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(Printable Forms: Trauma / Abscess)


DON'T Blindly Copy & Paste. READ/EDIT the Note!


OMFS Consult Note: _/_ / 2013, : AM / PM

NAME: ___, 
DOB: _/_ /_

: _ y/o (status (s/m/w/d) ____________) (race: ______) male / female presents to JMC / NCB ED with

PAIN: ___/10 (–) LOC: Duration: _, (–) Nausea: x _, (–) Vomiting: x_ 

PMH: Unremarkable / Asthma (last attack______, (–) hospitalized, (–) intubated) / DM (on/off insulin) / HTN / HLD / CHF


Allergies: NKDA

PH: never been hospitalized




- Smoking __ cigs/ppd x _ yrs,

- EtOH __ beers/drinks per day/week,

- Illicit drugs (marijuana, cocaine, PCP, etc.)



Physical Examination

VS: BP: _/ _ ; PR: _ ; Tc: _ F; Tm: _ F; RR: _ ; O2 sat: ________ % on RA (2L NC)







CBC: _ > _ / _ < _

BMP: ___/___, ___/___, ___/___ < ____


Radiographic Findings:

CT Head:


A/P: _____y/o male/female presents to ED with ...... 



First & Last Name, DMD/DDS




First & Last Name, DMD






Consultation Request:

Reason for consultation: 30 y/o male presents for 1 wk f/u s/p ORIF of multiple mandible fractures. Pt. has PMH of…. Please evaluate & provide any recommendations including risk stratification, modification & recommendations for removal of teeth/archbars/ under IV sedation






COMPLETE History and Physical

Date: ___ / ___ / ___ @ ___: ___ am / pm




Identification: Patient’s name, age, race, sex, occupation, marital status,

CC: In the patient’s own words, why he or she is there & how long the s/s were

HPI: Pt. states that he/she was assaulted by a friend 2hrs ago and was struck in the face with a bottle. She/he further states that the bottle shattered on the left side of her face cutting her left ear and resulting in pain in her left lower jaw. She is now unable to open or close her mouth fully. She denies LOC, headache, dizziness, light headedness or nausea/vomiting associated with the incident.
If (+) LOC, ask for duration, last remembered, 1st thing they noticed when the gain consciousness, and what was the pt doing at the time?




- DM2 (diet controlled / on insulin)


- Asthma (last attack 2 months ago, hospitallized, intubated ..)

Past Hospitalizations: 2007, 2005 – childbirth

Preventive Health Maintenance (appropriate to age):

- Immunizations (Pneumo for >65):

- Last PPD/CXR:

- ECG:

- PAP test:

- Mammogram:

- Dental check-up:

- Vision:

- Hearing test:


- Albuterol inhaler prn


ALL: Penicillin–skin rash, Shrimp–Anaphylactic

PSHx: C–section x2 – 2007, 2005–no complications, Epidural anesthesia

- Transfusions: None


- Mother: 58–alive w/ HTN

- Father: deceased at age 50 due to gunshot wound. 

- 3 Siblings alive and well.

- Health status or cause of death of parents, brothers or sisters, giving their current age or age at time of death. In addition to any known cause of death, give the chief symptoms of the illness. Note familial incidence of rheumatic disease, allergy, migraine, diabetes, hypertension, anemia, bleeding tendency, kidney disease, heart trouble, cancer, mental and nervous disorders, with special attention to the diseases suggested by the patient’s history.


- Birthplace:

- Unemployed / employed: school teacher

- Lives with: boyfriend & 2 children ages 2 and 4. No previous history of domestic violence,

- Tobacco: __ ppd x 10yrs = __ pack years

- EtOH: 5 x 40oz Colt 45s daily

- Illicit drugs: Cocaine (snorts 1/week), Marijuana

Sexual Hx: orientation, partner(s), marriage, divorce, age and health of partner, children, satisfaction with sexual functioning, abuse, other problems e.g. erectile dysfunction, dyspareunia, libido.



GENERAL: Pt. generally in good health, obese, weight gain/loss, fatigue, recent illness, night sweats, fevers, weakness

SKIN: Rashes, hair/nail changes, pruritus, scaring, bruises, bleeding, texture/pigment changes

HEAD: Trauma, dizziness, syncope, headaches,

- EYES: Vision changes, glasses/contacts, photophobia, pain, conjunctivitis, diplopia

- EARS: Hearing, tinnitus, pain, vertigo, discharge,

- NOSE: Sinus problems, epistaxis, obstruction, changes, sinusitis

- OROPHARYNX: Bleeding gums, lesions, missing dentition

- THROAT: Swelling, goiter, thyromegaly, hoarseness

NECK: Pain, limitation of motion, swelling, masses, goiter

BREAST: Pain, masses, nipple discharge, lesions, plaque(s)

RESP: SOB (exertional, nocturnal, intermittent, constant), pleuritic pain, cough, productive cough, sputum, chest pains, pneumonia, hemoptysis,

CVS: chest pain, palpitations, orthopnea, dyspnea on exertion, murmurs, peripheral edema, paroxysmal nocturnal dyspnea, edema, varicose veins, intermittent claudication

GI: appetite changes, dysphagia, abdominal pain, ulcers, heartburn, nausea, vomiting, diarrhea, constipation, hemorrhoids, blood in stools, jaundice, hernias, ascites

GU: dysuria, polyuria, nocturia, urinary frequency, incontinence, hematuria, UTI in the past, kidney problems,


Males: urethral discharge, pain or masses in penis, pain or masses in scrotum or testicles, hernias

Females: vaginal discharge, pruritis, lesions, pain, dyspareunia, dysmenorrhea, oligomenorrhea, menorrhagia, postmenopausal bleeding, odor

-> Menstrual history: Last Menstrual Period (LMP): ____________ or ____/_____/___

-> Age at menarche/menopause: _________

-> Obstetric history: Type of contraception used: _________, pregnancies: x _____, abortions: x ____, living children: x_____ , complications of pregnancy:_________________________________________

ENDOCRINE: weight loss, hot/cold intolerance, polydypsia, polyuria, polyphagia, goiter, excessive sweating, body hair changes

HEMOPOIETIC: bleeding tendency, easy bruisability, anemia, blood clots

MSK: pain, cramps, stiffness, fractures, dislocations, arthritis, limitations in movement, OA, RA

NEURO: dizziness, visual disturbances, paraesthesia, tremors, seizures, paralysis, gait disturbance, vertigo, memory defects, aphasia, dysarthria, incoordination, syncope.

PSYCH: depression, anxiety, obsessive-compulsive symptoms, violent impulses, psychosis, suicidal ideations



GENERAL: well developed, well nourished, NAD, obsese, Alert & Oriented x 3 (to Person, Place, & Time), appropriately responsive. Pain of ___/10 in severity.

Height: ___' ____'' Weight: ___ lbs

V/S: BP: _____ / _____ Tc: _____ T Max: _____ Pulse: _____ Respiration: _____

SKIN: intact, lacerations, abrasions, contusions, swelling, rashes, tattoos, texture, color, moisture, eruptions, pigmentation, cyanosis, jaundice, petechiae, spider angiomata, distribution of hair

HEAD: normocephalic, atrumatic, lacerations, contusions, scalp tenderness

EYES: PERRLA (Pupils Equal Round Reactive to Light & Accommodation – focus on far/near objects), EOMI (Extraocular Movements Intact), sclera clear, gross vision intact, tearing, discharge, conjunctiva pink/red/bloody, glasses, periorbital ecchymosis, diplopia, blurriness

Fundoscopic: discs normal, blood vessels normal, hemorrhages, exudates, pigmentation, lenticular opacities, retinal dislocation, papilledma

EARS: lacerations, discharge, hearing grossly intact, hemotympanum, Battle’s Sign/mastoid ecchymosis (Base of Skull/Middle Cranial Fx),

Hearing: air conduction, bone conduction, tympanic membranes intact

NOSE: nares patent, symmetric, discharge, septal deviation, obstruction, epistaxis, crusted blood, congestion, septal hematoma, sinus tenderness


EOE: swelling, pain, step defect, V3 parasthesia, Trismus (_____mm),

IOE: uvula midline / deviated (R/ L), multiple missing teeth (pretrauma) #_________, malocclusion, swelling, lacerations, FOM bleeding, tongue papillary atrophy, tongue deviation, discoloration

NECK: thyromegaly, JVD, carotid pulsation, abnormal pulsation, tracheal tug, trachea midline, stiffness, range of motion intact

LYMPH NODES: LAD, tenderness of cervical, mandibular, supraclavicular, axillary, epitrochlear, inguinal glands

SPINE: Vertebral tenderness, curvatures, mobility intact, kiphosis, CVA tenderness

CHEST: Conformation, symmetry, mobility, abnormal pulsation, retro manubrial dullness, dilated veins

BREAST: Appear normal and symmetrical, tenderness, masses, discharge, plaques


Inspection: cough, type of respiration, symmetry of respiratory movements, adequacy of respiratory movements

Palpation: fremitus

Percussion: resonance, lung borders & their mobility.

Auscultation: CTA B/L, equal breath sounds, wheezing (isp/ exp), crackles (coarse/fine), friction rubs, egophony

CVS: Normal S1 S2, RRR, S2 splitting , murmurs, friction rub, gallops, PMI shifted (L/ R), precordial heave

ABDOMEN: soft, non-tender, non-distended, BS present x 4 quadrants

RECTAL: Declined / Deferred / Not indicated

- Hemorrhoids, fissures, fistulae, sphincter tone intact, tenderness, masses, prostate, FOBT (+/-)

EXTREMITIES: FROM x 4 extremities w/ no limitations, UE strength (L: 5/5, R 4/5), LE strength (L: 5/5, R 4/5)peripheral pulse palpable, pulses equal (carotid, radial, femoral, popliteal, dorsalis pedis, posterior tibial pulses), varicosities, clubbing (fingers / toes), LE edema

NEURO: CN II–XII appear grossly intact, AO x3, appropriately responsive, follows commands, gait disturbance, dysdiadochokinesia, finger-to-nose intact


-> Normal: patellar, biceps, ankle, abdominals.

-> Abnormal: Babinski, Hoffman, clonus

GENITALIA: Declined / Deferred / Not indicated

Male: urethral discharge, lesions on penis, hydrocele, varicocele, testicular masses, hernias


-> Pelvic examination: vulvar lesions, vaginal discharge

-> Cervix: inflammation, friability, discharge

-> Uterus: position, enlarged, tenderness

-> Adnexae: masses, tenderness



- CBC: _ > _ / _ < _

- BMP: ___/___, ___/___, ___/___ < ____


EKG: NSR @ 75 bpm, no ST or T wave changes



- CT Head:

- CT Chest:

- CXR:

- MIR:


ASSESSMENT: ___ y/o m/f


Case discussed with Chief Resident/Attending – Pt. to be admitted.



- Admit to OMS Service Dr. ....

- IV antibiotics – Clindamycin 300mg IVPB q6h

- Pain manangement – Motrin elixir 600mg PO q6h prn pain

- Dressing change by nursing q6h

- Obtain Panorex – transport to dental clinic – AM

- DVT PPX: SQH / Lovenox

- Diet: Full liquid / Diabetic / Cardiac / Low K+ / Low Na+


Dispo: Pt. to be d/c after surgery to repair Left mandibular angle fracture. Estimated stay of 4 days.


First Name, Last Name DMD/DDS

OMFS Resident


First Name, Last Name DMD / DDS, MD







Standard Admission Doctor's Orders


Date: ___ / ___ / 2011 Time: ___ : ___ am / pm


Admit to OMFS Dr. _______________

Dx: Left/Right Mandible Fracture, R/L ZMC Fracture

Condition: Stable

Vitals: Every Shift


Activity: OOB (Out Of Bed)

Nursing: Suction at bedside, Head of bed elevated 30 degrees, Ice pack to face

Diet: Clear Liquid / Puree / Soft / Regular

IVF: D5 0.45% NS 1,000ml @ 50/100mL/hr


- Motrin (600mg) po q6h pain,

- Morphine Sulfate (4mg) SC q4h prn process if severe pain

- Percocet (3mg/325mg) prn/q4h process if moderate pain

- Benadryl (50mg) prn at bedtime

- Zofran (4mg) IV/IM prn (anti-nausea)

- Famotidine (20mg) po bid (only if the pt. is NPO overnight)

- Decadron (8mg) IVSS q8h


- Unasyn (Ampicillin + Sulbactam) (3g) IVSS q6h between 15 & 30 minutes

- Clindamycin (600-900mg) IV q6h


- CBC,

- SMA7 (Basic Metabolic Panel),

- UA,


- Type & Screen (Blood type)

CMP (Comprehensive Metabolic Panel - includes LFTs)


- EKG (>50 y/o),

- Chest x-ray (>50 y/o), β-HCG


Please have patient transported to Dental Clinic tomorrow @ 8am for Panorex - Please arrange transportation as necessary






Standard AM Note


Oral Maxillofacial Surgery Progress Note
MRN #: 


Pt. examined at bedside. No events overnight. Pt. is in mild pain but controlled with medication. Pt. denies any nausea, vomiting, fevers, chills, shortness of breath, chest pain, abdominal pain. Pt. feels like he is improving.


Vitals: BP: _ / _ P: _  R: _ T: _ O2: _ % RA
GEN: NAD, Pt. is lying upright comfortably in bed, breathing comfortably on RA
H: NC/AT, no scalp tenderness
E: EOMI, PERRL, gross vision intact
E:Gross hearing intact, TMs clear b/l
N:Nares patent, MMM, no septal deviation
T: uvula midline,
IOE: MIO: _ mm, FOM,

Neck: supple, thyroid midline, no LAD
ABD: NT/ND, soft, + BS
EXT: FROM x4, not limitations, WWP, distal pulses equal b/l
Neuro: AAOx3, CNII-XII grossly intact, no focal deficits

CBC: > / <
Chem:  / ,  / ,  /  < 

A/P: __ yo

- c/w Abx (Unasyn 3g q6h)
- c/w __ diet
- OR on __
- NPO after midnight
- HOB elevated, yankauer at bedside
- Care as per primary team
- Please call or page OMFS with any questions






OMFS Pre-Op Note

Pre-Op Diagnosis: Left ZMC Fx

Planned Procedure: ORIF Left ZMC Fx


- CBC: _ > _ / _ < _

- BMP: ___/___, ___/___, ___/___ < ____

- PT/PTT: 10.6,/ 24.6, INR: 1.1
- Type & Screen: B Positive


CXR: WNL – no abnormalities or pathology noted. A – airway intact, B – no fractures noted/no pleural effusion or infiltrate, C – cardiomediastinal silhouette is not enlarged

EKG: None



- VS Qshift

- D5 ½ NS at 130 cc/hr (@ 0.5ml/kg/hr)

- HOB elevated 30 degrees


- Clindamycin 900mg QH8

- Pseudoephedrine 30 mg Q6H Prn

- Morphine 4mgQ4H prn pain

- Ibuprofen 400mg Q6H prn pain

- Percocet 1-2 tabs Q4H prn pain

- Zofran 4mg Q8H prn nausea

- Benadryl 50mg Prn QD

- Heparin 5000 units SQ Q8H

- SCDs

- regular diet qmeal

Consent: Signed, in medical record. Risks and benefits explained. Discussed complications, including, but not limited to, pain, swellin, bleeding, infection, need for further surgery, malunion, nonunion, damage to adjacent structures, damage to nerves, noncosmetic result, and death. Questions answered.


First Name Last Name, DMD

OMFS Intern/Resident






OMFS Post-Op Note

Admit to: PACU for 23 hour admission, then 3A/4A

Diagnosis: Left ZMC Fx

Condition: Stable

VS: q2h, the per routine


Activity: Up with assistance until stable, then ad libitum

Diet: Clear liquids, advance to full liquid as tolerated


- HOB at 30 degrees

- Yankauer suction at bedside

- Foley to gravity

- No pressure to face or chin

- Wire cutters at bedside

- Strict I&Os

- IVF: D5 and 1/2 NS at 100ml/hr

- Pain meds: Ibuprofen 400mg q6h prn pain, Percocet 1-2 tabs q4h prn mod-severe pain, Morphine 4mg q4h prn severe pain,

- ABx: Clindamycin 900mg QH8

- Decadron 8mg q8h 3 times, first dose 4h after last OR dose


First Name Last Name, DMD

OMFS Intern/Resident







OMFS Discharge Summary


Date of Admission:
Date of Discharge:

Admission Diagnosis:
Discharge Diagnosis:



ED Course:

OR Course:

Hospital Course:

Physical exam on discharge:

VS: T: , BP: , PR: , RR: , O2:  

Discharge Assessment: Pt. stable for discharge home with/without services.

Discharge Plan:

Discharge patient to home.

Diet: Soft foods for 1 week, advance as tolerated

Activity: No heavy lifting for __ weeks.




Followup: F/u with OMFS clinic (JMC 3rd Floor Bldg 1) in 1 week on _ / _ /13 at 8 am for __.







Consents (R/B/A, not limited to:)


Risks: pain, bleeding, swelling, infection, damage to adjacent teeth/structures, temporary/permanent numbness of the tongue/lips/chin/cheek, oro-antral communication
Benefits: relieft of pain, infection, removal of decayed tooth
Alternatives: none, RTC,
Risk of no Tx: pain, swelling, infection




Risks: pain, bleeding, swelling, infection, damage to adjacent teeth/structures, temporary/permanent numbness of the tongue/lips/chin/cheek, oro-antral communication, malocclusion, malunion, nonunion, scarring, need for secondary procedures, extraction of any necessary teeth, possible weakness of marginal mandibular branch of CN VII, damage to nerves, noncosmetic result

Benefits: reduction of fracture, relief of pain, restoration of occlusion

Alternatives: no tx

Risk of no Tx: pain, bleeding, swelling, infection, malocclusion



Blood Transfusions: (requires Type & Screen)
Risks: Allergic reaction & hives, fever, actue hemolytic reaction, lung injury, blood-borne infectionm delayed hemolytic reaction, iorn overload, graft-vs-host disease

Benefits: tx for anemia, tx for blood loss, decrease anemic symptoms

Alternatives: no transfusion

Risk of no Tx: anemia, weakness, fatigue, dizziness





HEENT Physical Exams/Findings




Battle sign - Think Basilar Skull Fracture
Auricular hematoma may lead to Cauliflower ear
Bolster dressing - Suture guaze tightly with silk sutures
Normal Tympanic Membranes

Abnormal tympanic membranes






(Detailed Eye Exam by Dr. Haitham Al Shetawi)


Swelling of the conjunctiva


Drooping of the upper or lower eyelid



Increased inter-pupillary distance



Increased distance between the medial canthi of the eyes, while the inter-pupillary distance is normal

(28 – 35mm)


Retrobulbal Hemotoma:

Increased bleeding behind the globe

can lead to blindness


Oculocardiac Reflex (Aschner phenomenon, Aschner reflex, or Aschner-Dagnini reflex)
- Normal Intraocular Pressure is (10 - 20 mmHg)
- Bradycardia w/ traction applied to EOM and/or compression of the eyeball
- Mediated by CN III & CN X of parasympathetic sys
- Afferent: V1 synapses w/ visceral motor nucleus of CN X in the reticular formation of the brain stem
- Efferent: CN X from cardiovascular center in the medulla to the heart, of which increases stimulation, leading to decreased output of the SA node






Septal Hematoma










Incision & Drainage

1) Contact bone at a 45 degree angle

2) Insert hemostat CLOSED, dissect open, remove opened

3) Insert drain w/ tissue pick-ups/hemostat

(You can place a suture thru the drain prior to placement)

4) Place 1-2 silk sutures to secure the drain


Sublingual abscess

Palatal abscess

External Approaches for I&D






Suggested Sutures to Use


Copious irrigate & careful inspect the wound for foreign debris prior to placing sutures



Limit/Avoid the amount of epi in ears or nose due to cartilage

Cartilage has no blood supply and use of epinephrine can result in necrosis of tissue


Blue Prolene is advised around areas with black hair or dark skinned individuals





Midface Fractures



Fracture Type


Zygomaticomaxillary complex (tripod fracture)

40 %



15 %


10 %


10 %

Zygomatic arch

10 %

Alveolar process of maxilla

5 %

Smash fractures

5 %


5 %






Lefort Fractures

Lefort I - Maxilla completely separately from the face - fracture goes thru the lateral pyriform rim, thru maxillary sinus wall, through tuberosity, and thru the pterygoid plates
Lefort II - Pyramidal shaped fracture - the fracture goes thru the nasofrontal suture, thru the lacrimal bones and down thru the infraorbital rims
Lefort III - Fracture course thru the nasofrontal suture, across the lacrimal bones, thru the inferior orbital fissure, across the lateral orbital rims and thru the frontozygomatic & zygomaticotemporal sutures







Mandible Fxs



1)   Angle  - Located distal to the 3rd Molar
2)   Body - Usually extends from the region of the distal canine to 2nd / 3rd molar region
3)   Parasymphysis - Involves fx anterior to the canines
4)   Midline/Symphysis - fx located between the central incisors
5)   Ramus - fx located superior to the angle
6)   Condylar - Involves the condylar process superior to the ramus
7)   Subcondylar - fx below/involving the sigmoid notch
8)   Coronoid - Located in the area of the coronoid process superior to the ramus







Orbital Floor Fx



Orbital (~40 mm from infraorbital rim to optic foramen, 30cc volume)
Floor only (Blowout/Trapdoor fracture)










ZMC (Zymgomatico-Maxillary-Complex Fracture)
Floor only (Blowout/Trapdoor fracture)






Zygomatic Arch Fx



coming soon...









Nasal Bone Fx
















Bite Wounds


Dog bites:
- Capnocytophaga ochracea (Gram-Negative) or Pasteurella multocida (Gram-Negative coccobacillus)
- Tx: Augmentin / Unasyn (3G IV)
- Check Tetanus & Rabies


Human bites:
- Eikenella corrodens (fastidious Gram-negative facultative anaerobic bacillus)
- Tx: Augemtin / Unasyn






EtOH Withdrawal Tx


Alcoholic Seizures occur w/in 24hrs
DT can occur w/in 48-72hrs


Delirium Tremens (DT) Prophylaxis Regimen
Thiamine 100mg PO / IM/IV daily
Folate: 1mg/day PO
Magnesium: the goal mg should be >2.0mg/dl



Generic Name Product

1st Dose



2nd Dose


Chlodiazeposide (Librium)






Diazepam (Valium)






Lorazepam (Ativan)






Multi-Vitamin, Folate, Thiamine







Pt. w/ DT should be transferred to the ICU & managed medically


Signs & Symptoms of Alcohol Withdrawal
Tremor, restlessness, insomnia, nightmares, paroxysmal sweats, tachycardia, fever, nausea, vomiting, seizures, hallucinations (auditory, visual, tactile), increased agitation, & tremulousness






IV Fluids



Fluid  Osmolality (mOsm/L)  Na (mmol/L) Cl (mmol/L)   K (mmol/L)  Ca (mmol/L)  Mg (mmol/L)  Glucose (g/L)  Glucose (mmol/L)   Lactate (mmol/L)  Acetate (mEq/L)  Gluconate (mEq/L) Notes 
Blood (in vivo)   278-305 135-145  95-108  3.5-5 1.1-1.4 0.75-1.2  0.65-1.1  3.6-6.1  1-1.8      
Normal Saline; 0.9% Saline  308  154  154                 Isotonic 
Hartmann's; CSL (compound sodium lactate)  281  131  112  5  4        29      
Hartmann's + D5W  605  131  111  5  4    50  278       Isotonic
Lactated Ringer's   275  130  109  4  1.5        28      
Plasmalyte  294  140  98  5    1.5        27  23  
3% Saline   1026  513  513                  
5% Saline  1710  855  855                  
Half Normal Saline; 0.45% Saline  154  77  77                 Hypotonic
Half Normal Saline + 5% Dextrose; 0.45% Saline + D5  432  77  77        50  278        
Bart's; D4S; 0.18% sailine + 4% Dextrose  284  31  31       40   222        
5% Dextrose; D5W 278            50   278       Isotonic









Blood products


Type & Screen: Pt's blood type (ABO & Rh) screend for common antibodies

Cross-match: Pt's serum checked for preformed Abs vs the donor's RBCs


- 1 unit = ~250 ml (should increase Hb by 1g/dL and increase Hct by 3%) transfused 3-4h/unit




Fascial Planes


Sagittal Section Showing Deep Cervical Fascial Layers



Infrahyoid Cross-Section Showing Layers of Deep Cervical Fascia



Suprahyoid Cross-Section Showing Layers of Deep Cervical Fascia



Sagittal Section Showing Fascial Spaces



Infrahyoid Cross-Section Showing Fascial Spaces



Coronal Section Showing Deep Cervical Fascial Layer



Coronal Section Showing Fascial Spaces



Sagittal Section Showing Pathway of Infection



Suprahyoid Cross-Section Showing Pathway of Infection







Surgical Approaches to the Face


a Bicoronal flap procedure: frontal sinus, naso-orbitoethmoid (superior aspect), medial canthal tendon, supraorbital rim, orbital roof, superior aspect of the medial and lateral orbital wall, zygomatic arch, and mandibular condyle (with preauricular extension)

(Peterson's 2nd ed.)

b Perinasal incisions: naso-orbitoethmoid region, medial canthal tendon, and nasolacrimal sac. These incisions are generally avoided because of the potential for significant scarring. This incision is not needed when the bicoronal incision is used.
Subciliary and transconjunctival incision with lateral canthotomy: infraorbital rim, medial and lateral orbital wall, and orbital floor
c Upper eyelid crease incision/Superior Tarsal crease: superior and lateral regions of the orbit. It is generally used to expose the frontozygomatic suture. This incision is not needed when the bicoronal incision is used
d Subciliary: infraorbital rim, medial and lateral orbital wall, and orbital floor
e Transconjunctival incision with lateral canthotomy does allow access to the frontozygomatic suture. This requires detachment of the lateral canthal tendon and incision through the orbicularis oculi muscle and periosteum deep to the lateral periorbital skin. The subciliary approach may allow better access to the lateral nasal region
f Maxillary vestibular incision: maxilla and zygomaticomaxillary buttress
g Mandibular vestibular incision: mandible from the ramus to the symphysis. This approach is not usually recommended for comminuted fractures – Skip Premolar area
h Cervical incisions: mandible, except for when there is a high condylar neck fracture. The approach is generally indicated when anatomic reduction is crucial. It allows the surgeon to visualize the reduction of the lingual cortex. It is also indicated for comminuted and complicated fractures such as a fracture of the atrophic edentulous mandible







Physiologic Changes During Pregnancy







Meds for Pregnant Pts





This site was created to help guide OMFS interns and residents through their residency. It is created for educational use only. All images belong to the sources below.






5) Peterson's 2nd Ed.


7) The Maxillofacial Wilderness Guide – Turner, DDS, MD