1、Oral&Maxillofacial TraumaChapter 72022-10-2312022-10-2322022-10-2332022-10-2342022-10-2352022-10-236(from Cambridge Advanced Learners Dictionary)2022-10-237Clear foreign body in upper airwayOral and Maxillofacial SurgeryPrevention of InfectionDamage to maxillofacial structureObstructive Asphyxiareim
2、plantationWound ClosureJudge bleeding situationPrevention of AsphyxiaAbility to anti-infection,regenerationvaccinationOral cavityFragment dislocation,MalocclusionSkull base fractureSection 3 RescueContusions&LacerationsProperty:blunt material&fell to hard objectAbility to anti-infection,regeneration
3、2 Luxation of TeethIncidenceTraffic AccidentSportsFallingBustupLabor injury2022-10-23824万万14.2万人万人10亿元亿元1993年年1997年年2001年年30万万19万人万人18.5亿元亿元75.5万万54.6万人万人3.09b RMBFinancial Financial LossLoss致伤人数致伤人数No of traffic No of traffic accidentaccidentTraffic Accident2022-10-2392022-10-2310Blood,saliva1 Clin
4、ical features of asphyxiaContusions&Lacerations2 Luxation of TeethFinancial LossDefinition of traumaHematoma resorptionTooth protection priorityFracture of Alveolar ProcessBandage&TransportationContusions&LacerationsDamage to specific structurepsychotherapyTooth tracedProperty:Animal(Wolf,dog,Bear)o
5、r human beingsRegional numbnessDamage to specific structureRemoval of foreign bodyanti-infectionObstructive AsphyxiaContusions&LacerationsArch bar appliedEffect of Trauma on the Human Body2022-10-23112022-10-2312Debridement Time:24 48 hTend to hematoma,edemaRespiratory tractAsphyxiaAbility to anti-i
6、nfection,regenerationWound healing2022-10-2313 Increase infectious incidence Malocclusion caused-Diagnosis Occlusion regained-Treatment2022-10-2314Mouth opening,mastication,swallowingBleedingParalysis瘫痪Leading difficulty breathingdietworse oral hygieneAsphyxia 窒息2022-10-2315 InfectionOral cavityNasa
7、l cavityPharyngeal cavityOrbitParanasal sinusBacteriaTempHumidity2022-10-2316Parotid GlandFacial N.Trigeminal N.Salivary fistulaFacial paralysisRegional numbness2022-10-2317 Facial contour Psychological trauma2022-10-2318Evaluate trauma soonIdentify the key trauma,manage the fatal firstCareful histo
8、ry taking,thorough physical examRescue in timeManagement in orderGeneral Rules2022-10-23192022-10-2320Dysphoria,sweating,inhaling respirationDifficult to inhale,hypopnea,nasal alar movement,labial cyanosisThree concave signs、Rapid breathing,weak pulse,decreased BPPupils diluted,No reflection to ligh
9、tProdrome2022-10-2321Oral cavityChoose the way to stop bleedingChoose the way to stop bleedingDifficult to inhale,hypopnea,nasal alar movement,labial cyanosisUpper airwaypain-killerDamage to maxillofacial structureMiddle stage:Tingle to supression,emotional faint,unconsciousness,decrease BP,labial p
10、alenessTooth tracedSolution:soap water,saline,hydrogen dioxideOral and Maxillofacial SurgerySteve GF ShentransportationGingival or labial swelling,lacerationOcclusion regained-TreatmentAbility to anti-infection,regenerationhematoma,edemaPrevention of AsphyxiaFacial paralysisThorough debridementRescu
11、e in timeWound closure Foreign body obstructionInspiratory AsphyxiaLow AirwaySwellingForeign bodyBlood,salivaVomitUpper airwayTissue dislocation Obstructive Asphyxia2022-10-2322Clear foreign body in upper airwaySuspend maxillaIntubationHold the tongue outObstructive Asphyxia 吸入性窒息吸入性窒息气管切开术气管切开术2022
12、-10-2323Two steps：Judge bleeding situationChoose the way to stop bleeding2022-10-2324Three categoriesArterialCapillaryVenousBased on origin2022-10-2325压迫止血压迫止血指压止血法指压止血法包扎止血法包扎止血法填塞止血法填塞止血法结扎止血法结扎止血法药物止血法药物止血法2022-10-2326(2)Purpose of anti-shock(1)Definition&Classification Traumatic shockExsanguine
13、shock 20%Body weightToxic shockInfectious shock Restore circulation2022-10-2327(4)Principles of Treatment (3)Features of ShockEarly stage:Dysphoria,quick&superficial breath,sweating,palenessMiddle stage:Tingle to supression,emotional faint,unconsciousness,decrease BP,labial palenessLate stage:weaker
14、 pulsation,unmeasurable BP,hyponuria,anuria 30ml/hHemostasis,blood transfusion,pain control,fluid transfusion,sedation2022-10-2328(1)JudgementConsciousness,pulse,BP,respiration,pupil(2)Early discovery,early managementRetrograde obliviscenceCerebral concussionIntermediate wake-upExtradural hematomaCe
15、rebral fluid leakSkull base fracture2022-10-23292022-10-2330DebridementWound closureAntibiotics2022-10-23312022-10-2332Abrasions 擦伤Contusions挫伤Contusions&Lacerations挫裂伤Incised&Puncture Wound切割伤及刺伤 Bite Wound 咬伤 Types of injuries2022-10-2333Effect on breathingtrigeminal nerveFracture of Alveolar Proc
16、essOral&Maxillofacial Trauma2 Luxation of TeethManagement of soft tissure injuriesTooth tracedSalivary fistulamalocclusionTypes of injuriesDamage to specific structureThorough debridementTraumatic shockProperty:rough surface1 Contusion of TeethtransportationEffect of Trauma on the Human BodyPsycholo
17、gical traumatoxic shockSection 3 RescueGeneral RulesSection 3 Rescue1.Abrasions2022-10-23341.Abrasions2022-10-23352.Contusions2022-10-2336Property:Blunt object with high mechanical force3.Contusions&LacerationsCharacterlIrregular wound edge,saw-toothedlBig lacerationlw/wo necrotic tissue&open fractu
18、resManagementl Debridementl Wound Closure2022-10-23373.Contusions&Lacerations2022-10-2338Property:Sharp object or instruments4.Incised&Puncture WoundCharater l Regular wound edgel Bleedingl Small access,but deep woundManagementl Debridementl Wound closure2022-10-2339Property:Animal(Wolf,dog,Bear)or
19、human beingsCharacterl Tooth tracedl Heavy contaminationl Tend to infectionManagementl Thorough debridementl Infection controll Skin graft after granular tissue regeneratedl Vaccination of Tetanus,Rabies5.Bite Wound2022-10-2340Gingival or labial swelling,lacerationThorough debridementpsychotherapyPr
20、evention of AsphyxiaBandage&TransportationDescribe the ways of hemastasis.Character:Irregular wound edge,foreign body,pain,oozing&yellowish plasma oozingIn accordance with tooth luxation or fracturemouth openingCerebral fluid leakSkull base fractureTooth tracedObstructive AsphyxiaChoose the way to s
21、top bleedinghematoma,edemaSection 3 RescuepsychotherapyTissue dislocationClear foreign body in upper airwayCareful history taking,thorough physical examOcclusion regained-TreatmentpsychotherapyJudge bleeding situationDebridement2022-10-23411.wash wound Time：6-12h Solution:soap water,saline,hydrogen
22、dioxideDebridement3.Closure2.Clean wound Removal of foreign body Trimming of necrotic tissue2022-10-23422022-10-2343Management of soft tissure injuries2022-10-2344Management of soft tissure injuries2022-10-23452022-10-23462022-10-23471.Tooth injuries 1.1 Contusion of TeethEtiology:Extrinsic force bl
23、unt tooth injuriesPeriodontal ligaments or dental pulpCharacter:l Extrusion of toothl Mobilityl Percussion&Toothache when chewingManagementl Tooth restl Tooth groundl Simple ligation2022-10-23481.Tooth injuries 1.2 Luxation of TeethClassificationCharacterl Tooth dislocated or exfoliatedManagementl T
24、ooth protection priorityl Reductionl Fixationl ReimplantationPartial luxationComplete luxation-Tooth dislocation-Semi luxation-Intrusive movement2022-10-2349Gingival or labial swelling,lacerationAdjacent teeth or alveolar process movement when one affected tooth touchedFragment dislocation,Malocclus
25、ionIn accordance with tooth luxation or fracture2.Fracture of Alveolar ProcessCharacters2022-10-2350l Extrinsic force to dental alveolar process,mainly to upper jawl Reduction under LAl Arch bar applied2.Fracture of Alveolar ProcessEtiologyManagement 2022-10-23512.Fracture of Alveolar Process2022-10
26、-2352Abrasions 擦伤Anti-shock treatmentIncrease infectious incidenceCerebral concussionRich blood supplyCharacter:Irregular wound edge,foreign body,pain,oozing&yellowish plasma oozingSolution:soap water,saline,hydrogen dioxideFacial paralysis(1)JudgementRegional numbnessRich blood supplyDamage to maxi
27、llofacial structureClean woundBite Wound-contaminationSkull base fractureObstructive AsphyxiaFacial paralysis2 Luxation of Teethperiodontal ligamentSimple ligationTooth tracedStainless steel wire ligation,Arch bars2022-10-23531.Describe the characteristics of OMF Trauma?2.Describe the etiology,clini
28、cal features and management of asphyxia.3.Describe the ways of hemastasis.4.What is debridement?5.Describe the common site of dental alveolar process fracture,and their clinical manifestation.2022-10-23541.LJ Peterson,et al:Contemporary Oral&Maxillofacial Surgery.4th ed.Mosby.Missorri.20032.W Booth,
29、et al:Maxillofacial Surgery.Vol 1,2.1st ed.Churchill Livingstone.London.19993.邱蔚六主编邱蔚六主编.口腔颌面外科学口腔颌面外科学.第第5版版.人民卫生出版社人民卫生出版社.20042022-10-2355Hold the tongue outSection 3 RescueTooth tracedParanasal sinusDescribe the characteristics of OMF Trauma?Section 3 RescueDescribe the ways of hemastasis.Abrasi
30、ons 擦伤Rich blood supplyDescribe the etiology,clinical features and management of asphyxia.Ability to anti-infection,regenerationInspiratory AsphyxiatransportationContusions&LacerationsDifficult to inhale,hypopnea,nasal alar movement,labial cyanosis2 Luxation of TeethThorough debridementinspiratory a
31、sphyxiaJudge bleeding situationadjacent toothDysphoria,sweating,inhaling respirationLJ Peterson,et al:Contemporary Oral&Maxillofacial Surgery.Effect of Trauma on the Human Body-Semi luxationWound ClosureSkull base fractureDifficult to inhale,hypopnea,nasal alar movement,labial cyanosisSPECIALIZED a
32、severe injury,usually caused by a violent attack or an accidentRegular wound edgeTooth protection priorityBite Wound(3)Features of ShockPartial luxationDamage to specific structureIntracranial hematomaProperty:rough surfaceDamage to specific structurenasal cavity1 Clinical features of asphyxia(2)Pur
33、pose of anti-shocktrauma noun C or UNasal cavityPrevention of AsphyxiaSubdermal tissue(no open wound)Property:rough surfaceIncised&Puncture Wound切割伤及刺伤Thorough debridementRich blood supplyBlood,salivadental pulpGingival or labial swelling,lacerationmaxillofacialPrevention of AsphyxiaGingival or labial swelling,lacerationRestore circulationWound healingBite WoundOral cavityCombined injury to other viscera-Fatal to lifeBased on originIdentify the key trauma,manage the fatal firstInfection controlClassificationLeading difficulty breathingComplete luxationBlood,salivaTHE ENDTHE END2022-10-2356
