口腔颌面部损伤

1. Chapter 7 Oral & Maxillofacial Trauma 口腔颌面部损伤 Dr. Steve GF Shen Oral and Maxillofacial Surgery School of Stomatology Shanghai Ninth People’s Hospital Shanghai Second Medical University

2. Vocabulary

3. Vocabulary

4. Vocabulary

5. Vocabulary

6. Vocabulary

7. Definition of trauma trauma  noun [C or U] • severe emotional shock and pain caused by an extremely upsetting experience:the trauma of marriage breakdownHe had psychotherapy to help him deal with his childhood traumas. • SPECIALIZED a severe injury, usually caused by a violent attack or an accident (from Cambridge Advanced Learner's Dictionary)

8. Section 1 Introduction Incidence Labor injury War Traffic Accident Bustup Falling Sports

9. Traffic Accident

10. Effect of Trauma on the Human Body • Combined injury to other viscera -Fatal to life • Damage to maxillofacial structure • Stomatognathic dysfunction • Facial esthetic problem • Psychological trauma

11. Section 2 Characteristics of OMF Trauma 1. Rich blood supply

12. 1. Rich blood supply Tend to hematoma, edema Respiratory tract Asphyxia Ability to anti-infection, regeneration Wound healing Debridement Time: 24 – 48 h

13. 2. Relationship btw tooth & OMF trauma Increase infectious incidence Malocclusion caused - Diagnosis Occlusion regained - Treatment • Cerebral concussion • Cerebral contusion • Intracranial hematoma • Skull base fracture 3. Cranio-cerebral trauma

14. 4. Cervical trauma Bleeding Paralysis 瘫痪 5. Effect on breathing Asphyxia 窒息 Leading difficulty breathing 6. Effect of on digastric system Mouth opening, mastication, swallowing diet worse oral hygiene

15. 7. Multi-sinus - contamination Oral cavity Nasal cavity Pharyngeal cavity Orbit Paranasal sinus Bacteria Temp Humidity Infection

16. 8. Damage to specific structure Salivary fistula Facial paralysis Regional numbness Parotid Gland Facial N. Trigeminal N.

17. 9. Facial Defect Facial contour Psychological trauma

18. Section 3 Rescue General Rules Evaluate trauma soon Identify the key trauma, manage the fatal first Careful history taking, thorough physical exam Rescue in time Management in order

19. Section 3 Rescue 1. Prevention of Asphyxia

20. 1.1 Clinical features of asphyxia Prodrome Dysphoria, sweating, inhaling respiration Difficult to inhale, hypopnea, nasal alar movement, labial cyanosis Three concave signs、Rapid breathing, weak pulse, decreased BP Pupils diluted, No reflection to light

21. 1.2Etiology of Asphyxia Foreign body obstruction Tissue dislocation Upper airway Obstructive Asphyxia Swelling Foreign body Blood, saliva Vomit Inspiratory Asphyxia Low Airway

22. 吸入性窒息 气管切开术 1.3Rescue of Asphyxia Clear foreign body in upper airway Suspend maxilla Intubation Hold the tongue out Obstructive Asphyxia

23. Section 3 Rescue 2. Hemostasia Two steps： Judge bleeding situation Choose the way to stop bleeding

24. 2.1Judge bleeding situation Based on origin Three categories Arterial Capillary Venous

25. 2.2Methods of hemostat 压迫止血 指压止血法 包扎止血法 填塞止血法 结扎止血法 药物止血法

26. 3. Anti-shock treatment (1)Definition & Classification Traumatic shock Exsanguine shock>20% Body weight Toxic shock Infectious shock (2)Purpose of anti-shock Restore circulation

27. (3)Features of Shock Early stage: Dysphoria, quick & superficial breath, sweating, paleness Middle stage: Tingle to supression, emotional faint, unconsciousness, decrease BP, labial paleness Late stage: weaker pulsation, unmeasurable BP, hyponuria, anuria <30ml/h (4)Principles of Treatment Hemostasis, blood transfusion, pain control, fluid transfusion, sedation

28. 4. Combined Craniocerebral Injuries (1)Judgement Consciousness, pulse, BP, respiration, pupil (2) Early discovery, early management Retrograde obliviscence Cerebral concussion Intermediate wake-up Extradural hematoma Cerebral fluid leak Skull base fracture

30. 5. Prevention of Infection Debridement Wound closure Antibiotics 6. Bandage & Transportation

31. Section 4 Soft Tissue Trauma

32. Section 4 Soft Tissue Trauma Types of injuries Abrasions 擦伤 Contusions 挫伤 Contusions & Lacerations 挫裂伤 Incised & Puncture Wound 切割伤及刺伤 Bite Wound咬伤

33. 1. Abrasions • Character: Irregular wound edge, foreign body, pain, oozing & yellowish plasma oozing • Management: Debridement, remove foreign body, Dry wound, drain when infected • Property: rough surface Epidermis & superficial dermis

34. 1. Abrasions

35. 2. Contusions • Property: blunt material & fell to hard object Subdermal tissue (no open wound) • Charater: petechia, swelling, pain • Management: • Hemostasis • Pain-killer • Prevention of infection • Hematoma resorption • Re-establishment of function

36. 3. Contusions & Lacerations Property: Blunt object with high mechanical force Soft tissue • Character • Irregular wound edge, saw-toothed • Big laceration • w/wo necrotic tissue & open fractures • Management • Debridement • Wound Closure

37. 3. Contusions & Lacerations

38. 4. Incised & Puncture Wound Property: Sharp object or instruments Soft tissue • Charater • Regular wound edge • Bleeding • Small access, but deep wound • Management • Debridement • Wound closure

39. 5. Bite Wound • Property: Animal (Wolf, dog, Bear) or human beings • Character • Tooth traced • Heavy contamination • Tend to infection • Management • Thorough debridement • Infection control • Skin graft after granular tissue regenerated • Vaccination of Tetanus, Rabies

40. Debridement • Definition Main Entry: de·bride·ment Pronunciation: di-'brEd-m&nt, dA-, -"mänt, dA-brEd-'mänFunction:nounEtymology: French débridement, from débrider to remove adhesions, literally, to unbridle, from Middle French desbrider, from des- de- + bride bridle, from Middle High German brIdel -- more at BRIDLE: the surgical removal of lacerated, devitalized, or contaminated tissue

41. Debridement Protocol 1. wash wound Time：6--12h Solution: soap water, saline, hydrogen dioxide 2. Clean wound Removal of foreign body Trimming of necrotic tissue 3. Closure

43. Management of soft tissure injuries • Tongue injuries • Cheek injuries • Palate injuries • Injuries at other regions • Length maintain, longitudinal closure • Independent closure, but tongue suture domination • Big needle with big, depth suturing or matric suturing

44. Management of soft tissure injuries

46. Section 5 Injury of Teeth and Dental Alveolar Process

47. 1. Tooth injuries 1.1 Contusion of Teeth • Etiology: Extrinsic force blunt tooth injuriesPeriodontal ligaments or dental pulp • Character: • Extrusion of tooth • Mobility • Percussion & Toothache when chewing • Management • Tooth rest • Tooth ground • Simple ligation

48. 1. Tooth injuries 1.2 Luxation of Teeth Classification - Tooth dislocation - Semi luxation - Intrusive movement Partial luxation Complete luxation • Character • Tooth dislocated or exfoliated • Management • Tooth protection priority • Reduction • Fixation • Reimplantation

49. 2. Fracture of Alveolar Process Characters Gingival or labial swelling, laceration Adjacent teeth or alveolar process movement when one affected tooth touched Fragment dislocation, Malocclusion In accordance with tooth luxation or fracture

50. 2. Fracture of Alveolar Process Etiology • Extrinsic force to dental alveolar process, mainly to upper jaw Management • Reduction under LA • Arch bar applied