BNH N NHA

CHU

Sinh vin: Nguyn Nh V

L Ngc Tng
Hong Th Hi Yn
Nguyn Th Thu

A. HNH CHNH
1.
2.
3.
4.

5.

6.

H tn: L NGC TNG

Tui: 21
Gii: Nam
Ngh nghip: Sinh vin
a ch: S 1 Tn Tht Tng- ng a- H
Ni
a ch lin h: Phng 302 k tc x E2 i
hc Y H Ni - 0975076607
Ngy thm khm: 17/11/2015

B. CHUYN MN
1. L DO VO VIN
Chy mu khi nh rng.

2. BNH S
Cch vo vin 5 thng, bnh nhn thy chy mu thng
xuyn khi nh rng (3-4 ngy/ tun), khng km au rng
hay but rng. Cch 3 tun bnh nhn i ly cao rng ln
u tin, chy mu. 1 tun gn y, bnh nhn li thy
chy mu khi nh rng, c bit l vng rng ca, rng
nanh hm di v rng hm nh hm trn bn phi; km
theo l vng ny ty ; khng au hay but rng, khng
chy mu t nhin. Bnh nhn ti khm ti Trung Tm Nha
khoa 225 Trng Chinh ngy 17/11/2015.
Hin ti: + Chy mu khi nh rng
+ Li vng rng ca, rng nanh hm di v
rng hm nh trn phi ty
t

+ Khng au rng, but rng; khng chy mu

nhin

3. TIN S
a. Bn thn
* Ton thn

Khng ht thuc l.

Khng ung ru

Cha pht hin bnh l ton thn: i tho

ng, bnh tim mch, bnh mu

Thi quen n ung:

+ a s n thc n mm
+ Khng xuyn ung nc c ga
+ Khng n cay
+ Hay n m: n m tm

Stress: khng

D ng: khng

* Rng ming
Thi quen v sinh rng ming
+ Chi rng:
1 ln/ngy: sau khi n sng
3 pht/ ln
Cch thc: chi ngang; chi 3 mt tt c
cc rng (mt ngoi, mt trong, mt nhai)
Bn chi: P/s lng mm; thay bn chi 4
thng/ ln
+ Khng s dng nc sc ming, ch t nha
khoa, tm tre.
+ Khng chi li
+ Khng thm khm nh k

Thi quen xu: nghin rng

Tin s nha khoa:

+ Cha pht hin bnh l rng ming

+ Ly cao rng ln u cch y 3 tun
+ Tng b au c cn khi cn vt cng cch y 3
nm, sau 2 thng t khi.
b. Gia nh
- Cha pht hin g bt thng.

4. KHM BNH
a. Khm ton thn

Tinh thn: tnh to, tip xc tt

Th trng: bnh thng
(W: 52 kg; H: 166 cm; BMI= 18,9 )

Da, nim mc: hng ho

Lng, tc, mng: bnh thng

Tuyn gip: khng to

Hch ngoi vi: khng s thy

Khng ph

Du hiu sinh tn:

+ Mch: 78 nhp/ pht
+ Nhit : 36,8C
+ Huyt p: 120/80 mmHg

b. Khm ngoi ming

Hnh thi khun mt: hnh oval
Cn xng qua cc tng mt; i xng qua
ng gia
Rnh mi m: bnh thng
Da: mu sc da bnh thng, khng c khi
u bt thng
Trng lc c cn 2 bn: bnh thng
Hch sau tai, hch mang tai, hch di hm,
hch dc c c n chm, hch thng n:
khng s thy
Tuyn mang tai: khng sng, n khng au

Khun mt hnh oval

Khm hch di hm

Khm khp thi dng - hm

Khp TD- hm chuyn ng trn
tru, chuyn ng hai bn u
nhau
V tr tnh: Li cu nm trong
khp, n khng au, khng
sng
V tr ng (h-ngm ming;
a hm sang hai bn; a hm
ra trc):
+ C ting lc cc li cu bn
tri; n khng au, khng sng.
+ a hm sang bn bnh
thng.
+ a hm ra trc lch v bn
phi.

ng h ming: cong lch sang tri

Khm c: Khng cng cng

Khm c c n chm

c. Khm trong ming

c.1. Khm m mm
ng ci: l thn rng ca hm trn v
mt phn nh li -> ng ci trung bnh.

H ming ti a: bng 3
khot ngn tay bnh
nhn
Nim mc m, mi:
hng ho, khng c tn
thng vim, lot.
Li:
+ Hnh dng, kch thc,
chuyn ng bnh
thng
+ Nim mc li hng
ho, khng c vt lot,
khng c khi u bt
thng
+ su ngch tin
nh: 2cm

cc ng tuyn nc bt (Stenon,
Wharton) v tr bnh thng; nim mc
ng tuyn khng sng n, chy dch bnh
thng (dch trong)

Phanh mi, phanh li

+ Phanh mi trn: bm phn li dnh;
Phanh mi di: bm ranh gii li- nim mc
ming
+ Phanh li: bm ranh gii li- nim mc ming

c.2. Khm rng

- S lng rng: 28
- Hnh thi cung rng:
+ Hnh ch U
- Khp cn:
+ Tng quan 2 hm
bn phi: Angle 1
+ Tng quan 2 hm
bn tri: Angle 1

Cung rng hnh ch

U

+ cn cha: 0.5 mm
+ cn chm: 1 mm
-

+
+
+
+

Tn thng c:
Mn tt c cc rng, c bit vng rng ca
Khng c rng lung lay, rng su, gy v rng, mn c rng
Khng c rng iu tr
Khm sang chn khp cn (nghim php Fremitus): m tnh

+ Kim tra im chm qu mc, im cn tr sang bn:

R2.6, 2.7 c im chm qu mc

+ Kim tra im cn tr sang bn:

KHM M NHA CHU

CC VNG LC PHN

TTCT
I

II

III

IV

VI

Mu sc Hng m Hng nht Hng nht Hng m Hng m Hng nht

nh gi
li/vim
li

Kch
thc

R1.4, sng
nh

Bnh
thng

Bnh
thng

Bnh
thng

Sng nh

Bnh
thng

Trng
lc

Gim

Bnh
thng

Bnh
thng

Bnh
thng

Gim

Bnh
thng

Chy
mu khi
khm

R1.4

Khng

Khng

Khng

Khng

Khng

vim

1mm

1mm

1mm

1mm

1mm

Cn bm
tt li
Chiu
su
rnh/ti
li

Khm
mt bm
dnh
Lung lay
rng

2mm

Cha pht hin c bit

Mt rng

Khng

Mt bm
dnh

Khng

VNG 1

VNG 2

VNG 3

VNG 4

VNG 5

VNG 6

5. TM TT BNH N
Bnh nhn nam, 21 tui, vo vin vi l do chy mu khi nh
rng. Qua hi bnh v thm khm pht hin cc triu chng v hi
chng sau:
Hi

th hi

nha chu

Vng I: li chuyn mu hng m, sng nh; gim sn chc,

chy mu R1.4 khi thm khm, cn bm 1, cao rng 0,
khng mt bm dnh.

Vng V: nh li chuyn hng m, sng nh; gim sn chc

nhng khng chy mu khi thm khm; cn bm 1, cao rng
0, khng mt bm dnh.

Cc vng cn li cn bm 1; khng mt bm dnh

M

cng

+ Mn ra cn v mt nhai tt c cc rng
Khp thi dng hm: ting lc cc khi h ming, a hm ra
trc lch v bn phi
=> CHN ON S B: Vim li mn tnh khu tr mc nh
do cao rng, mng bm/ lon nng khp thi dng hm mc 2

6. CN LM SNG
Phim

PANORAMA

Khng c hnh nh tiu xng rng.

Theo di rng mc rng 1.8, 2.8, 3.8, 4.8

7. CHN ON XC NH
Vim li mn tnh khu tr mc nh do
cao rng, mng bm/ lon nng khp thi
dng hm mc 2
7. CHN ON PHN BIT
Vim li cp
Vim quanh rng
Vim li do thiu Vitamin C

8. TIN LNG: Tt
9. K HOCH IU TR
* Nha chu
- Kim sot cao rng, mng bm, lm nhn b mt
thn chn rng.
- Hng dn li bnh nhn v sinh rng ming.
- n thuc iu tr, hn khm li nh k.
- Theo di mc rng 1.8, 2.8, 3.8, 4.8
* Khp thi dng hm:
- Mi chnh im chm qu mc.
- Xem xt s dng mng nhai iu chnh khp
cn

Thank teacher for your

attention!