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CASE PRESENTATION ON PERI OPERATIVE CARE OF MAXILLO FACIAL SURGERY

CASE PRESENTATION ON PERI OPERATIVE CARE OF MAXILLO FACIAL SURGERY. SUBMITTED BY: SUBMITTED TO: PREETHY FRANCIS RADHAMANI P.C. INTRODUCTION. DEMOGRAPHIC DATA. NAME : XYZ AGE : 20 years old

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CASE PRESENTATION ON PERI OPERATIVE CARE OF MAXILLO FACIAL SURGERY

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  1. CASE PRESENTATION ON PERI OPERATIVE CARE OF MAXILLO FACIAL SURGERY SUBMITTED BY: SUBMITTED TO: PREETHY FRANCIS RADHAMANI P.C

  2. INTRODUCTION

  3. DEMOGRAPHIC DATA NAME : XYZ AGE : 20 years old SEX: : Male MR NO : 209631 NATIONALITY : Saudi DIAGNOSIS : Multiple Facial bone fractures.

  4. CHIEF COMPLAINTS Complaint of Bleeding from nose LOC , swelling around right eye and eye lids and periorbital area on right side.

  5. NAME OF SURGERY • 1)ORIF OF RIGHT ZYGOMA (Either of a pair of bones that from the prominent part of the cheeks and contribute to the orbits)MAXILLARY(Maxillae is the upper jaw) AND MANDIBLE(lower jaw) FRACTURE.2)ORIF OF NASAL BONE FRACTURE.

  6. History intended for surgical procedure • Sustaining MULTI FACIAL TRAUMA on Zygoma , Maxillary ,mandible and Nasal Bone. • DATE OF ADMISSION: 11/08/13 • DATE OF SURGERY: 12/08/2013 • DATE OF DISCHARGE: 21/08/2013

  7. PHYSICAL ASSESSMENT • ON ADMISSION IN EMERGENCY ROOM 1.General Appearance • Patient is Oriented to time, place and person. • Looks weak and fatigue. • Unable to mobilize upper and lower face joints. • Upper teeth fracture

  8. 2.Integumentary System • Skin is warm. • Abrasions presents on the face. • Noted abrasion on upper and lower extremities. • 3.Neurological System • No spine and cranial bone fracture. • GCS 15/15

  9. Head and Neck • Hair is equally distributed. • Abrasions on face. • Patient’s pinna is same colour as facial skin aligned with eye level. • Lips are pink but swollen. • Upper teeth fracture seen. • No lymph node enlargement on neck.

  10. Face And Nose • Right facial hematoma and facial edema. • Bleeding from nose. • Nasal bone fracture septum deviated to left. • Difficulty to take breath through nose. • Swelling on right eye, eye lids and periorbital area on right side.

  11. Respiratory System • Thorax • The thorax is symmetric on inspection. • Equal air movements. • Clear breath sound on auscultation.

  12. Cardiovascular System • Airway Adequate • Heart sound : s1 and s2 normal • BP is 120/80mmHg • Pulse rate-66/mts • Lungs – Breath sound present, normal & clear . • Genitourinary system • With Foleys catheter FG.16present.

  13. Gastrointestinal System • Patient have soft abdomen, no tenderness. • Musculoskeletal System • Able to mobilize his upper and lower limb . • Can perform ADL • Tenderness at the site of fracture . • Visible deformity.

  14. PATIENT HISTORY Past Medical History • No known History of HTN,DM and Asthma. Present Medical History • Patient have some LOC and weakness.

  15. Present Surgical History • He undergone RIGHT ORIF ZYGOMA , MAXILLARY and MANDIBLE BONE and NASAL BONE FRACTURE done under general anesthesia on 12/08/13. • Past Surgical History • He have no surgical history

  16. VITAL SIGNS • BP- 120/86mmhg • PR- 66 b /mts • Temperature- 36.4C • SPO2- 98% • Pain scroe-8 Assess by Facial numerical scale • GCS -15/15.

  17. TREATMENT ORDERED BY FACIOMAXILLARY SURGEON • HaematologicalInvestigations • ABO RH group. • Urine analysis. • Chest X-ray. • Non contrast enhanced CT Brain • Medications • ABO RH Group A positive blood Group. • CHEST X-RAY Chest X-ray shows normal.

  18. Investigations:

  19. C T BRAIN STUDY CT brain shows fractures and some air in soft tissues

  20. DRUG STUDY Name of drug :Inj . Augmentine Dose : 1.2gm Route : I . v Action : Antibiotic Indication Lower Respiratory Tract Infections, Skin and Skin Structure Infections , other bacterial infections Contraindication When susceptibility test results show susceptibility to amoxicillin, indicating no beta-lactamase production, AUGMENTIN should not be used.

  21. Name of drug : Inj.flagyl Dose : 100ml Route : I . v Action : Antibiotic Indication : BACTERIAL SEPTICEMIA, BONE AND JOINT INFECTIONS Contraindication : When susceptibility test results show susceptibility to injection full dose can’t give to patient . Pregnancy (1st trimester)

  22. Name of drug : Inj . perfaglan Dose : 100 mg Route : I . v Action : Analgesics Indication : Pain Contraindication : Sensitive patient in NSAID drugs

  23. Name of drug : Inj. Hydrocortisone Dose : 100mg Route : I . v Action : Anti-inflammatory drug Indication : Corticosteroid- responsive dermatoses. Contraindication: Exclude viral disease (e.g, chickenpox, measles).

  24. Name of drug : Inj . Diclofenac Dose : 75mg Route : I . v Action : Anti-inflammatory drug(NSAID) Indication : Pain, Osteoarthritis (OA) or rheumatoid arthritis (RA) in patients at high risk for developing NSAID-induced gastric or duodenal ulcers Contraindication :Pregnancy ,Aspirin allergy. Coronary artery bypass graft surgery.

  25. ANATOMY OF FACICAL BONES The facial skeleton serves to protect the brain; house and protect the sense organs of smell, sight, and taste; and provide a frame on which the soft tissues of the face can act to facilitate eating, facial expression, breathing, and speech. The primary bones of the face are the mandible, maxilla, frontal bone, nasal bones, and zygoma. Facial bone anatomy is complex, yet elegant, in its suitability to serve a multitude of functions.

  26. LIST OF FOURTEEN FACIAL BONES. Inferior nasal concha (2) Lacrimal bones (2) Mandible Maxilla (2) Nasal bones (2) Palatine bones (2) Vomer Zygomatic bones (2)

  27. The hyoid bone is sometimes included, and sometimes excluded. The ethmoid bone (or a part of it) is sometimes included, but otherwise considered part of the neurocranium; the same is the case with the sphenoid bone. Some sources describe the maxilla's left and right parts as two bones. Likewise, the palatine bone is also sometimes described as two bones.

  28. Mandible The mandible is a U-shaped bone. It is the only mobile bone of the facial skeleton, and, since it houses the lower teeth, its motion is essential for mastication. It is formed by intramembranous ossification. The mandible is composed of 2 hemimandibles . The hemimandibles fuse to form a single bone by age 2 years.

  29. Maxilla The maxilla has several roles. It houses the teeth, forms the roof of the oral cavity, forms the floor of and contributes to the lateral wall and roof of the nasal cavity, houses the maxillary sinus, and contributes to the inferior rim and floor of the orbit. Two maxillary bones are joined in the midline to form the middle third of the face.

  30. Function • The alveolar process of the maxillae holds the upper teeth, and is referred to as the maxillary arch. Each maxilla attaches laterally to the zygomatic bones (cheek bones).Each maxilla assists in forming the boundaries of three cavities: • The roof of the mouth • The floor and lateral wall of the nasal antrum • The wall of the orbit

  31. Components • Each half of the fused maxillae consists of: • The body of the maxilla • Four processes • The zygomatic process • The frontal process of maxilla • The alveolar process • The palatine process • Infraorbital foramen • The maxillary sinus

  32. Articulations • Each maxilla articulates with nine bones: • two of the cranium: Thefrontal and ethmoid • seven of the face: Thenasal, zygomatic, lacrimal, inferior nasal concha, palatine, vomer, and the adjacent fused maxilla.

  33. Zygoma The zygoma forms the lateral portion of the inferior orbital rim, as well as the lateral rim and lateral wall of the orbit. Additionally, it forms the anterior zygomatic arch, from which the masseter muscle is suspended. The masseter muscle acts to close the mandible for mastication and speech. On its lateral surface, the zygomatic bone has 3 processes. Inferiorly, a concave process projects medially to articulate with the zygomatic process of the maxilla, forming the lateral portion of the infraorbital rim.

  34. Frontal Bone Anterior surface The frontal bone forms the anterior portion of the cranium, houses the frontal sinuses, and forms the roof of the ethmoid sinuses, nose, and orbit. Anteriorly, the external surface is convex superiorly, and it articulates with the parietal bones posteriorly and the greater wing of the sphenoid posteroinferiorly.

  35. Nasal Bones The paired nasal bones form the anterosuperior bony roof of the nasal cavity. They are approximately quadrangular. They articulate with the nasal process of the frontal bone superiorly, the frontal process of the maxillary bone laterally, and with one another medially. Their inferior border is free and forms the superior margin of the piriform aperture.

  36. FACIAL BONES AND ITS FUCTIONS

  37. FACIAL MUSCLES Structure and Actions The facial muscles are subcutaneous (just under the skin) muscles that control facial expression. They generally originate from the surface of the skull bone (rarely the fascia), and insert on the skin of the face. When they contract, the skin moves. Innervation The facial muscles are innervated by facial nerve (cranial nerve VII), with each nerve serving one side of the face.[ In contrast, the nearby masticatory muscles are innervated by the mandibular nerve, a branch of the trigeminal nerve (V) cranial nerve. Development The facial muscles are derived from the second branchial/pharyngeal arch.

  38. List of muscles • The facial muscles include • Occipitofrontalis • Temporoparietalis muscle • Procerus • Nasalis muscle • Depressor septinasi • Orbicularis oculi • Corrugator supercilii • Zygomaticus major • Zygomaticus minor

  39. FACIAL NERVE

  40. The motor part of the facial nerve arises from the facial nerve nucleus in the pons while the sensory and parasympathetic parts of the facial nerve arise from the nervusintermedius. The motor part and sensory part of the facial nerve enters the petrous temporal bone via the internal auditory meatus (intimately close to the inner ear) then runs a tortuous course (including two tight turns) through the facial canal, emerges from the stylomastoid foramen and passes through the parotid gland, where it divides into five major branches.

  41. CRANIAL NERVE BRANCHES Intra cranial Greater petrosal nerve - provides parasympathetic innervation to several glands, including the nasal gland, palatine gland, lacrimal gland, and pharyngeal gland. It also provides parasympathetic innervation to the sphenoid sinus, frontal sinus, maxillary sinus, ethmoid sinus and nasal cavity. Nerve to stapedius - provides motor innervation for stapedius muscle in middle ear Chorda tympani • Submandibular gland • Sublingual gland • Special sensory taste fibers for the anterior 2/3 of the tongue.

  42. Extra cranial • Distal to stylomastoid foramen, the following nerves branch off the facial nerve: • Posterior auricular nerve - controls movements of some of the scalp muscles around the ear • Branch to Posterior belly of Digastric muscle as well as the Stylohyoid muscle • Five major facial branches • Temporal branch of the facial nerve • Zygomatic branch of the facial nerve • Buccal branch of the facial nerve • Marginal mandibular branch of the facial nerve • Cervical branch of the facial nerve

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