1 C J Mieny, U Mennen: Principles of Surgical Patient Care - Volume ...

Classification of Occlusal and Mandibular AvailabilityNatural teeth present for an occlusion:- occlusion with a stable mandible- occlusion without a stable mandible.No natural teeth present for an occlusion:- an "artificial" occlusion (dentures) with a stable mandible- no occlusion possible.Treatment PlanningEach treatment for facial skeletal trauma depends on:- an accurate clinical assessment- good facial radiographs (these are often very difficult to produce).The treatment which is then to be applied is chosen according to the following:- the patient's general condition- head injuries present (especially in view of the timing of a surgical intervention andthe use of cranio-facial fixation procedures)- severe ophthalmologic lesions (especially globe perforation, corneal defects,hyphema, lenticular displacement, and orbital apex syndrome)- the occlusal and mandibular availability- the lacerations in the facial region which may be utilized as entrances for bony openreductions and fixation procedures.The timing of a surgical intervention depends on:- the neurosurgical and the general physical condition of the patient- the severity of the trauma to the facial region- the time elapsed since the injury was sustained. The treatment is more accurate whenit is done before oedema has occurred or after the facial oedema has subsided.- compound or closed fractures of the facial skeleton- injuries which might influence the administration of a general anaesthetic such ascervical injuries, pneumothorax, partial rupture of the trachea or other injuries32