Oral And Maxillofacial Injury

Oral and maxillofacial injury

Oral and maxillofacial injury Features 1 Abundance of blood vessels benefit: the ability of resistance of infection the ability of reparation are stronger shortcoming: bleed swelling asphyxia

bleeding  There

are many blood vessels on the oral and maxillofacial tissues  External carotid artery  Lingual artery  External maxillary artery  Internal maxillary artery  Superficial temporal artery

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2 the tooth in the jaw disadvantage fragments of teeth scatter to adjacent tissues the second injury calculi and bacteria enter deep tissues infection of wounds caries infection of bone affect coalesce of fracture

2 the tooth in the jaw Advantage  Disturbance

of occlusion relationship is important factor to diagnose the fracture  Restoration of natural occlusion is the standard of reduction  Teeth can be used as points of attachment for fixation appliances

Teeth use for mobilization and reduction

3 easily complicate injury of head  Concussion

of the brain  Cerebral contusion  Extradural hematoma  Cerebrospinal fluid escape

4 sometimes complicate injury of neck  Severe

injury can cause paraplegia

5 easily cause asphyxia  Because

of blockage of blood clot, secretion,swelling,tongue-backward, foreign bodies,displacement of tissues

6 influence on eating ,drinking and oral health  When

we treat the patient who had suffered injury,we should cleanse oral cavity to prevent infection of wounds

7 easily cause infection  Infection

of a wound depends on the presence of pathogenic bacteria in the wound in sufficient number to overcome the resistance of the tissues  There are numberless of bacteria in the oral cavity  Wounds that contain a foreign body,and especially sticks,dirt or clothing,are more likely to be infected than those that do not

8 abnormity of face  Resulted

from swelling ,displacement of tissues or injury of major organ  It is very important to recover the outline of the patient

treatment of emergency  It

is fundamental principle to save lives before treating the local wounds  The patients who suffered injury may have some complications which are fatal,for example :asphyxia,shock,head injuries .

treatment of emergency 1 asphyxia obstructive asphyxia inhalation asphyxia

obstructive asphyxia  The

blockage usually is refer to blood clot,vomit,displacement of tissues,tongue-backward

Treatment

remove the blockage timely tug the tongue to the normal position insert ventilation conductor

Pull the tongue outwards

Press the fragment of maxilla upwards

inhalation asphyxia  Blood,saliva,vomit

can be inhaled to trachea or lung which caused asphyxia Treatment tracheotomy  We

could use tracheotomy,then aspirate blood,saliva,secretion and so on

2 bleeding  It

is key to prevent bleeding immediately

 Digital

pressure on the facial or Superficial temporal artery can arrest it temporarily but the bleeding point should be ligated as soon as possible

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Prevent bleeding

3 shock traumatic shock treatment principle: keep silence relieve pain prevent bleeding supply liquid

3 shock hemorrhagic shock treatment principle: supply blood volume

4 prophylaxia infection  In

the early stage, we must carry out debridement  Antibiotic should be performed

debridement Definition It

is a fundamental treatment of prophylaxia infection There are three steps

debridement 1 cleaning wounds 2 trim wounds 3 suture wounds

debridement 1

cleaning wounds

remove foreign bodies with enough liquid  Then painted with an antiseptic solution 

debridement 2

trim wounds principle: reserve tissues as possible as you can trim edge of wounds before trimming, remove foreign bodies further

debridement 3  If

suture wounds

there is no infection,we should suture wound within 48 hours.if there is obvious infection,we suture wounds after preventing the infection

injury of soft tissues abrasion wounds contusion wounds incised and puncture wounds lacerated wounds bite wounds

abrasion wounds features skin abrasion few bleeding dirts or debrises or else foreign bodies on the surface of wounds

abrasion wounds treatment principle cleanse the surface remove the foreign bodies avoid infection

contusion wounds features skin and deep tissues suffer injury no open wounds the colour of local skin change swell and pain

contusion wounds treatment principle prevent bleeding relieve pain avoid infection prompt absorption of swelling recover functions

incised and puncture wounds features skin and soft tissues have cleft surface of wounds are small bacteria or dirts or debrises enter the deep tissues treatment principle: debridement

lacerated wounds features tissues is lacerated bleeding is more pain is intense condition is severe easily complicate shock

lacerated wounds treatment principle first: cleanse the wounds second: reduce tissues third: suture tissues

bite wounds  Easily

cause infection

Fractures of the jaw

Etiology  bare

fist

 automobile

accidents

 Falls  injuries

during extraction of teeth (especially

impacted mandibular third molars)

Fractured line of the maxilla  

  

Le fort Ⅰ: lower level fracture of the maxilla, located superior of alveolar process Le fort Ⅱ: middle level fracture of the maxilla, traversing nasal root, interior and basal wall of the fossa orbitalis, crevice between the zygoma and maxilla, lateral wall of maxilla to pterygoid process Le fort Ⅲ: superior level fracture, going through nasal root, fossa orbitalis, crevice between the zygoma and coronale to pterygoid process Split fracture: going through palate from alveolar process to soft palate complicated fracture: two or more than two kinds of fracture

Symptom of the maxillo fracture  Fractured

block moving  Malocclusion  Orbital and around affection  Head injury, such as fracture of skull base, and Cerebrospinal fluid escape

Location of the mandibular fracture 

the mental central region

 The

mental foramen region

 The

region of Angle

 The

neck at the condyle and the coronoid process

Symptom of the madibular fracture Fractured block moving  Deformity and malocclusion  abnormal mobility  Trismus, or restricted opening of the jaw  Numbness of the lower lip Pain

Treatment  Replacement  Principle:

correct occlusion

 Fixation  Operative

methods: opening replacement and

fixation  Solid interior fixation is advocated, because of profiting early functional exercise  Between occlusive fixation sometimes is needed

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