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don't get distracted by the subtitle applied on up to me. There isn't gonna be lots of this because that we don't have the time. Um, before we start, I have one promise and one disclaimer. So the promise will be that everyone out of you will know it. Least one call fact about my experts trauma at the end of this hour. So So you can hold me to that. And this claimer is that I don't have the time to cover head and neck anatomy in detail. I don't have the time to cover the conditions of the management, like factor plating, facial plastics and reconstruction on. And I don't have the time for dental goal. Our interval, our interaural and neck trauma. So? So please bear with this. So what is funny? Taste or trauma? Facial trauma is like an umbrella 10 for any physical trauma to the face and neck usually, Um and, um you can see that Have a picture of a soldier here. This guy fought in the first World War, and I put it specifically here because the specialty itself Max flags really developed on the in the last century during the pheasant second World War. Well, you had a dually trained doctor slash dentists, and, um, your nose throat doctors, um, treat facial fractures and facial trauma sustained during the war world. Waas So So this is where the original the specialty itself is, um, on more about the facial trauma. It's now, um, it's often part of all the trauma. So as you can imagine, you have, Ah, another person or intoxicated pass and falling down the side of stairs. Um, they're not only gonna damage the face, the only also gonna have many, many more issues like lymph actors. Spinal injury had one caution. Um, you name it and this rarely life threatening, which means that most of the marks extreme are isn't really am an emergency. We're gonna cover a couple of real emergencies in a moment. But for example, for fixing fractures, you need to wait a couple of days least for the swelling to subside before you can do anything about it. Really? It's treated my max back. Surgeons with an MCT multi deception are a team consisting of dentists of the Ent doctors, plastic sense neurosurgeon, very often orthopedics as well. Um, so this is basically like, uh, like, um, hub for, uh, the facial trauma. And it involves a bowl, both bony injuries and stuff. Tissue injuries. Um, so obviously you can fracture any bones in your face. Um, soft tissue injuries. You can get them the same us any any any any other part of your body. So lacerations, bruises, bands, and, um, our faces unique in the in that it you have all of your almost almost below her since. Or it, um, censor organs in your face and it lets you sense the world now, So it's very important in social life and communication. So you need to bear in mind that apart from bones and soft tissue also have special area such as ice, eyes, ears, nose, Um, all of the NEBs um facial. Um, you need You need your muscles to chew. You need your nerves and muscles of facial expression, and you also have salivary glands. So maintenance of your oral cavity and something that isn't to re trauma. It's more, more like an afterthought for most people is the psychological impact of facial trauma. So obviously you rely on their face, you know, day to day interactions with other people. So the in part off this figure man's are on sensory losses. Man's for those patients. So there's something also giving mind that be on two. Repairing those injuries. You also need to really think holistically about a patient on ground ourselves a little bit in, um, what facial trauma looks like in the in the UK Many, um So I think those false assaults, road traffic, collusion, spot injuries and congressional injuries. So in the developing world, majority of facial trauma is from road traffic collisions. However, in UK, especially, it's mainly due to false and assaults, and most of those associated with alcohol consumption, either By the Australian, all the victim of assaults on people generally lose the balance when they're intoxicated. Um, and minorities are sports in the professional injuries. Um, and on the right hand side, there is something to think about way we are the primary demographic for my sex, Stroman. So people are aged going out to the clubs, going after the POB, um, driving the scope test and so on and so on and so on. It's a huge bad and for our healthcare system as well off economically in for patient outcomes were over 500,000 presentations a year. In the UK itself, 22% of those injuries are associated with alcohol consumption. On we have something that I think is really remarkable that we have out of those 500,000 almost 20% or glass of like injuries. So you can imagine people breaking their glasses in a park and much in there in your face, Um, sounds terrible. And it is terrible in a generating massive gospel for any justice. Well, so I suppose you had your is them or whatever it's called about your demographic about your epidemiology can't stop. So it's also quite interesting in terms of marks, fax, drama, because sometimes prevention is the best solution to the problem. There was this guy professor shepherds from from Wells. Hey, looked into how to prevent facial injuries, and he came up with this report, Um whereby, um in some parts in the UK, where you have high levels off interpersonal violence, you're gonna have these, um, special glasses, which a reinforced on. They don't break easily, so you can imagine breaks as a glass of your window pane a z o. R. As your shield, uh, in your car. So if you don't get longer, these injuries and it's also extends now to sending alcohol in bottles in, like beer in bottles. And what kind in glass bottles? Some places it is. Enforce the day off from yourselves in plastic bottles because of the period of the levels off the last related injuries. Um, and we sort of solved that problem. Uh, we tried, but there is a new pandemic. Um, we just east good or injuries. So, as you know, it's become quite popular, even even in Cambridge. And you don't really need to. You don't really have a driving license to your sponsor. Um, and you convert easily get one like book want when you're intoxicated, coming back from you, don't You don't want to walk back to college after a night out. So you just want to get in the scooter and and do you know, damage your place terribly on. And also, this is where we are also the mostly the most injured demographic, really. So coming back to the topic is the emergencies so hard to save the face and discovered a patient so obviously the most important imagine. See of the mall is airway compromise and anything that will compromise your airway or you're lying. Ah, we'll kill you in minutes. Um, anything else can wait at least for you to to to for front ambulance to be booked and to even have the chance to to pick you up. Uh, you need to manage the airway on some. So I have a question for you there. What do you think is happening in this picture Here? You can, um you know, Celtic, and you can talk in chopped at any point. If you have any questions, just let me know. Um, something is stuck in the class and throat. Yes. So what? What does it look like? What do you think it might be? Um, it looks like a tooth. Yes, it's a tooth. It's actually very come on. Problem that you have fever that come out of the sockets. And they gave this large in the truck. Yeah. Um, and your patient is basically has a foreign body in the talk to struck, and they or asphyxiating? Yeah, it's very good. Very good. Um, then beyond that, we have massive hemorrhage, So we have bleeding coming from the fractures arm from aspirations and nosebleeds cannot be over. Overlooked as well. On to a specific imagine since I wanted to talk about is a retrobulbar hemorrhage, which is basically like a compartment syndrome a garage where you could have bleeding in your eye socket. We did. This place is the eyeball. It compromises your eyesight by destroying your basically cutting off the blood supply from your from your optic nerve and the other one septal and peanut amount, um, us, which don't sound life threatening. And they are not. However, they can have very, very important functional into statically aesthetic problems associated with them. Uh, one more could be which I don't want to talk about. Uh, because it's not Drama is floor of the mouth infections like Ludwig's angina, um, or of incense angina. So have you had about 80 or less? I don't know so sense for advanced from a life support, and it will be the bane of us to join your doctor. Even a somatic constant. You need to know their stay in day out. Um, so it stands for a B, C, D. E, and you have a way breathing Circulation's that you can export her. So it just it is structured this way in, um, in the sequence, how fast it's going to kill you. So aside, management airway's gonna heal in a couple of minutes. Even briefing problems, maybe give you, like, 15 minutes when you're relaxed, are compromised circulation like extra, like using lots of bladder exsanguination. Um, hyperbole. Next drug card. A cardiogenic shock. Um, all of it can kill you are quickly. However, you have the chance to get to the hospital, release this ability. So this is looking into immediately what you what you have. So usually you want to save limp before them. Ah, you want to. There's always life before a limb, and it's always last me for a face. So only after a couple of on the after all those steps are I can't it for you can look into disability, which is looking, for example, into into the eye movements and eyesight on exposure, which means looking for signs of dog on some signs of other. There's so called distracted in distracting injuries where you have an injury which is very concerning to you. However, it's unlikely to kill you so Fisher fractures look terrible. Facial lacerations with terrible they are not life threatening, so we need to look for the actual problem, which might be a tiny thing watching one of the bronchitis, for example, and specifically for facial trauma. This couple of examples so they're ever compromise, can come from swelling from foreign body, such a CR broken teeth or even your tongue if you lose consciousness, your tongue. And if you have multiple fractures, your tongue can get a large degree in your or if I drink so you can just fix it this way, Um, and you can get a referring substructure is also buy some types of fractures. So, as I mentioned, there's this bucket handle Monday. Able fracture and also palate drop in in left wart type of fractures were basically your polyps this largest, and it and it's in the blocks. Your in the blocks everything I always need to clear cervical spine. So always into look for neck injuries and the bars. Larger skull fractures, which are very common in traffic collisions, for example, or any falls like if you fall from a ladder. Um, briefing so usual. Usually well, um, culprits. So you have any more chemotherapy, which basically stands for blood in our in your in your chest. Pulmonary edema will promote confusions. Circulation's We can have a high privilege and shock from from breaking out and then disability. You know, people people speak wall and reactive to light. So we're looking to the people are function. So apparel, uh, you can assess Glasgow comma score. Or, if you don't have the time for full worker, are you congested? DTP you for? Um, so it's basically to assess our risk to your patient this, um, and then you have movements. And obviously, vision. Vision is very important because even though it might not be life threatening, it might be in my my have a huge impact on the patient's life and something you need to look into the vision because, unless you know, it's there is some compromise. A patient. Maybe, um, your patient might not be aware of this, even when they're in shock after after an accident, but you need to check vision and exported route, which is the pneumonic lot on the floor in four more. So you're looking for signs of blood and signs of other injuries and after you after you deal with a TLS. So you're a me a two year approach. You can you can move forward to the initial survey where you're looking to the different types of injuries that it get on. Do you wear them out? So the fasting, that's very apparent. Distress signal symmetry When you have, um, side, um, attic or your cheekbone. Fact, just you can be depressed. You can have stepped deformities in your face. Um, and obviously you can have some other some other problems due to swelling due to damage, for example, um, the bleeding's and hematomas. Um, then you have soft tissue injuries. So there is There are some covered. You can have a full on flare of lacerations, nasal injuries, your protein doctor injuries and so on and so on. Only injuries, which we're gonna cover in detail, eyes and I movements. So we need to at least be aware of those. You don't need to know. Then you just call ophthalmologist, um, mountain teeth. I'm not gonna cover so anything that happens in your mouth or with your teeth incident. Although lower and intraoral injuries, you can perform a tongue blade test have you had about it in, um, had an economic to me or anywhere else. Ah, bread. A little bit about it in a book before, but not too much detail. Yes, it's okay. You Can you tell us what? What that might be. Um, I called, Yes. So you know the time blade or tongue depressor? Oh, he's basically like a stick. It's It's sometimes it's it's mental. Sometimes it wouldn't, um, and you basically used to the present tongue when you're doing the, um, oral examination. However, if you you can also ask your patient to buy down on the on the time blade. Yeah, and if they are not able to do this because of the pain, then they might be out tmj temporomandibular joint your jaw joint. Um, problem. Or there might be some practice, um, for bony injury also need to remember to help pay for it. So if you if you talk to the face on some things moving or if you talk to the face and there's some crepitus, there is some way it sounds coming in. Some crackles. Then it's like there's some fractures on down. After that, you know, you're four cranial nerve examination. So we're looking to the function of it of the 12 Creon. That's, um um a true A medicine. I wanted to talk about your irritable bowel hemorrhage. Retrobulbar hematoma where you can see this is this time. So you get this stuff conjunctival hemorrhage. And also periorbital swelling and periorbital hemorrhage. Just Well, um, ecchymosis is very little like a mall. Says Prepon eyes, um, and also on the CT scan. So this is your nose. These are your eyes. This is your cheekbone on that. There would be a brain. This is you're not nasal nasal cavity. Basically, you can see on the right hand side behind the eye. You have this thing you, which is basically god extrapolating and calculating behind the eye, pushing it forward and compressing the optic nerve. So this is a true emergency, because unless you treated in a couple of minutes, you want you to lose your eyesight. Um, so I tried not to include lots and lots of gory staff which is never inevitably associated with facial trauma. I want to show this. And so it's honest. If you're sensitive, just look away. So this is how you manage your, um, your ritual Bald or hemorrhage? Um, it's called lateral compartment me. And if your control assists, we're basically have this temple ligament on the lateral part of the eye, which which prevents the eye from popping out off the ice. Okay, um, and in emergency, to relieve the pressure and to stay the I, you need to call it So it's done with the scissors. You need to can't can't cut this in fewer and lateral conflict. Um, it's basically here. It's shown with local anesthetic. However, sometimes you don't even have time to apply in the local. You just do it immediately to save patients. I side then coming back to normal. Yes, Lee time eso When you perform that procedure, is the patient conscious? Yes, very offer. They're often they are conscious. Um, however, you just let them know that you need to you need to say their eyesight. So you need to do this. Otherwise, there is no way for the pressure too. Like to get out from the eye. You, If you're lucky enough like if you're in other books, you can probably get your ophthalmology immediately. You can get your honest ideology immediately. You can get a rapid sequence, intubation and the induction. They can put you down to sleep in a couple of seconds, and then they can do this. However, if you're just in a local hospital in an emergency department, you know that immediately, cause otherwise the patient's been on this eye sight. Um, so the title, some pain now are terrible disability for alive. So I I know it This just start off this problem with, like, you know, home thought this is just something to do. It's actually in. Imagine sees, pronounces it questions. Yeah. Thank you. So, coming back to not so good restart. You have septile hematomas. The's look quite benign. However, they really, really Oh, no, not so. This is what it looks like. You basically get a bleed within your septum. We're basically your mucus periods gym or your, um your, um your skin in the vestibule of your nose gets lifted up, and then you have a bleed within the space between the cartilage and between them because, uh um and unless you re Paris, it can It can get, um, infected. It can get really inflamed. And then you're gonna have several preparations. You're gonna have loss of esthetics off of your nose. You can get lots of function of, you know, you can get septal deviation, get fibrosis and scarring. So So there's lots of Southern can go wrong with those, and they're really easily moment. You just put the needle on, drained the hematoma. Uh oh. It's it's not really off the nasal blood supply. If you're keen, we can We can go for this if you know just that, you know before word. Yeah, I don't mind going through. All right, so we have to plaques i to plexuses. You have your interior Texas, which is little area or diesel box flexes. And you have your Woodruff, Texas, of the posterior plexus on 90% or 95% off the nosebleeds will be from from the anterior from the anterior sides of the littlest area. And you have seven blood vessels that supply. So if I run a comedy, so you have one and two are anterior posterior ethmoid. Allow trees, then you have free would be rusty. No politician artery which comes down here, supplies the polyp and then comes back as a greater politics. Not tree. Then you have this one. Which is them, Um, superior. Really? A look around for the facial artery. And then you get external nasal in, turn on these all and so on. So this is what the blood supply looks like. Off note is that you also have an anastomosis between the external and internal carotid. It's so you can have get an infection in your nose that spread out your brain. So this is something also quite important. Clinically. Teo, if you have a post urinals meat of unknown source, you need to work it out because otherwise you're basically might be getting an infection. Or, um, for an obsessive, The express to your brain on Ben can cause meningitis and careful itis. You know, Sinus from balls is lots of lots of lots of terrible stuff can happen so similarly to your nasal hematomas. You can also get a peanut hematoma. So this is what it looks like when you get basically. Also, get a collection of blockage in your skin and your on your cartilage and and unless to drain it, you get this. This'll what lot of boxers and infighting support to get it a lot. It's got a cauliflower year, which is quite disfiguring. So you you want to avoid that at all cost. And now we go to the bane off marks marks of just facial projects. We we tried to piece our anatomy and the mechanism of injury together. So I have a question for you. What to do? I think he's a front. Okay, for, um, is a front Childress like of mine, uh, defect in the bone on It's not fully broken, but it's just like on the surface, in a way, Yeah, that's a That's a very good shot. Um, any other take us. All right, so So I'm gonna give you two answers when it's like a dummy. One is clinical. So, like a typically a fracture is a disruption in the continuity, um, of your cortical bone. So, as you can remember, you can each of your bones, his cortex and then consulates parts. So if you have a break in the cortical part, full thickness break in the colon. Corticobasal. This will be called the fracture. Then a fracture can be complete. An incomplete. So what do you What do you refer to be? An incomplete fracture and the complete fracture would be through the bone. So we will go for cortex for the counselors bone and then for cortex and game, and then you can get this placement and so on. So this is the real definition when you basically lose the bony control when you have a disruption in the cortex. However, I think the more useful definition of a fracture is that it is a soft tissue injury of a broken bone inside. Because when you think about it, broken bone was not a pill. You broken bone will not even make you lose your limb. However, when you get a compartments in room if you get a lead, if you get an open fracture which gets infected, this is going to kill. You gonna get septic? Um, or you can almost your land your fracture. If it's unstable, you can pierce your brought blood vessels in peace, and that's a computer muscles. Um, so it is not. The fracture is not the bone itself not well, because your lots of trouble, it's basically the soft tissue that's damaged because of the fracture. So So this is how how how I like to feel about your feeling about it because it's very exciting, especially in your eloquent call us when you get your orthopedic today, you shouldn't feel like straight really geology. Describing fractures are you know what the fracture was told? Um, you can describe it, however you don't look into, and it's soft tissue injury, which is very important. So So there's this. I think if you if you can take one thing away from from this from this hour, it'll be this definition and facial practicing numbers. So as you can imagine the constructor, any bone in your body and you can fracture any bones in your face. Um, you know, if I have quite a few bones, Um, and there are some very specific sort of fracture Parton's that occur because of how our school has developed, how it's evolved use to serve its function on. But we have some place you trouble front of the others. So the mosque on the fracture is then this diagrammatic, um, Marcus allergic, complex or tribal fracture. So the try. But I like the type of name because it basically it is what it is so zygomatic. Oh, so it's like a market bone maxillary maxilla fracture. And then we have free parts. We have fracture at or near by this cycle. Matic Arch, which is askew can remember, is formed by the temporal process of the zygomatic bone in the zygomatic process off the temporal bone. Then we have our side comma and our max a lot. And we have a frontal process here, um, in front, all from the zygomatic sutra here. So we get a fracture here. You get a fracture here, and we've got a fracture here. Then we have one. People are factors which are very, very, very common. So anything in a month, double any partisan. Wonderful can can can be fractured Mom, Zealand. So anything in your meat vice can get fractured. Nasal injuries are very, very, very common because quite a thing, Bone. Uh, it's that's quite a lot of Citrus around it. And, uh, for often, get the punch in. You know, it's every four. If you fall face down, you're going to damage your nasal bone. The family have this another complex fracture. It's postnasal or be talking Boyd, where your fracture or nasal bones parts of your own bait in part of the ethmoid bones. These are terrible to repair. And then I have orbital fractures. Just that you conceived are not very common. However, they are very, very important clinically because of the stuff that can go wrong in the eye or the orbit itself. So now that we know will fractures are and how how often they happen, we conduct down to particle of factors. So the first one is Monday Bill of Fractures. Eso I said my injections you can fracture, your mind will in and all the different points And they all named very, very straight forward after market me. So you have your second a second. Remember, you're you're a month able forms from two bones on. Then they you it's together midline. So there's the synthesis. An effusion in the midline in the human body is got the synthesis so you can have synthesis pubis in your in your in your, um you know, palace. You can have synthesis of the maxilla of your mandible. So? So this will be if it is. The fracture went straight for would be simply, um if it it's nearby, but not right in the midline. We call it parasymphyseal we can have body of the mandible fractures. You can have angle of the Monday for fractures. We're gonna have rain. Ramos fractures. As you can imagine, they not very common, although they look like they would fracture a lot. And this is because this is the thickest. Don't think it's part of your month ago except Kandahar fractures. We have the condyle remarkable. Which kind of fracture and coronoid, uh, which basically gets pulled by temporal is comprised muscle. Um, and there's a lot of 444 cigs acted on this. It's quite stable, and this is why it doesn't fracture a lot. However, condyle basically smashes ah smashes into the into the joint space in the temporal bone. And and this is white processed because it's it's a bone hitting another bone. And there are two from, you know, in a month, double. Um, do you remember which those are? Um I'm not too sure. Okay, so this one is easy is the mandible are foramen. Um, and then you have enough, and then artery whenever you the usual free coming down here. Here, here, here, here, and the curve down. Supply all of your welcome teeth and then they come out. So you can imagine it would come out of this side and this one would come out on here and this part on the or mandible or of your face called the Chin. All of the mental, um, as it is called in, Um, I believe in in locking. And then you also have a genuine So you always have three times for anything that happens to this area. It will be either your chin under under your mentum or your genial. So you have junior classes that come from Virginia. Glasses will be in a master, the downstream chin. To your punk. I had someone raising. I know that's not to do with factor, but into, um that, like, nose very close. Is he? Is that why it's really painful when is damaged on duty? Exactly. Exactly. Does this white white is because it is called inferior? Overall are enough. So your other all our process is the part where the teeth are lodged. So we were all lower part of your Your mandible will be here and then you haven't although are part of your maxilla where you have your top teeth and then this inferior are, though, or Nash, which implies the resistant to your old for the Mexican. Um, it's also called a few or dental now, which basically means with dust. It supplies the sensation all of your teeth down there. Moreover, it's a price sensation to your bundle, and then it comes out for the mental Framan and supply sensation of reaching over your lower lip over your your gums gingival on the vestibule of your of your lower job. So it it is quite important that the fracture distorted to damage. And there's also why you you you have some problems of, like impacted a thief. Impacted molars When you do the extractions or your route can basically get down to where you are. Nerve canal is, and this is terrible. Um, and that's also why you want to treat them telling infections quite quite soon rather than later, because you couldn't get it upsets. You can get the religion. Anything that gets infected in there around the teeth is off the bone basically or leads to the to the loss of bone. So if you have any infection around the root, it can dissolve your bone so you get, like, a largest space. And then, as you can imagine, anything coming from your from your mouth or from there, all the cavity we're going for your teeth and and will, in fact, everything that's going there. So So it's quite terrible, and this is exactly why it hurts a lot on. And then there's also also leads me to to do one thing I would forget to to to talk about, which is that we care about Montebello fractures because they are mostly open fractures. So if there's any disruption in your in your gums, bring any bleeding here or are cavity that's coming from the fracture. It means it's terrible. It's an open fracture you need. You need it either. Intravenous are long term like a week off this week, up until biotics and very strong antibiotic things are often to to treat that and then you can have more fractures where the elbow or plate off them. Bonus fractured, and it leads to a T 4 lbs basically so you can get a tooth getting displaced most often. The periodontal ligament the stone, and you have to you just come out. However, sometimes they can piece for the bone. The bone itself can get fractures. So the things with the from you know, among people are mental foramina money, blurry mental Framan which now spots for them. So this is the mom. People are division off the trigeminal nerve coming to infuriate enteral. And if you're a dental slashing in feel are the are comes out as a as a mental note, there's also one muscle I belief were just supplied by there. Um, where this now I'm schooled. Mentalities. Um, never mind. Specific type of mandibular fracture is called pocket handle fracture. It looks like a bucket handle. Have your Honda Low, which is your hired bone. And then you have your market, which is you're basically mandible. So here it is, by lab draw. So in both sides, parasymphyseal around the synthesis fracture of the mandible. And why we care. We care about because of this, because if we get lost off the continuity of the bone here, it all gets pulled it down both by the muscles and by the gravity most. Most of the times when you have trauma, your patient will be either consciously or unconsciously eating down. So you basically can get their tongue even more likely done normally to love their own forms and basically asphyxiated patient. So this is quite important if you if you consider that might help me huge blow to your to your bottom of your face. You need to consider backing hunting, fracture and another. Another sign of fracture is that something will Martoma It is so no morning. We just a name for something that always indicates something in medicine. So this part off of pneumonic for a fracture. So if you have ah, if you miss something on an X ray if you need something on city if you have ah, if you have a bleed under your tongue, it will always be a fracture and you need to need to rethink everything has steps. And you need to find this fracture because it's bleeding because your float full of the mouth would get coagulated. It will become infected, and also it might be an open fracture so it might get your bone might get infected. You might get osteonecrosis. You can get osteomyelitis, you can get it spread everywhere. You can get subject always if you if you see someone with blood on blood under the tongue under the floor of the mom. Just just just tell them. But they have a fracture. Little fractures. These are terrible as you can imagine. Getting a blow into in your face in your cheek in your eyebrow. Um, there is a sample off of times. There are blow out practice which, caused by objects of there too large to enter your your home, your orbit, they're blowing in fractures, which are the revised. And, um, I'm just going to talk about the blowout fracture because these are by far the most common. You're gonna have the large fracture when you have a small fracture. And the mechanism of the injury itself is very similar. But before we die, then I'm just a quick revision of them of the orbit. So in your arm. But I think you have six or seven bones. You can you can correct me. So we have from the orbital orbital part or or become plate of the frontal bone. So front meaning your forehead. Then you have your orbital part of the recycle my bone or your cheekbone. Well, that sounds into the orbit. Then you have your maxilla. So your upper job extending here into the frontal process of the maxilla in the orbital process of the maxilla. Here you have your, um, nasal equipment, doc, which basically collect your tears and collects and drains it drains it for your nose. So this is why you cry. You always get a runny nose because your tears that basically coming down here So nasal nose lacrimal tears. There's a lacrimal duct. See, it's on the lacrimal bone. It's very easy then here, this one is this. This part is a bit more difficult. So this purple bit is your lesser greater wing of stuff. You know, a bomb. So this comes comes in park in the in the middle. Part of the brain on this part is always the most treated for students. So there's ethmoid bone here in red. They want to. They mentioned bananas if void orbital truck. Just so you can imagine if something's all right busy here on the sutras. And, you know, the bones are quite seen and, um, and quite busy here, so you can imagine it will fracture altogether. And then this time a little bit, which will be always had a next week exam without fail without failure. So you know, no one knows what is this. It's almost always is in almost all of the head and neck. It's dance, so you it is your, um, orbital process of your polyp time bone. So as you can imagine, your heart polyps has a little bit coming superior, really, and pokes out just in your orbit. So this is important to remember that your parting bone has an orbital process, and, conversely, there's also a good tip is that your maxilla is a polyp time process down there. So you're a monkey, like basically comes around your nose. Contribution are bit contribution to your nose to the puree form. Ah, purchase of your nose. Sort of a pear shaped pressure on entrance to your nose. Um, forms your cheek part of your cheek for parts of your mid face. Then it forms. The Advil are ridge, where you have all of your upper teeth, and then it also contributes to your heart polyps. So this is why you have almost an entire specialty devoted to this bone, and anything that's in it is involved with. We're just quite quite phenomenal if you think about all the other specialties their specialties that are based on physiology, specialties that are based on the pathogenesis of the disease. So, for example, oncology is based on the pathogenesis of concept. Wherever it happens, you have You have specialties like orthopedics, cetera with which deals with bone anywhere. One other would be ent Where have you know, stroke where you place it on the anatomical reason our monkey affection surgery basically focus on focuses on this one bone and anything that surrounds it. Just quite remarkable. I think coming back to our orbital floor front just saw a Zion looted to have a hammock, which is a larger fracture. We have a truck door fracture, so the difference is the size and also the appearance. So here you can see this is a CT scan. We see what we say from the from the from the sites of this lateral here. So to orient ourselves, this would be from this would be back. This is our from our bones. It is the forehead. This is, um also the forehead it's of. This is where your brain is. Think you know, we're bringing him your eye. This would be a safe, you know, a bone. You would have your own. You would have your brain. Sure as well. You're, uh, not not fighting all the are, uh, pituitary clown. Um, and then here would be a four of the orbit. This is the maxilla. And this is the maxillary Sinus. Basically in the airfield space with them. Then marks letter bomb. There's a new market bone, which means it's a field, basically. So, as you can see has this place down. And if you really and then you have this homework from media for metal contents hang. So you're on Byetta conference. Can be muscles can be thought can be blood on so on. And someone this year you should have a beautiful black space which indicates there's on the air. However, here we concede start the start fluid level, which means that there is some fluid here. Just like it could be a lot. If you have a front for extending to your brain or either we have a fracture extending your optic nerve. You can also get CSF. So service spinal fluid flowing into your, um, monkey lot on the other side. of review. Your trumped of it just might small This is that frontal doesn't, um you know, based means we're looking from the front and we cutting the face vertically. So we have in the in the middle here we have your nose and your turbinates. We have your maxillary Sinus again with your beautiful outline. And then we have the floor off the orbit with the fracture here, which is close on itself. Um, it's very often appears in kids, so we have a our bit on in the arm. It blow out, Meaning that my confidence about the injury trumpeter fracture probably meaning it opened and closed on itself in this place, more. And then here we have herniation or protruding of your vehicle contents. Eat your maxillary Sinus very often. This would not be a problem, because it's mainly fart. However, sometimes muscles can get caught here. We're not mask and going to copy here and cause a lot of trouble. Um, so I have I had stopped em sick use if you wanted to try them. I have to. I think if you want to attend those, just give them a shot in the Ford. This will be likely in the second year. I mean, your head and I can not to me. Um, you have six pairs off my muscles. You have 4% off straight muscles so that this would be rectus, meaning straight and 13 on Ben. You have inferior and superior oblique muscles. And the one of this on the bottom will be the inferior rector's because it's inferior to the eyeball. And then this is also with classic had a neck. And not only question, I got it, I think from from one on the from phone off the handle on the few previous exams. So there's this describes loss of sensation or altered sensation in the front. Um, And on this subject, um, So I'm just gonna before what? This is infraorbital in front meaning below or bit meaning below the orbit or below the I infraorbital Never. And I got a tickle facial nerve. It comes from cycle, Mom, which is a cheek. It comes for design rheumatica facial frame and just a very small frame and you're not gonna see it on their skulls. Um, next year, so So there's something very mind and adjust TV you that their supply to your face. And just quite simple. These are all branches of them. Trigeminal nerve from the pharmacy brand. You have to practically are now which is above the trochlear off the superior oblique. We have your supraorbital on the so promising about orbit being form. It probably done that in for our bit on the and then you have your like room on there, which is a big misleading because it's surprised, like right, right lacrimal gland and to lock the lacrimal gland. That's not see it on the back room bone because our eyes are a lot of infusion really rotated. So the tiers that are produced in your lateral superior your part of your arm removed from the lacrimal gland flow downwards with gravity. Your nasal lacrimal duct get trained to nose. So is the last time on that Derek have is I don't take a facial psychological temporal. So these are two that are very often for gotten, um, in for a bit on, uh, and infrastructure and a half so we can have a truck laying on the bottom Is the pulley Provigil it in fear of like Well, come if I recall a temporal auricle means your ear temporal means your temple decided we've had so or equal temporal in half. Then we have a back on the half about bacco means the inside of your cheek and mental illness a sleeve covered with the Monday blood factors, which is, um um after your team and the most common fractures. As we've covered a psych shown you are meet face fractures. So zygomatic march on itself. Zygomaticomaxillary a tripod fractures where you get a fracture from zygoma left Fourth classifications of fractures, about which I will talking in detail nasal and nasal bit more fractures which I'm not gonna live in. Tribal fractions are they cover it Factors in three places You here in here very often. It is not true. Fracture it is. That's them. This association of the bones you usually have such with have sutra. So this caused ask is this diastase is off bones, so we can marching. Sometimes your bones will be your most trail part will be very helpful Searchers between bones and then does this associate from each other? It's called diastasis rectus Texas. So here we have that dramatic of frontals, which you can get? Uh huh. You think about it. And we we manage it by plating. Basically. So you open. So, for desk me to a cart above on the line off your ears, buff, your hairline. We'll pull out your fault, pull down their forehead and your face down to the level of your eye, and then we play to take you and pull it up together. Leftward, front chest. Then the most common ones Then was talked about once there was this guy in the last century called it run a lot Fort. He was a Frenchman. He was a surgeon. And for his underground is he looked into facial fractures and what he did, he got a lot of kind of our heads on. He kicked them. He killed them with, about He should shop them. He dropped them from a from a head. Um, and so on. And so one. So, um, it was quite was quiet. Um, weight. Honestly, I don't think you do it fasting these next. But he did that and he find out that they're free lines of fractures Where this college most come on to the facial skin. From this, the most common to do fracture. Do that for one. So there are three types level that left for one. Also called green fracture or trans mind is Larry Fracture, which means trans meaning from Magdala through maxilla. So through upper job or a floating maxilla. So as you can imagine, the other factor for the maxilla it will get disassociated, and you will be able to pull it out Really from your patient is only held by your soft tissues. Um, so this is what it looks like and this is a worry in time. So if you think about leftward Juan Worry fracture wearing sign is the bruising, which, uh, the more so Christmas is rising off the greater polyp time all tree. So if you have this side on the are on her so remember, if you have a bleed on your floor looking mouth, get it from, uh, trauma under your tongue that will be always be on it for fracture. So this will always be Monty. Lot of structure you're bleeding on your on your hard palate network to it's barama doll Looks like a pyramid. You have ah, have a fracture from from the monkey lot to the to the nasal bones coming trio. Um well, I'll be this well, for the front of your all big and sometimes not mobile And the most tragic one he's left for free. Um, which is craniofacial disjunction cranium. Meaning cranium. Meaning that school vault the brain of old facial meaning Face disjunction as you can imagine. If you have a full fracture for all those points, Basically, this up a studio place from from your, you know, from your from a brain volt. It comes with the nasal frontal nasal front of such a So between the nose and the frontal bone for the maxilla frontal structure for the orbital wall. So the zygomatic arch is like, um, article frontal so shot. And because off this practice here. So when you have a fracture of zygomatic arch your temporal this muscle, which basically a temple muscle coming down to your mandible can get it can get caught up in the fracture so you won't be able to open your mouth. Oh, close your mouth. Um, so all of that looked very nice, especially on those on those pictures. However, in realize you're gonna get more intricate buttons, obviously gonna come by pure. The fourth fractures how they they most often present in various comp configurations. So we can have left for two and leftward free together the fourth one that for two together you can have incomplete. Actually, you can have. We had lunch. So this is what most commonly happens, and you can think about it, what can go wrong and then you can apply it to your case is that they're not Not so not so clear. And this is just this side now I'm not gonna focus on it. A lot is how do you find fractures? So you have, like, a geek, so off your face house kind of town. Need to put it together for the patient person, too. Come back to their normal life, get their quality to find the head before So it's obviously quite difficult and therefore there's lots of radiology involved. Um, you can see here is a CT free the reconstruction where you see something like this you can do your free deep. Lanning. There is also Fiat or 12 the reality coming into surgery right now, we will be able to plan all of your surgery just using disease. Those reconstruction? Um, there are a couple of special views. I'm just going to show you those views. I will send you this if you want. So you can. You can use it for for next year's and not to me. Um, you can have Oh, pretty, which is mostly using max parts, which is 180 degrees of your mind. The ball of your of your teeth. Um, And then there are some special special lines that you can look, Look for if they are disrupted. This means that there is some kind of fracture going on. So there is a fracture here on the left. Inside. This is the single, um, is I committed Aren't fracture, so I'm rushing here. This is not this is not very important. Um, and then you have here you can see lots and lots of soft tissue swelling on the right side. You can't see the fracture, but it can see the signs of the fracture. So as you remember, I told you that fractures are soft tissue injuries with a broken bone. Inside, we don't see a broken bone. Here. We can see the swelling of the eye. We can see the herniation or protrusion of the orbital contents into the maxillary Sinus. And here we can see on there fluid level on the bottom of the Sinus, which is not a problem on the other side and CT and city reconstruction. So this is when you want to look into more detail. This is if you're interested. This is probably the best book about about my ex lax trauma for really, really gory pictures. So unless you go into it, um, I don't recommend. All right, So just let you know, thank you very much for the medical Education Society for hosting me. Thank you to the combination of ST or on Mexico Facial Surgery Society. Um, we quite nice. We don't really have lots of people, so we'd be very keen to have you on. Um, if you're interested in Mark's fax us a career option, there is British associations off or on much of a facial surgeons, which is a great website. They have a lovely website with lots of results. Is, um they're working to have students. Um, and you can let me know if you want to. If you want to discuss Max fax If you want to discuss facial trauma, if you want to get any of those results is and I know that we're over running now. Um, so for for for the closing remarks, just type in charge. 40 of, like, today. It can be something very small. Could be something very simple. Um, well, we don't mean a lot to me if you feel like anything today, and it'll make it make me happy because I fulfilled my promise that you're going to learn something. Thank you very much, Little Terry. Also. Yeah. Great factors. The soft tissue injury, Broken Mountainside. Okay, so if you could fill out the feedback for for Jeremy that we really helpful would be really helpful place before we also, if the hip to prove it. Also for us to improve at the future. Um, but if you got any questions, even drop them in the chart on mute yourselves. Um, any questions at all?