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Maxillofacial Trauma

Maxillofacial Trauma. Group Captain A J Gibbons RAF MA (Cantab) FDS FRCS FRCS (OMFS) Consultant Oral and Maxillofacial Surgeon Peterborough NHS Foundation Hospital. Anatomical considerations. Airway Protect sensory organs Facial muscles Mastication and speech Plates.

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Maxillofacial Trauma

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  1. Maxillofacial Trauma Group Captain A J Gibbons RAF MA (Cantab) FDS FRCS FRCS (OMFS) Consultant Oral and Maxillofacial Surgeon Peterborough NHS Foundation Hospital

  2. Anatomical considerations • Airway • Protect sensory organs • Facial muscles • Mastication and speech • Plates

  3. Incidence of Fractures Condyle 35% Angle 25% Parasymphysis 22% Frequently 2 fractures N Jones Craniofacial Trauma Oxford University Press 1997

  4. Airway Management Maxilla displaced Tongue Airway obstruction Haemorrhage Soft tissue swelling

  5. Oedema

  6. Blast Injuries Primary injury Secondary injury Tertiary injury Flash burn

  7. Airway Management Posture Chin lift or jaw thrust Oral airway Nasopharangeal Intubate Surgical

  8. Tracheostomy

  9. Breathing

  10. Tooth in lung

  11. Circulation

  12. Neurological Disability Expose

  13. Orbital Compartment Syndrome • Leads to ophthalmic artery occlusion • Lateral canthotomy & cantholysis 1. Clamp x 30 seconds • Decompress 4. Protect cornea 2. Cut cathus, cut canthal tendon Emergency War Surgery Manual, 3rd Edition

  14. Secondary Survey History Head to toe Clean up Good records Re-evaluate

  15. “P” System of Examination David David

  16. Clinical Signs and Symptoms of Fractures Pain Swelling and bruising Deformity Loss of function Abnormal mobility Neurovascular disturbance Deranged occlusion

  17. Occlusion

  18. Assessment Soft Tissue Injury Bone Injury Soft Tissue Loss Bone Loss Teeth

  19. Views at 90 Degrees

  20. Radiographs

  21. CT

  22. CT Head and C Spine • Inform OMFS early • If facial injuries request face as well as head and c-spine

  23. Initial Management Antibiotics Analgesia Tetanus Clean and dress wounds Maintain airway Monitor

  24. Early management of soft tissue injury Debride Preserve tissue Primary closure Delayed primary closure

  25. Tatoos

  26. Explore the wound tract

  27. Outcome Variables • Infection • Occlusion • Scars • Mouth opening • Nerve damage • Removal of plate

  28. Nasal Fractures

  29. Dental Pain

  30. Treatment • Pulpitis – Local aesthetic • Periapical infection – Antibiotics, analgesics, drain infection

  31. Gibbons’ Rules • Systematic examination • Midface trauma check eyes and nose • CT head and neck think face • Clean soft tissues thoroughly

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