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口腔颌面部损伤 PowerPoint Presentation
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口腔颌面部损伤

口腔颌面部损伤

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口腔颌面部损伤

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  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

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

  30. Section 4 Soft Tissue Trauma

  31. 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

  32. 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

  33. 1. Abrasions

  34. 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

  35. 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

  36. 3. Contusions & Lacerations

  37. 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

  38. 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

  39. 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

  40. 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

  41. 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

  42. Management of soft tissure injuries

  43. Section 5 Injury of Teeth and Dental Alveolar Process

  44. 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

  45. 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

  46. 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

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