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Maxillofacial Trauma and Management

Maxillofacial Trauma and Management

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Published by just man55
short text for management of maxillofacial trauma for dental student
short text for management of maxillofacial trauma for dental student

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Published by: just man55 on Dec 29, 2009
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05/05/2013

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Maxillofacial trauma
 تحص
1
 
Maxillofacial trauma andmanagement 
content:
 
initial assessment
 
anatomical consideration and displacement
 
dentoalveolar fracture
 
diagnosis and radiograph
 
principle of treatment
 
definitive treatment (soft tissue, mandible, dentoalveolar, midface fracture, upperface fracture).
 
Complication of fracture
Initial assessment 
(1)(2)
The commonest causes of fractured jaws are fights, road accidents, falls and sport. frequently in themandible as in the maxilla.Fractures may be direct, following a blow at the point where the break occurs, or may be indirect asa result of a blow on the bone at some distance from where the lesion occurs.They may be single, linear or comminuted compound. In the young, incomplete or greenstickfractures of the mandible can occur.All traumatised patients need to be fully assessed.
 
Initial assessment of trumatised patients .
 
A - Airway maintenance with cervical spine controlB - Breathing and ventilationC -Circulation with haemorrhage controlD - Disability: neurological statusE - Exposure: complete examination of the patient
 Airway and cervical spine 
In unconscious patients respiratory obstruction may be caused by blood clot, or a foreign
body(denture,tooth…..) in the oropharynx or larynx.
 clear of debris to reestablish the airway. To keep the tongue forward, a suture may be passedthrough it, or the patient turned on his side, with control of the cervical spine.
 
 
 
Maxillofacial trauma
 تحص
2
 
Breathing 
Once an airway has been established, then the adequacy of ventilation must be assessed.Artificial ventilation must be commenced immediately when spontaneous ventilation is inadequate.Early diagnosis of these potentially life-threatening conditions is essential so that they can bemanaged and permit adequate ventilation of the patient.
Circulation 
Reduction and fixation will often arrest haemorrhage because movement disturbs the natural arrest.The pulse and blood pressure should be monitored to ensure that the patient does not becomeshocked.
"Q:What are clinical manifestation &management of shocked patient ?" 
In the maxillofacial truama there is no excessive bleeding because there is no large vessels as inthe lower limbs to arrest the bleeding you can either :1. make compression on injured vessels (in the active bleeding).2. reduction &stability (inactive bleeding).N.B
in case of internal haemorrahge refer the patient to hospital & take ultrasound picture.
Disability 
(1) 
Assessment of conscious state is commonly carried out using the Glasgow Coma Scale; whichrecords the patient's motor, verbal and eye movements in response to stimulation.
 
EYE OPENING MOTOR RESPONSE VERBAL RESPNSE1_Spntanous2_To speech3_On pain4_None1_Moves to command2_Moves to pain(localized thepain)3_Withdraws from pain4_Flexion5_Extension6_No movement1_Coherent conversation2_Confuse3_Incoherent4_Incomprehentible5_No response
From the previous table
 
Take the best score from each category to give a total coma score. And
as the score is decreased the problem is increased.
N.B:
In addition to glassgow scale you should make rapid assessment for intercranial tension &examination of vital signs.
 
 
Maxillofacial trauma
 تحص
3
 
There are many signs to detects increasing of Intercranial tension:
(4)
1_Vomiting 
:vomiting is a good sign of increase intercranial tension after head trauma especially ifbrain concussion is present.
2_Pupils 
:at first there is a sluggish reaction to light then it progress to no reaction and this stagecalled (dilated fixed pupils).#the main problem of increase intercranial tension is a compression on cranial nerves.
Exposure and environmental control 
All of the victim's clothing is removed to permit full assessment and exclude other injuries.
Control and Prevention of infection
 
1. clean the wound by running saline.2. Do not cut the tissues spontaneously specially in the face.3. close the wound as soon as possible under local anesthesia if necessary.4. antibiotic course.
Pain
This can be severe particularly with comminuted and grossly displaced fractures, and should beused but not Morphine or its derivatives because they may mask the signs of increasing intracranialPressure as will as its side effect(addiction) so Non-steroidal anti-inflammatory drugs may beprescribed.
 ANATOMICAL BACKGROUND
to facilitate understand the fractureand concept on fracture displacement and factor affect on it:
 
For describing injuries the face is divided into three parts. The lower third is the mandible and thesoft tissues covering it , The middle third , The upper third lies above this.
 
Mandible
(4)
 
Muscles attaches to mandible are :1. posteriorly
lateral ptregoid muscle to condyle
medial ptregoid muscle to medial surface of angle &ramus of mandible
massetar muscle to lateral surface of angle
temporalis muscle to coronoid processThese muscles pull the mandible anteriorly and inward.
HEAD INJURY:
head injury may cause brain concussion and this result ofacceleration & deceleration and this patient should be under close observationhourly through 24 houres.
 

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