1、口腔颌面部损伤,Dr. Steve GF Shen Oral and Maxillofacial Surgery School of Stomatology Shanghai Ninth Peoples Hospital Shanghai Second Medical University,Oral & Maxillofacial Trauma,Chapter 7,10/26/2018,2,Vocabulary,10/26/2018,3,Vocabulary,10/26/2018,4,Vocabulary,10/26/2018,5,Vocabulary,10/26/2018,6,Vocabul
2、ary,10/26/2018,7,Definition of trauma,trauma noun C or U severe emotional shock and pain caused by an extremely upsetting experience: the trauma of marriage breakdown He had psychotherapy to help him deal with his childhood traumas. SPECIALIZED a severe injury, usually caused by a violent attack or
3、an accident,(from Cambridge Advanced Learners Dictionary),10/26/2018,8,Section 1 Introduction,War,Incidence,Traffic Accident,Sports,Falling,Bustup,Labor injury,10/26/2018,9,Financial Loss,致伤人数,No of traffic accident,Traffic Accident,10/26/2018,10,Traffic Accident,10/26/2018,11,Combined injury to oth
4、er viscera -Fatal to lifeDamage to maxillofacial structureStomatognathic dysfunctionFacial esthetic problemPsychological trauma,Effect of Trauma on the Human Body,10/26/2018,12,1. Rich blood supply,Section 2 Characteristics of OMF Trauma,10/26/2018,13,Debridement Time: 24 48 h,Tend to hematoma, edem
5、a,Respiratorytract,Asphyxia,Ability to anti-infection, regeneration,Wound healing,1. Rich blood supply,10/26/2018,14,Cerebral concussionCerebral contusionIntracranial hematomaSkull base fracture,Increase infectious incidenceMalocclusion caused - DiagnosisOcclusion regained - Treatment,2. Relationshi
6、p btw tooth & OMF trauma,3. Cranio-cerebral trauma,10/26/2018,15,Mouth opening, mastication, swallowing,4. Cervical trauma,5. Effect on breathing,6. Effect of on digastric system,Bleeding Paralysis 瘫痪,Leading difficulty breathing,diet,worse oral hygiene,Asphyxia 窒息,10/26/2018,16,7. Multi-sinus- cont
7、amination,Infection,Oral cavity Nasal cavity Pharyngeal cavity Orbit Paranasal sinus,Bacteria Temp Humidity,10/26/2018,17,8. Damage to specific structure,Parotid Gland Facial N. Trigeminal N.,Salivary fistula Facial paralysis Regional numbness,10/26/2018,18,9. Facial Defect,Facial contour Psychologi
8、cal trauma,10/26/2018,19,Evaluate trauma soon Identify the key trauma, manage the fatal first Careful history taking, thorough physical exam Rescue in time Management in order,General Rules,Section 3 Rescue,10/26/2018,20,1. Prevention of Asphyxia,Section 3 Rescue,10/26/2018,21,Dysphoria, sweating, i
9、nhaling 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,1.1 Clinical features of asphyxia,Prodrome,10/26/2018,22,1.2 Etiology of Asphyxia,Foreign body obstruction,Insp
10、iratory Asphyxia,Low Airway,Swelling Foreign body Blood, saliva Vomit,Upper airway,Tissue dislocation,Obstructive Asphyxia,10/26/2018,23,1.3 Rescue of Asphyxia,Clear foreign body in upper airway Suspend maxilla Intubation Hold the tongue out,Obstructive Asphyxia,10/26/2018,24,2. Hemostasia,Two steps
11、：,Judge bleeding situation Choose the way to stop bleeding,Section 3 Rescue,10/26/2018,25,2.1 Judge bleeding situation,Three categories,Arterial Capillary Venous,Based on origin,10/26/2018,26,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,2.2 Methods of hemostat,10/26/2018,27,3. Anti-shock treatment,(2) Purpose
12、 of anti-shock,(1) Definition & Classification,Traumatic shock Exsanguine shock 20% Body weight Toxic shock Infectious shock,Restore circulation,10/26/2018,28,(4) Principles of Treatment,(3) Features of Shock,Early stage: Dysphoria, quick & superficial breath, sweating, paleness Middle stage: Tingle
13、 to supression, emotional faint, unconsciousness, decrease BP, labial paleness Late stage: weaker pulsation, unmeasurable BP, hyponuria, anuria 30ml/h,Hemostasis, blood transfusion, pain control, fluid transfusion, sedation,10/26/2018,29,(1) Judgement,4. Combined Craniocerebral Injuries,Consciousnes
14、s, pulse, BP, respiration, pupil,(2) Early discovery, early management,Retrograde obliviscence Cerebral concussion Intermediate wake-up Extradural hematoma Cerebral fluid leak Skull base fracture,10/26/2018,30,10/26/2018,31,Debridement Wound closure Antibiotics,5. Prevention of Infection,6. Bandage
15、& Transportation,10/26/2018,32,Section 4 Soft Tissue Trauma,10/26/2018,33,Abrasions 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 injuries,Section 4 Soft Tissue Trauma,10/26/2018,34,Character: Irregular wound edge, foreign body, pain, oozing & y
16、ellowish plasma oozing Management: Debridement, remove foreign body, Dry wound, drain when infected,1. Abrasions,Property: rough surface,Epidermis & superficial dermis,10/26/2018,35,1. Abrasions,10/26/2018,36,2. Contusions,Charater: petechia, swelling, pain Management: Hemostasis Pain-killer Prevent
17、ion of infection Hematoma resorption Re-establishment of function,Property: blunt material & fell to hard object,Subdermal tissue (no open wound),10/26/2018,37,Property: Blunt object with high mechanical force,3. Contusions & Lacerations,Character Irregular wound edge, saw-toothed Big laceration w/w
18、o necrotic tissue & open fractures Management Debridement Wound Closure,Soft tissue,10/26/2018,38,3. Contusions & Lacerations,10/26/2018,39,Property: Sharp object or instruments,4. Incised & Puncture Wound,Charater Regular wound edge Bleeding Small access, but deep wound Management Debridement Wound
19、 closure,Soft tissue,10/26/2018,40,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,5. Bite Wound,10/26/2018,41
20、,Definition,Debridement,Main Entry: debridement Pronunciation: di-brEd-m&nt, dA-, -“mnt, dA-brEd-mn Function: noun Etymology: French dbridement, from dbrider to remove adhesions, literally, to unbridle, from Middle French desbrider, from des- de- + bride bridle, from Middle High German brIdel - more
21、 at BRIDLE : the surgical removal of lacerated, devitalized, or contaminated tissue,10/26/2018,42,Protocol,1. wash woundTime：6-12hSolution: soap water, saline, hydrogen dioxide,Debridement,3. Closure,2. Clean woundRemoval of foreign bodyTrimming of necrotic tissue,10/26/2018,43,10/26/2018,44,Cheek i
22、njuries Palate injuries Injuries at other regions,Management of soft tissure injuries,Tongue injuries,Length maintain, longitudinal closure Independent closure, but tongue suture domination Big needle with big, depth suturing or matric suturing,10/26/2018,45,Management of soft tissure injuries,10/26
23、/2018,46,10/26/2018,47,Section 5 Injury of Teeth and Dental Alveolar Process,10/26/2018,48,1. Tooth injuries,1.1 Contusion of Teeth,Etiology: Extrinsic force blunt tooth injuries Periodontal ligaments or dental pulp,Character: Extrusion of tooth Mobility Percussion & Toothache when chewing Managemen
24、t Tooth rest Tooth ground Simple ligation,10/26/2018,49,1. Tooth injuries,1.2 Luxation of Teeth,Classification,Character Tooth dislocated or exfoliated Management Tooth protection priority Reduction Fixation Reimplantation,Partial luxation,Complete luxation,- Tooth dislocation - Semi luxation - Intr
25、usive movement,10/26/2018,50,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,2. Fracture of Alveolar Process,Characters,10/26/2018,51,Extrinsic force t
26、o dental alveolar process, mainly to upper jaw,Reduction under LA Arch bar applied,2. Fracture of Alveolar Process,Etiology,Management,10/26/2018,52,2. Fracture of Alveolar Process,10/26/2018,53,Stainless steel wire ligation, Arch bars,10/26/2018,54,Questions,Describe the characteristics of OMF Trau
27、ma? Describe the etiology, clinical features and management of asphyxia. Describe the ways of hemastasis. What is debridement? Describe the common site of dental alveolar process fracture, and their clinical manifestation.,10/26/2018,55,Reference,LJ Peterson, et al : Contemporary Oral & Maxillofacial Surgery. 4th ed. Mosby. Missorri. 2003 W Booth, et al: Maxillofacial Surgery. Vol 1, 2. 1st ed. Churchill Livingstone. London. 1999 邱蔚六主编.口腔颌面外科学. 第5版. 人民卫生出版社. 2004,10/26/2018,56,THE END,
