口腔颌面部损伤.ppt

口腔颌面部损伤,Dr.SteveGFShenOralandMaxillofacialSurgerySchoolofStomatologyShanghaiNinthPeoplesHospitalShanghaiSecondMedicalUniversity,Oral&MaxillofacialTrauma,Chapter7,2019/12/8,2,Vocabulary,2019/12/8,3,Vocabulary,2019/12/8,4,Vocabulary,2019/12/8,5,Vocabulary,2019/12/8,6,Vocabulary,2019/12/8,7,Definitionoftrauma,traumanounCorUsevereemotionalshockandpaincausedbyanextremelyupsettingexperience:thetraumaofmarriagebreakdownHehadpsychotherapytohelphimdealwithhischildhoodtraumas.SPECIALIZEDasevereinjury,usuallycausedbyaviolentattackoranaccident,(fromCambridgeAdvancedLearnersDictionary),2019/12/8,8,Section1Introduction,War,Incidence,TrafficAccident,Sports,Falling,Bustup,Laborinjury,2019/12/8,9,FinancialLoss,致伤人数,Nooftrafficaccident,TrafficAccident,2019/12/8,10,TrafficAccident,2019/12/8,11,Combinedinjurytootherviscera-FataltolifeDamagetomaxillofacialstructureStomatognathicdysfunctionFacialestheticproblemPsychologicaltrauma,EffectofTraumaontheHumanBody,2019/12/8,12,1.Richbloodsupply,Section2CharacteristicsofOMFTrauma,2019/12/8,13,DebridementTime:2448h,Tendtohematoma,edema,Respiratorytract,Asphyxia,Abilitytoanti-infection,regeneration,Woundhealing,1.Richbloodsupply,2019/12/8,14,CerebralconcussionCerebralcontusionIntracranialhematomaSkullbasefracture,IncreaseinfectiousincidenceMalocclusioncaused-DiagnosisOcclusionregained-Treatment,2.Relationshipbtwtooth&OMFtrauma,3.Cranio-cerebraltrauma,2019/12/8,15,Mouthopening,mastication,swallowing,4.Cervicaltrauma,5.Effectonbreathing,6.Effectofondigastricsystem,BleedingParalysis瘫痪,Leadingdifficultybreathing,diet,worseoralhygiene,Asphyxia窒息,2019/12/8,16,7.Multi-sinus-contamination,Infection,OralcavityNasalcavityPharyngealcavityOrbitParanasalsinus,BacteriaTempHumidity,2019/12/8,17,8.Damagetospecificstructure,ParotidGlandFacialN.TrigeminalN.,SalivaryfistulaFacialparalysisRegionalnumbness,2019/12/8,18,9.FacialDefect,FacialcontourPsychologicaltrauma,2019/12/8,19,EvaluatetraumasoonIdentifythekeytrauma,managethefatalfirstCarefulhistorytaking,thoroughphysicalexamRescueintimeManagementinorder,GeneralRules,Section3Rescue,2019/12/8,20,1.PreventionofAsphyxia,Section3Rescue,2019/12/8,21,Dysphoria,sweating,inhalingrespirationDifficulttoinhale,hypopnea,nasalalarmovement,labialcyanosisThreeconcavesigns、Rapidbreathing,weakpulse,decreasedBPPupilsdiluted,Noreflectiontolight,1.1Clinicalfeaturesofasphyxia,Prodrome,2019/12/8,22,1.2EtiologyofAsphyxia,Foreignbodyobstruction,InspiratoryAsphyxia,LowAirway,SwellingForeignbodyBlood,salivaVomit,Upperairway,Tissuedislocation,ObstructiveAsphyxia,2019/12/8,23,1.3RescueofAsphyxia,ClearforeignbodyinupperairwaySuspendmaxillaIntubationHoldthetongueout,ObstructiveAsphyxia,2019/12/8,24,2.Hemostasia,Twosteps：,JudgebleedingsituationChoosethewaytostopbleeding,Section3Rescue,2019/12/8,25,2.1Judgebleedingsituation,Threecategories,ArterialCapillaryVenous,Basedonorigin,2019/12/8,26,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,2.2Methodsofhemostat,2019/12/8,27,3.Anti-shocktreatment,(2)Purposeofanti-shock,(1)Definition&Classification,TraumaticshockExsanguineshock20%BodyweightToxicshockInfectiousshock,Restorecirculation,2019/12/8,28,(4)PrinciplesofTreatment,(3)FeaturesofShock,Earlystage:Dysphoria,quick&superficialbreath,sweating,palenessMiddlestage:Tingletosupression,emotionalfaint,unconsciousness,decreaseBP,labialpalenessLatestage:weakerpulsation,unmeasurableBP,hyponuria,anuria30ml/h,Hemostasis,bloodtransfusion,paincontrol,fluidtransfusion,sedation,2019/12/8,29,(1)Judgement,4.CombinedCraniocerebralInjuries,Consciousness,pulse,BP,respiration,pupil,(2)Earlydiscovery,earlymanagement,RetrogradeobliviscenceCerebralconcussionIntermediatewake-upExtraduralhematomaCerebralfluidleakSkullbasefracture,2019/12/8,30,2019/12/8,31,DebridementWoundclosureAntibiotics,5.PreventionofInfection,6.Bandage&Transportation,2019/12/8,32,Section4SoftTissueTrauma,2019/12/8,33,Abrasions擦伤Contusions挫伤Contusions&Lacerations挫裂伤Incised&PunctureWound切割伤及刺伤BiteWound咬伤,Typesofinjuries,Section4SoftTissueTrauma,2019/12/8,34,Character:Irregularwoundedge,foreignbody,pain,oozing&yellowishplasmaoozingManagement:Debridement,removeforeignbody,Drywound,drainwheninfected,1.Abrasions,Property:roughsurface,Epidermis&superficialdermis,2019/12/8,35,1.Abrasions,2019/12/8,36,2.Contusions,Charater:petechia,swelling,painManagement:HemostasisPain-killerPreventionofinfectionHematomaresorptionRe-establishmentoffunction,Property:bluntmaterial&felltohardobject,Subdermaltissue(noopenwound),2019/12/8,37,Property:Bluntobjectwithhighmechanicalforce,3.Contusions&Lacerations,CharacterIrregularwoundedge,saw-toothedBiglacerationw/wonecrotictissue&openfracturesManagementDebridementWoundClosure,Softtissue,2019/12/8,38,3.Contusions&Lacerations,2019/12/8,39,Property:Sharpobjectorinstruments,4.Incised&PunctureWound,CharaterRegularwoundedgeBleedingSmallaccess,butdeepwoundManagementDebridementWoundclosure,Softtissue,2019/12/8,40,Property:Animal(Wolf,dog,Bear)orhumanbeingsCharacterToothtracedHeavycontaminationTendtoinfectionManagementThoroughdebridementInfectioncontrolSkingraftaftergranulartissueregeneratedVaccinationofTetanus,Rabies,5.BiteWound,2019/12/8,41,Definition,Debridement,MainEntry:debridementPronunciation:di-brEd-m&nt,dA-,-mnt,dA-brEd-mnFunction:nounEtymology:Frenchdbridement,fromdbridertoremoveadhesions,literally,tounbridle,fromMiddleFrenchdesbrider,fromdes-de-+bridebridle,fromMiddleHighGermanbrIdel-moreatBRIDLE:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue,2019/12/8,42,Protocol,1.washwoundTime：6-12hSolution:soapwater,saline,hydrogendioxide,Debridement,3.Closure,2.CleanwoundRemovalofforeignbodyTrimmingofnecrotictissue,2019/12/8,43,2019/12/8,44,CheekinjuriesPalateinjuriesInjuriesatotherregions,Managementofsofttissureinjuries,Tongueinjuries,Lengthmaintain,longitudinalclosureIndependentclosure,buttonguesuturedominationBigneedlewithbig,depthsuturingormatricsuturing,2019/12/8,45,Managementofsofttissureinjuries,2019/12/8,46,2019/12/8,47,Section5InjuryofTeethandDentalAlveolarProcess,2019/12/8,48,1.Toothinjuries,1.1ContusionofTeeth,Etiology:ExtrinsicforceblunttoothinjuriesPeriodontalligamentsordentalpulp,Character:ExtrusionoftoothMobilityPercussion&ToothachewhenchewingManagementToothrestToothgroundSimpleligation,2019/12/8,49,1.Toothinjuries,1.2LuxationofTeeth,Classification,CharacterToothdislocatedorexfoliatedManagementToothprotectionpriorityReductionFixationReimplantation,Partialluxation,Completeluxation,-Toothdislocation-Semiluxation-Intrusivemovement,2019/12/8,50,Gingivalorlabialswelling,lacerationAdjacentteethoralveolarprocessmovementwhenoneaffectedtoothtouchedFragmentdislocation,MalocclusionInaccordancewithtoothluxationorfracture,2.FractureofAlveolarP