1、口腔頜面部損傷,Dr. Steve GF Shen Oral and Maxillofacial Surgery School of Stomatology Shanghai Ninth Peoples Hospital Shanghai Second Medical University,Oral & Maxillofacial Trauma,Chapter 7,2020/8/22,2,Vocabulary,2020/8/22,3,Vocabulary,2020/8/22,4,Vocabulary,2020/8/22,5,Vocabulary,2020/8/22,6,Vocabulary,2

2、020/8/22,7,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 accid

3、ent,(from Cambridge Advanced Learners Dictionary),2020/8/22,8,Section 1 Introduction,War,Incidence,Traffic Accident,Sports,Falling,Bustup,Labor injury,2020/8/22,9,Financial Loss,致傷人數(shù),No of traffic accident,Traffic Accident,2020/8/22,10,Traffic Accident,2020/8/22,11,Combined injury to other viscera -

4、Fatal to life Damage to maxillofacial structure Stomatognathic dysfunction Facial esthetic problem Psychological trauma,Effect of Trauma on the Human Body,2020/8/22,12,1. Rich blood supply,Section 2 Characteristics of OMF Trauma,2020/8/22,13,Debridement Time: 24 48 h,Tend to hematoma, edema,Respirat

5、ory tract,Asphyxia,Ability to anti-infection, regeneration,Wound healing,1. Rich blood supply,2020/8/22,14,Cerebral concussion Cerebral contusion Intracranial hematoma Skull base fracture,Increase infectious incidence Malocclusion caused - Diagnosis Occlusion regained - Treatment,2. Relationship btw

6、 tooth & OMF trauma,3. Cranio-cerebral trauma,2020/8/22,15,Mouth opening, mastication, swallowing,4. Cervical trauma,5. Effect on breathing,6. Effect of on digastric system,Bleeding Paralysis癱瘓,Leading difficulty breathing,diet,worse oral hygiene,Asphyxia 窒息,2020/8/22,16,7. Multi-sinus - contaminati

7、on,Infection,Oral cavity Nasal cavity Pharyngeal cavity Orbit Paranasal sinus,Bacteria Temp Humidity,2020/8/22,17,8. Damage to specific structure,Parotid Gland Facial N. Trigeminal N.,Salivary fistula Facial paralysis Regional numbness,2020/8/22,18,9. Facial Defect,Facial contour Psychological traum

8、a,2020/8/22,19,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,2020/8/22,20,1. Prevention of Asphyxia,Section 3 Rescue,2020/8/22,21,Dysphoria, sweating, inhaling resp

9、iration 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,2020/8/22,22,1.2 Etiology of Asphyxia,Foreign body obstruction,Inspiratory Asphy

10、xia,Low Airway,Swelling Foreign body Blood, saliva Vomit,Upper airway,Tissue dislocation,Obstructive Asphyxia,2020/8/22,23,1.3 Rescue of Asphyxia,Clear foreign body in upper airway Suspend maxilla Intubation Hold the tongue out,Obstructive Asphyxia,2020/8/22,24,2. Hemostasia,Two steps：,Judge bleedin

11、g situation Choose the way to stop bleeding,Section 3 Rescue,2020/8/22,25,2.1 Judge bleeding situation,Three categories,Arterial Capillary Venous,Based on origin,2020/8/22,26,壓迫止血,指壓止血法,包扎止血法,填塞止血法,結(jié)扎止血法,藥物止血法,2.2 Methods of hemostat,2020/8/22,27,3. Anti-shock treatment,(2) Purpose of anti-shock,(1)

12、 Definition & Classification,Traumatic shock Exsanguine shock 20% Body weight Toxic shock Infectious shock,Restore circulation,2020/8/22,28,(4) Principles of Treatment,(3) Features of Shock,Early stage: Dysphoria, quick & superficial breath, sweating, paleness Middle stage: Tingle to supression, emo

13、tional faint, unconsciousness, decrease BP, labial paleness Late stage: weaker pulsation, unmeasurable BP, hyponuria, anuria 30ml/h,Hemostasis, blood transfusion, pain control, fluid transfusion, sedation,2020/8/22,29,(1) Judgement,4. Combined Craniocerebral Injuries,Consciousness, pulse, BP, respir

14、ation, pupil,(2) Early discovery, early management,Retrograde obliviscenceCerebral concussion Intermediate wake-upExtradural hematoma Cerebral fluid leakSkull base fracture,2020/8/22,30,2020/8/22,31,Debridement Wound closure Antibiotics,5. Prevention of Infection,6. Bandage & Transportation,2020/8/2

15、2,32,Section 4 Soft Tissue Trauma,2020/8/22,33,Abrasions 擦傷 Contusions挫傷 Contusions & Lacerations挫裂傷 Incised & Puncture Wound切割傷及刺傷 Bite Wound 咬傷,Types of injuries,Section 4 Soft Tissue Trauma,2020/8/22,34,Character: Irregular wound edge, foreign body, pain, oozing & yellowish plasma oozing Manageme

16、nt: Debridement, remove foreign body, Dry wound, drain when infected,1. Abrasions,Property: rough surface,Epidermis & superficial dermis,2020/8/22,35,1. Abrasions,2020/8/22,36,2. Contusions,Charater: petechia, swelling, pain Management: Hemostasis Pain-killer Prevention of infection Hematoma resorpt

17、ion Re-establishment of function,Property: blunt material & fell to hard object,Subdermal tissue (no open wound),2020/8/22,37,Property: Blunt object with high mechanical force,3. Contusions & Lacerations,Character Irregular wound edge, saw-toothed Big laceration w/wo necrotic tissue & open fractures

18、 Management Debridement Wound Closure,Soft tissue,2020/8/22,38,3. Contusions & Lacerations,2020/8/22,39,Property: Sharp object or instruments,4. Incised & Puncture Wound,Charater Regular wound edge Bleeding Small access, but deep wound Management Debridement Wound closure,Soft tissue,2020/8/22,40,Pr

19、operty: 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,2020/8/22,41,Definition,Debridement,Main Entry: de

20、bridement Pronunciation: di-brEd-m&nt, dA-, -mnt, dA-brEd-mnFunction: nounEtymology: 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 lacer

21、ated, devitalized, or contaminated tissue,2020/8/22,42,Protocol,1. wash wound Time：6-12h Solution: soap water, saline, hydrogen dioxide,Debridement,3. Closure,2. Clean wound Removal of foreign body Trimming of necrotic tissue,2020/8/22,43,2020/8/22,44,Cheek injuries Palate injuries Injuries at other

22、 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,2020/8/22,45,Management of soft tissure injuries,2020/8/22,46,2020/8/22,47,Section 5 Injury of T

23、eeth and Dental Alveolar Process,2020/8/22,48,1. 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,2020

24、/8/22,49,1. 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 - Intrusive movement,2020/8/22,50,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,Cha