Dr. Steve GF Shen

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Chapter 7
Oral Maxillofacial Trauma

• Dr. Steve GF Shen
• Oral and Maxillofacial Surgery
• School of Stomatology
• Shanghai Ninth Peoples Hospital
• Shanghai Second Medical University

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Vocabulary
abrasion ??
adjacent tooth ??
alar ???
antibiotics ???
anti-infection ???
anuria ??
arch bar ????
arterial ???
asphyxia ??
bandage ??
bite wound ??
blood supply ??
bustup ??
capillary ?????
cerebral ??
cerebral fluid ???
cervical ??
concussion ??
contaminate ??
contusion ??
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Vocabulary
cyanosis ??
debridement ???
alveolar process ???
dental pulp ??
devitalize ??
dysfunction ????
dysphoria ????
edema ??
esthetic ???
exfoliate ??
exsanguine ???
extradural ?????
extrinsic force ??
extrusion ???
facial nerve ???
foreign body ??
fracture ??
gingival ???
hematoma ??
hemostasia ??,???
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Vocabulary
hemostat ???
hyponuria ??
hypopnea ???
incised wound ???
inhale ??
inspiratory asphyxia ?????
intracranial ???
intubation ??
lacerate ??
laceration ??
ligation ??
luxation ??
malocclusion ????
mandible ???
mastication ??
maxilla ???
maxillofacial ???
mouth opening ???
nasal cavity ??
obliviscence ??
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Vocabulary
obstructive asphyxia ?????
occlusion ??
oral cavity ??
oral hygiene ????
orbit ??
pain-killer ???
paralysis ??
paranasal sinus ???
parotid gland ??
percussion ??
periodontal ligament ????
petechia ??,??
pharyngeal cavity ??
plasma ??
psychological ???
psychotherapy ????
rabies ???
regenerate ??
reimplantation ??
rescue ??,??
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Vocabulary
respiratory ???
saliva ??,??
salivary ???
shock ??
skull base ??
stomatognathic ???
subdermal ???
swallow ??
sweat ??
tetanus ???
toothache ??
toxic shock ?????
transportation ??,??
trauma ??,??
trigeminal nerve ????
unconsciousness ????
upper airway ????
vaccination ????
venous ???
viscera ??
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Definition of trauma

• trauma  noun C or U
• severe emotional shock and pain caused by an
  extremely upsetting experiencethe 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

(from Cambridge Advanced Learner's Dictionary)
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Section 1 Introduction
Incidence
Labor injury
War
Traffic Accident
Bustup
Falling
Sports
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Traffic Accident
Financial Loss
????
No of traffic accident
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Traffic Accident
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Effect of Trauma on the Human Body

• Combined injury to other viscera -Fatal to life
• Damage to maxillofacial structure
• Stomatognathic dysfunction
• Facial esthetic problem
• Psychological trauma

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Section 2 Characteristics of OMF Trauma

• 1. Rich blood supply

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1. Rich blood supply

• Tend to
• hematoma, edema

Respiratory tract
Asphyxia

• Ability to anti-infection, regeneration

Wound healing

• Debridement Time 24 48 h

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2. Relationship btw tooth OMF trauma

• Increase infectious incidence
• Malocclusion caused - Diagnosis
• Occlusion regained - Treatment

3. Cranio-cerebral trauma

• Cerebral concussion
• Cerebral contusion
• Intracranial hematoma
• Skull base fracture

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4. Cervical trauma

• Bleeding
• Paralysis ??

5. Effect on breathing
Asphyxia ??

• Leading difficulty breathing

6. Effect of on digastric system

• Mouth opening, mastication, swallowing

diet
worse oral hygiene
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7. Multi-sinus - contamination

• Oral cavity
• Nasal cavity
• Pharyngeal cavity
• Orbit
• Paranasal sinus

Bacteria Temp Humidity
Infection
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8. Damage to specific structure
Salivary fistula Facial paralysis Regional
numbness

• Parotid Gland
• Facial N.
• Trigeminal N.

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9. Facial Defect

• Facial contour
• Psychological trauma

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Section 3 Rescue
General Rules

• Evaluate trauma soon
• Identify the key trauma, manage the fatal first
• Careful history taking, thorough physical exam
• Rescue in time
• Management in order

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Section 3 Rescue

• 1. Prevention of Asphyxia

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1.1 Clinical features of asphyxia
Prodrome
Dysphoria, sweating, inhaling respiration Difficul
t to inhale, hypopnea, nasal alar movement,
labial cyanosis Three concave signs?Rapid
breathing, weak pulse, decreased BP Pupils
diluted, No reflection to light
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1.2 Etiology of Asphyxia
Foreign body obstruction
Upper airway
Tissue dislocation

• Obstructive Asphyxia

Swelling Foreign body Blood, saliva Vomit

• Inspiratory Asphyxia

Low Airway
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1.3 Rescue of Asphyxia
Clear foreign body in upper airway Suspend
maxilla Intubation Hold the tongue out

• Obstructive Asphyxia

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Section 3 Rescue
2. Hemostasia
Two steps

• Judge bleeding situation
• Choose the way to stop bleeding

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2.1 Judge bleeding situation
Based on origin
Three categories

• Arterial
• Capillary
• Venous

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2.2 Methods of hemostat

• ????

• ?????

• ?????

• ?????

• ?????

• ?????

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3. Anti-shock treatment
(1) Definition Classification

• Traumatic shock
• Exsanguine shock gt20 Body weight
• Toxic shock
• Infectious shock

(2) Purpose of anti-shock

• Restore circulation

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(3) Features of Shock

• Early stage Dysphoria, quick superficial
  breath, sweating, paleness
• Middle stage Tingle to supression, emotional
  faint, unconsciousness, decrease BP, labial
  paleness
• Late stage weaker pulsation, unmeasurable BP,
  hyponuria, anuria lt30ml/h

(4) Principles of Treatment

• Hemostasis, blood transfusion, pain control,
  fluid transfusion, sedation

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4. Combined Craniocerebral Injuries
(1) Judgement

• Consciousness, pulse, BP, respiration, pupil

(2) Early discovery, early management

• Retrograde obliviscence Cerebral concussion
• Intermediate wake-up Extradural hematoma
• Cerebral fluid leak Skull base fracture

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5. Prevention of Infection

• Debridement
• Wound closure
• Antibiotics

6. Bandage Transportation
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Section 4 Soft Tissue Trauma
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Section 4 Soft Tissue Trauma
Types of injuries

• Abrasions ??
• Contusions ??
• Contusions Lacerations ???
• Incised Puncture Wound ??????
• Bite Wound ??

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1. Abrasions

• Property rough surface

Epidermis superficial dermis

• Character Irregular wound edge, foreign body,
  pain, oozing yellowish plasma oozing
• Management Debridement, remove foreign body, Dry
  wound, drain when infected

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1. Abrasions
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2. Contusions

• Property blunt material fell to hard object

Subdermal tissue (no open wound)

• Charater petechia, swelling, pain
• Management
• Hemostasis
• Pain-killer
• Prevention of infection
• Hematoma resorption
• Re-establishment of function

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3. Contusions Lacerations

• Property Blunt object with high mechanical force

Soft tissue

• Character
• Irregular wound edge, saw-toothed
• Big laceration
• w/wo necrotic tissue open fractures
• Management
• Debridement
• Wound Closure

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3. Contusions Lacerations
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4. Incised Puncture Wound

• Property Sharp object or instruments

Soft tissue

• Charater
• Regular wound edge
• Bleeding
• Small access, but deep wound
• Management
• Debridement
• Wound closure

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5. Bite Wound

• Property 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

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Debridement

• Definition

Main Entry debridement Pronunciation
di-'brEd-mnt, dA-, -"mänt, dA-brEd-'mänFunction
nounEtymology French débridement, from
débrider 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
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Debridement

• Protocol

1. wash wound Time6--12h
Solution soap water, saline, hydrogen dioxide
2. Clean wound Removal of foreign
body Trimming of necrotic tissue
3. Closure
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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

• Cheek injuries
• Palate injuries
• Injuries at other regions

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Management of soft tissure injuries
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Section 5 Injury of Teeth and Dental Alveolar
Process
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1. Tooth injuries
1.1 Contusion of Teeth

• Etiology
• Extrinsic force blunt tooth injuries
  Periodontal ligaments or dental pulp

• Character
• Extrusion of tooth
• Mobility
• Percussion Toothache when chewing
• Management
• Tooth rest
• Tooth ground
• Simple ligation

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1. Tooth injuries
1.2 Luxation of Teeth

• Classification

- Tooth dislocation - Semi luxation - Intrusive
movement

• Partial luxation

• Complete luxation

• Character
• Tooth dislocated or exfoliated
• Management
• Tooth protection priority
• Reduction
• Fixation
• Reimplantation

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2. Fracture of Alveolar Process

• Characters

• 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

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2. Fracture of Alveolar Process

• Etiology

• Extrinsic force to dental alveolar process,
  mainly to upper jaw

• Management

• Reduction under LA
• Arch bar applied

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2. Fracture of Alveolar Process
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Stainless steel wire ligation, Arch bars
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Questions

1. Describe the characteristics of OMF Trauma?
2. Describe the etiology, clinical features and
   management of asphyxia.
3. Describe the ways of hemastasis.
4. What is debridement?
5. Describe the common site of dental alveolar
   process fracture, and their clinical
   manifestation.

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Reference

1. LJ Peterson, et al Contemporary Oral
   Maxillofacial Surgery. 4th ed. Mosby. Missorri.
   2003
2. W Booth, et al Maxillofacial Surgery. Vol 1, 2.
   1st ed. Churchill Livingstone. London. 1999
3. ?????.???????. ?5?. ???????. 2004

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THE END