口腔颌面外科学：口腔颌面部创伤

1、口腔颌面外科学Oral and Maxillofacial surgery急诊科配备必要设备 Oral and Maxillofacial Truma口腔颌面部创伤 ConspectusFirst Aid of Maxillofacial TraumaSoft Tissue InjuresTeeth and alveolar injuriescontents ConspectusFirst Aid of Maxillofacial TraumaSoft Tissue InjuresTeeth and alveolar injuriescontents2013-10-21Barcelonakey

2、note speechesspecial topictrue state in China 2013.12 北京 首都医科大学2015.8 西安 第四军医大学2016.6 西安 第四军医大学承办 Rate 10%20% M/W 3:1 Years-old 20-40 (63.5%) Road traffic accident injury (RTAI) 1.1 Epidemiolgic tendency of oral and maxillofacial truma 1 Classification of injury nature open injury/closed injury soft

3、 tissue injury/hard tissues injury(24-47%) multi-site injury/multiple injury/compound injury 2 Classification of injury cause mechanical / chemical / biological / iatrogenic 3 Classification of injury severity1.2 Classification of oral and maxillofacial truma Abundant Blood Supply (Hematoma/healing)

4、Dental injuryCraniocerebral injuryCervical region injuryAsphyxia Facial deformityImpact on respiration and swallow InfectionOther salivary gland facial nerve1.3 Features of oral and maxillofacial truma Abundant Blood Supply (Hematoma/healing)Dental injuryCraniocerebral injuryCervical region injuryAs

5、phyxia Facial deformityImpact on respiration and swallow InfectionOther salivary gland facial nerve1.3 Features of oral and maxillofacial truma颌面部血管网 Abundant Blood Supply (Hematoma/healing)Dental injuryCraniocerebral injuryCervical region injuryAsphyxia Facial deformityImpact on respiration and swa

6、llow InfectionOther salivary gland facial nerve1.3 Features of oral and maxillofacial truma牙外伤固定 Abundant Blood Supply (Hematoma/healing)Dental injuryCraniocerebral injuryCervical region injuryAsphyxia Facial deformityImpact on respiration and swallow InfectionOther salivary gland facial nerve1.3 Fe

7、atures of oral and maxillofacial truma Abundant Blood Supply (Hematoma/healing)Dental injuryCraniocerebral injuryCervical region injuryAsphyxia Facial deformityImpact on respiration and swallow InfectionOther salivary gland facial nerve1.3 Features of oral and maxillofacial truma Abundant Blood Supp

8、ly (Hematoma/healing)Dental injuryCraniocerebral injuryCervical region injuryAsphyxia Facial deformityImpact on respiration and swallow InfectionOther salivary gland facial nerve1.3 Features of oral and maxillofacial truma Parotid Gland & Facial Nerve Abundant Blood Supply (Hematoma/healing)Dental i

9、njuryCraniocerebral injuryCervical region injuryAsphyxia Facial deformityImpact on respiration and swallow InfectionOther salivary gland facial nerve1.3 Features of oral and maxillofacial truma Craniocerebral injuryAsphyxiaHaemorrhageChest and abdomen injury1.4 serious complications of oral and maxi

10、llofacial truma prevention of asphyxia hemostasia management of craniocerebral injury anti-sho ck anti-infection evaluation Of Maxillofacial Traumae enswathement & Transfer 2 Emergency management of oral and maxillofacial truma Obstructive AsphyxiaForeign material : blood / vomit / bone fragment Tis

11、sue Displacement : Maxilla / Mandible chin fractureSwelling : Haematoma / EdemaInspiratory Asphyxia Directly Inspirated into Trachea / Lung alveolus2.1 Prevention of Asphyxia Respiratory DistressRestlessness, apprehension, anxietyTachypnea, tachycardia, pallorCyanosisDeclining peripheral oxygen satu

12、rationHypotension,weak pulseStridor, intercostal retraction, ”crowing” soundSign or Symptoms of Asphyxia Ventilate Maneuver : Jaw thrust Chin / Tongue lift Clearing the airway Orotracheal / Nasotracheal intubation Surgical airwayEmergency management of Asphyxia Orotracheal / Nasotracheal Intubation

13、Surgical Airway: cricothyroidotomy Surgical Airway: cricothyroidotomy Surgical Airway: cricothyroidotomy Surgical Airway: cricothyroidotomy Surgical Airway: Tracheostomy Surgical Airway: Tracheostomy Surgical Airway: TracheostomyECOM 叶克膜介绍 PressureLigationHemostatic Drug2.2 HemostasiaHemostasia-Pres

14、sureSuperficial Temporal a.v.Facial a.v.External Carotid a. Hemostasia- Pressure Ligation of external carotide artery Ligation of external carotide artery 2.3 EMERGENCY CONTROL OF Hemorrhagic Shock Be aware of and Recognize the presence of shock Identify the source of bleedingSimple measures to mana

15、ge bleeding of external woundsAvoid exploration of deeper bleeding siteAppropriate fluid resuscitationOperating room 2.4 First Aid of Craniocerebral injury1 Rate 17.5% 38%2 Vital sign: Consciousness/Pulse/Respiration/BP/Pupil3 CSF Rhinorrhea/Leak Cerebral Concussion Cerebral Contusion Epidural Haema

16、tom4 Emergency management: Management of Airway Sedation Decompression of intracranial pressure CT Scan & Consulting 2.5 Anti-InfectionEarly Debridement & SutureAntibioticsTetanus Prophylaxis TAT 1500 H AST( ) ! 2.6 Evaluation Of Maxillofacial TraumaAbbreviated Injury Scale AIS Injury Severity Score

17、 ISS Revised Injury Severity Score RISS2.7 Enswathement & TransferEnswathement:HemostasiaTemporarily fracture-fixingProtect woundsTransferkeep close watch on vital signAirway unblockedProper PositionSustain Stability 3 Soft Tissue Injures Abrasion wound:DebridementAnti-infection 3 Soft Tissue Injure

18、s Contused wound:HaemostasiaPain-relievingAnti-infectionHaematoma-curing 3 Soft Tissue Injures Punctured & Incised wound:Debridement & SutureFacial Nerve & Parotid DuctAnti-infection 3 Soft Tissue Injures Bite wound :Debridement & SutureTissue RepairPain-relievingHaemostasiaAnti-infection anti-hydro

19、phobia 3 Soft Tissue Injures Classification of wound contamination:I Clean II Contaminated III Infected Treatment: debridement 1 Preparationvessels Ligation of obvious bleedingLocal & Regional anesthesiaCleansingSterilizationSutureExcision minimal as possibleImmediate closure early as possible Lingu

20、al injury Maintain the length of tongue Maintain the function of tongue Wide suture distance & thick needle/line Buccal injury Suture by layerIdentify important structureClosure the wound surface Palatal injury Prevent communicationDirect closurePalatal flapProsthesis Parotid Gland & Facial Nerve Pa

21、rotid Gland & Facial Nerve KEY:Parotid capsule Parotid duct Facial nerveSialocele Parotid FistulaFacial paralysis Lingual injury Maintain the length of tongue Maintain the function of tongue Wide suture distance & thick needle/line management of parotid gland injuryTightly Suture of Parotid capsuleDuct probing & AnastomosisAntisialagogue medication Atropine Pressure bandageBland dietDuct ligationSuperficial parotidectom