1、口腔颌面部损伤,Dr. Steve GF ShenOral and Maxillofacial SurgerySchool of StomatologyShanghai Ninth Peoples HospitalShanghai Second Medical University,Oral & Maxillofacial Trauma,Chapter 7,2019/7/12,2,Vocabulary,2019/7/12,3,Vocabulary,2019/7/12,4,Vocabulary,2019/7/12,5,Vocabulary,2019/7/12,6,Vocabulary,2019/
2、7/12,7,Definition of trauma,trauma noun C or Usevere 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,(f
3、rom Cambridge Advanced Learners Dictionary),2019/7/12,8,Section 1 Introduction,War,Incidence,Traffic Accident,Sports,Falling,Bustup,Labor injury,2019/7/12,9,Financial Loss,致伤人数,No of traffic accident,Traffic Accident,2019/7/12,10,Traffic Accident,2019/7/12,11,Combined injury to other viscera -Fatal
4、to life Damage to maxillofacial structure Stomatognathic dysfunction Facial esthetic problem Psychological trauma,Effect of Trauma on the Human Body,2019/7/12,12,1. Rich blood supply,Section 2 Characteristics of OMF Trauma,2019/7/12,13,Debridement Time: 24 48 h,Tend to hematoma, edema,Respiratory tr
5、act,Asphyxia,Ability to anti-infection, regeneration,Wound healing,1. Rich blood supply,2019/7/12,14,Cerebral concussion Cerebral contusion Intracranial hematoma Skull base fracture,Increase infectious incidence Malocclusion caused - Diagnosis Occlusion regained - Treatment,2. Relationship btw tooth
6、 & OMF trauma,3. Cranio-cerebral trauma,2019/7/12,15,Mouth opening, mastication, swallowing,4. Cervical trauma,5. Effect on breathing,6. Effect of on digastric system,BleedingParalysis瘫痪,Leading difficulty breathing,diet,worse oral hygiene,Asphyxia 窒息,2019/7/12,16,7. Multi-sinus- contamination,Infec
7、tion,Oral cavityNasal cavityPharyngeal cavityOrbitParanasal sinus,BacteriaTempHumidity,2019/7/12,17,8. Damage to specific structure,Parotid GlandFacial N. Trigeminal N.,Salivary fistulaFacial paralysisRegional numbness,2019/7/12,18,9. Facial Defect,Facial contour Psychological trauma,2019/7/12,19,Ev
8、aluate trauma soonIdentify the key trauma, manage the fatal firstCareful history taking, thorough physical examRescue in timeManagement in order,General Rules,Section 3 Rescue,2019/7/12,20,1. Prevention of Asphyxia,Section 3 Rescue,2019/7/12,21,Dysphoria, sweating, inhaling respirationDifficult to i
9、nhale, hypopnea, nasal alar movement, labial cyanosisThree concave signs、Rapid breathing, weak pulse, decreased BPPupils diluted, No reflection to light,1.1 Clinical features of asphyxia,Prodrome,2019/7/12,22,1.2 Etiology of Asphyxia,Foreign body obstruction,Inspiratory Asphyxia,Low Airway,SwellingF
10、oreign bodyBlood, salivaVomit,Upper airway,Tissue dislocation,Obstructive Asphyxia,2019/7/12,23,1.3 Rescue of Asphyxia,Clear foreign body in upper airwaySuspend maxillaIntubationHold the tongue out,Obstructive Asphyxia,2019/7/12,24,2. Hemostasia,Two steps：,Judge bleeding situationChoose the way to s
11、top bleeding,Section 3 Rescue,2019/7/12,25,2.1 Judge bleeding situation,Three categories,ArterialCapillaryVenous,Based on origin,2019/7/12,26,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,2019/7/12,27,3. Anti-shock treatment,(2) Purpose of anti-shock,(1) Definition & Classification,Trau
12、matic shockExsanguine shock 20% Body weightToxic shockInfectious shock,Restore circulation,2019/7/12,28,(4) Principles of Treatment,(3) Features of Shock,Early stage: Dysphoria, quick & superficial breath, sweating, palenessMiddle stage: Tingle to supression, emotional faint, unconsciousness, decrea
13、se BP, labial palenessLate stage: weaker pulsation, unmeasurable BP, hyponuria, anuria 30ml/h,Hemostasis, blood transfusion, pain control, fluid transfusion, sedation,2019/7/12,29,(1) Judgement,4. Combined Craniocerebral Injuries,Consciousness, pulse, BP, respiration, pupil,(2) Early discovery, earl
14、y management,Retrograde obliviscenceCerebral concussionIntermediate wake-upExtradural hematomaCerebral fluid leakSkull base fracture,2019/7/12,30,2019/7/12,31,DebridementWound closureAntibiotics,5. Prevention of Infection,6. Bandage & Transportation,2019/7/12,32,Section 4 Soft Tissue Trauma,2019/7/1
15、2,33,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,2019/7/12,34,Character: Irregular wound edge, foreign body, pain, oozing & yellowish plasma oozingManagement: Debridement, remove foreign body, Dry woun
16、d, drain when infected,1. Abrasions,Property: rough surface,Epidermis & superficial dermis,2019/7/12,35,1. Abrasions,2019/7/12,36,2. Contusions,Charater: petechia, swelling, painManagement: HemostasisPain-killerPrevention of infectionHematoma resorptionRe-establishment of function,Property: blunt ma
17、terial & fell to hard object,Subdermal tissue (no open wound),2019/7/12,37,Property: Blunt object with high mechanical force,3. Contusions & Lacerations,CharacterIrregular wound edge, saw-toothedBig lacerationw/wo necrotic tissue & open fracturesManagementDebridementWound Closure,Soft tissue,2019/7/
18、12,38,3. Contusions & Lacerations,2019/7/12,39,Property: Sharp object or instruments,4. Incised & Puncture Wound,Charater Regular wound edgeBleedingSmall access, but deep woundManagementDebridementWound closure,Soft tissue,2019/7/12,40,Property: Animal (Wolf, dog, Bear) or human beingsCharacterTooth
19、 tracedHeavy contaminationTend to infectionManagementThorough debridementInfection controlSkin graft after granular tissue regeneratedVaccination of Tetanus, Rabies,5. Bite Wound,2019/7/12,41,Definition,Debridement,Main Entry: debridement Pronunciation: di-brEd-m&nt, dA-, -mnt, dA-brEd-mnFunction: n
20、ounEtymology: 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 at BRIDLE: the surgical removal of lacerated, devitalized, or contaminated tissue,2019/7/12,42,Protocol,1. wash
21、 wound Time：6-12h Solution: soap water, saline, hydrogen dioxide,Debridement,3. Closure,2. Clean wound Removal of foreign body Trimming of necrotic tissue,2019/7/12,43,2019/7/12,44,Cheek injuriesPalate injuriesInjuries at other regions,Management of soft tissure injuries,Tongue injuries,Length maint
22、ain, longitudinal closureIndependent closure, but tongue suture dominationBig needle with big, depth suturing or matric suturing,2019/7/12,45,Management of soft tissure injuries,2019/7/12,46,2019/7/12,47,Section 5 Injury of Teeth and Dental Alveolar Process,2019/7/12,48,1. Tooth injuries,1.1 Contusi
23、on of Teeth,Etiology: Extrinsic force blunt tooth injuriesPeriodontal ligaments or dental pulp,Character: Extrusion of toothMobilityPercussion & Toothache when chewingManagementTooth restTooth groundSimple ligation,2019/7/12,49,1. Tooth injuries,1.2 Luxation of Teeth,Classification,CharacterTooth di
24、slocated or exfoliatedManagementTooth protection priorityReductionFixationReimplantation,Partial luxation,Complete luxation,- Tooth dislocation- Semi luxation- Intrusive movement,2019/7/12,50,Gingival or labial swelling, lacerationAdjacent teeth or alveolar process movement when one affected tooth t
25、ouchedFragment dislocation, MalocclusionIn accordance with tooth luxation or fracture,2. Fracture of Alveolar Process,Characters,2019/7/12,51,Extrinsic force to dental alveolar process, mainly to upper jaw,Reduction under LAArch bar applied,2. Fracture of Alveolar Process,Etiology,Management,2019/7/
26、12,52,2. Fracture of Alveolar Process,2019/7/12,53,Stainless steel wire ligation, Arch bars,2019/7/12,54,Questions,Describe the characteristics of OMF Trauma?Describe the etiology, clinical features and management of asphyxia.Describe the ways of hemastasis.What is debridement?Describe the common si
27、te of dental alveolar process fracture, and their clinical manifestation.,2019/7/12,55,Reference,LJ Peterson, et al : Contemporary Oral & Maxillofacial Surgery. 4th ed. Mosby. Missorri. 2003W 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. 2004,2019/7/12,56,THE END,
