal fixation is best for open, comminuted fractures, or fractures involving bone loss

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    Description

    This quiz covers critical information regarding the assessment and management of various types of fractures including zygomatic, extracranial, intracranial, and mandibular fractures. It emphasizes the importance of monitoring neurological damage and potential complications during and after surgical procedures.

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