口腔颌面部损伤.ppt

口腔颌面部损伤口腔颌面部损伤口腔颌面部损伤口腔颌面部损伤Dr. Dr. Steve GF Steve GF ShenShenOral and Maxillofacial Oral and Maxillofacial SurgerySurgerySchool of StomatologySchool of StomatologyShanghai Ninth People’s HospitalShanghai Ninth People’s HospitalShanghai Second Medical UniversityShanghai Second Medical UniversityOral & Maxillofacial TraumaOral & Maxillofacial TraumaChapter 7Chapter 7VocabularyVocabularyabrasionabrasion擦伤擦伤擦伤擦伤adjacent toothadjacent tooth邻牙邻牙邻牙邻牙alaralar鼻翼的鼻翼的鼻翼的鼻翼的antibioticsantibiotics抗生素抗生素抗生素抗生素anti-infectionanti-infection抗感染抗感染抗感染抗感染anuriaanuria无尿无尿无尿无尿arch bararch bar牙弓夹板牙弓夹板牙弓夹板牙弓夹板arterialarterial动脉的动脉的动脉的动脉的asphyxiaasphyxia窒息窒息窒息窒息bandagebandage绑带绑带绑带绑带bite woundbite wound咬伤咬伤咬伤咬伤blood supplyblood supply血供血供血供血供bustupbustup斗殴斗殴斗殴斗殴capillarycapillary毛细血管的毛细血管的毛细血管的毛细血管的cerebralcerebral脑的脑的脑的脑的cerebral fluidcerebral fluid脑脊液脑脊液脑脊液脑脊液cervicalcervical颈的颈的颈的颈的concussionconcussion震荡震荡震荡震荡contaminatecontaminate污染污染污染污染contusioncontusion挫伤挫伤挫伤挫伤2024/7/252VocabularyVocabularycyanosiscyanosis发绀发绀发绀发绀debridementdebridement清创术清创术清创术清创术alveolar processalveolar process齿槽突齿槽突齿槽突齿槽突dental pulpdental pulp牙髓牙髓牙髓牙髓devitalizedevitalize失活失活失活失活dysfunctiondysfunction功能异常功能异常功能异常功能异常dysphoriadysphoria烦躁不安烦躁不安烦躁不安烦躁不安edemaedema水肿水肿水肿水肿estheticesthetic美学的美学的美学的美学的exfoliateexfoliate脱落脱落脱落脱落exsanguineexsanguine失血的失血的失血的失血的extraduralextradural硬脑膜外的硬脑膜外的硬脑膜外的硬脑膜外的extrinsic forceextrinsic force外力外力外力外力extrusionextrusion突出的突出的突出的突出的facial nervefacial nerve面神经面神经面神经面神经foreign bodyforeign body异物异物异物异物fracturefracture骨折骨折骨折骨折gingivalgingival牙龈的牙龈的牙龈的牙龈的hematomahematoma血肿血肿血肿血肿hemostasiahemostasia止血，止血法止血，止血法止血，止血法止血，止血法2024/7/253VocabularyVocabularyhemostathemostat止血钳止血钳止血钳止血钳hyponuriahyponuria少尿少尿少尿少尿hypopneahypopnea低通气低通气低通气低通气incised woundincised wound切割伤切割伤切割伤切割伤inhaleinhale吸气吸气吸气吸气inspiratoryinspiratory asphyxia asphyxia吸入性窒息吸入性窒息吸入性窒息吸入性窒息intracranialintracranial颅内的颅内的颅内的颅内的intubationintubation插管插管插管插管laceratelacerate撕裂撕裂撕裂撕裂lacerationlaceration撕裂撕裂撕裂撕裂ligationligation结扎结扎结扎结扎luxationluxation脱位脱位脱位脱位malocclusionmalocclusion咬合错乱咬合错乱咬合错乱咬合错乱mandiblemandible下颌骨下颌骨下颌骨下颌骨masticationmastication咀嚼咀嚼咀嚼咀嚼maxillamaxilla上颌骨上颌骨上颌骨上颌骨maxillofacialmaxillofacial颌面的颌面的颌面的颌面的mouth openingmouth opening张口度张口度张口度张口度nasal cavitynasal cavity鼻腔鼻腔鼻腔鼻腔obliviscenceobliviscence遗忘遗忘遗忘遗忘2024/7/254VocabularyVocabularyobstructive asphyxiaobstructive asphyxia阻塞性窒息阻塞性窒息阻塞性窒息阻塞性窒息occlusionocclusion咬合咬合咬合咬合oral cavityoral cavity口腔口腔口腔口腔oral hygieneoral hygiene口腔卫生口腔卫生口腔卫生口腔卫生orbitorbit眼眶眼眶眼眶眼眶pain-killerpain-killer止痛剂止痛剂止痛剂止痛剂paralysisparalysis瘫痪瘫痪瘫痪瘫痪paranasalparanasal sinus sinus副鼻窦副鼻窦副鼻窦副鼻窦parotid glandparotid gland腮腺腮腺腮腺腮腺percussionpercussion叩诊叩诊叩诊叩诊periodontal ligamentperiodontal ligament牙周韧带牙周韧带petechiapetechia瘀斑，瘀点瘀斑，瘀点pharyngeal cavitypharyngeal cavity咽腔咽腔plasmaplasma血浆血浆psychologicalpsychological心理的心理的psychotherapypsychotherapy精神疗法精神疗法rabiesrabies狂犬病狂犬病regenerateregenerate再生再生reimplantationreimplantation再植再植rescuerescue营救，抢救营救，抢救2024/7/255VocabularyVocabularyrespiratoryrespiratory呼吸的呼吸的呼吸的呼吸的salivasaliva涎液，唾液涎液，唾液涎液，唾液涎液，唾液salivarysalivary涎液的涎液的涎液的涎液的shockshock休克休克休克休克skull baseskull base颅底颅底颅底颅底stomatognathicstomatognathic口颌的口颌的口颌的口颌的subdermalsubdermal皮下的皮下的皮下的皮下的swallowswallow吞咽吞咽吞咽吞咽sweatsweat出汗出汗出汗出汗tetanustetanus破伤风破伤风破伤风破伤风toothachetoothache牙疼牙疼牙疼牙疼toxic shocktoxic shock中毒性休克中毒性休克中毒性休克中毒性休克transportationtransportation运输，搬运运输，搬运运输，搬运运输，搬运traumatrauma损伤，外伤损伤，外伤损伤，外伤损伤，外伤trigeminal nervetrigeminal nerve三叉神经三叉神经三叉神经三叉神经unconsciousnessunconsciousness神志不清神志不清神志不清神志不清upper airwayupper airway上呼吸道上呼吸道上呼吸道上呼吸道vaccinationvaccination接种疫苗接种疫苗接种疫苗接种疫苗venousvenous静脉的静脉的静脉的静脉的visceraviscera内脏内脏内脏内脏2024/7/256Definition of traumaDefinition of traumatrauma  noun [C or U]trauma  noun [C or U]1. 1.severe emotional shock and pain caused by an severe emotional shock and pain caused by an extremely upsetting experience:extremely upsetting experience:the trauma of marriage breakdownthe trauma of marriage breakdownHe had psychotherapy to help him deal with his He had psychotherapy to help him deal with his childhood traumas.childhood traumas.2. 2.SPECIALIZEDSPECIALIZED a severe injury, usually caused by a  a severe injury, usually caused by a violent attack or an accidentviolent attack or an accident(from Cambridge Advanced Learner's Dictionary)2024/7/257Section 1  IntroductionSection 1  IntroductionWarWarWarIncidenceIncidenceTraffic AccidentTraffic AccidentSportsFallingFallingBustupBustupLabor injuryLabor injury2024/7/258Traffic AccidentTraffic Accident2024/7/2510     Combined injury to other viscera -Fatal to lifeCombined injury to other viscera -Fatal to lifeCombined injury to other viscera -Fatal to life     Damage to maxillofacial structureDamage to maxillofacial structureDamage to maxillofacial structure     StomatognathicStomatognathicStomatognathic dysfunction dysfunction dysfunction     Facial esthetic problemFacial esthetic problemFacial esthetic problem     Psychological traumaPsychological traumaPsychological traumaEffect of Trauma on the Effect of Trauma on the Human BodyHuman Body2024/7/25111. Rich blood supplySection 2 Characteristics of OMF TraumaSection 2 Characteristics of OMF Trauma2024/7/2512DebridementDebridement Time: 24 – 48 h Time: 24 – 48 hTend to Tend to hematomahematoma, edema, edemaRespiratoryRespiratory tract tractAsphyxiaAsphyxiaAbility to anti-infection, Ability to anti-infection, regenerationregenerationWound healingWound healing1. Rich blood supply1. Rich blood supply2024/7/2513 Cerebral concussionCerebral concussion Cerebral contusionCerebral contusion Intracranial Intracranial hematomahematoma Skull base fracture Skull base fracture Increase infectious incidenceIncrease infectious incidence Malocclusion caused - DiagnosisMalocclusion caused - Diagnosis Occlusion regained - TreatmentOcclusion regained - Treatment2. Relationship btw tooth & OMF trauma2. Relationship btw tooth & OMF trauma3. 3. CranioCranio-cerebral trauma-cerebral trauma2024/7/2514Mouth opening, Mouth opening, mastication, swallowingmastication, swallowing4. Cervical trauma4. Cervical trauma5. Effect on breathing5. Effect on breathing6. Effect of on 6. Effect of on digastricdigastric system systemBleedingBleedingParalysisParalysis瘫痪瘫痪Leading difficulty breathingLeading difficulty breathingdietdietworse oral hygieneworse oral hygieneAsphyxia Asphyxia 窒息窒息2024/7/25157. Multi-sinus7. Multi-sinus- contamination- contamination InfectionInfectionOral cavityOral cavityNasal cavityNasal cavityPharyngeal Pharyngeal cavitycavityOrbitOrbitParanasalParanasal sinus sinusBacteriaBacteriaTempTempHumidityHumidity2024/7/25168. Damage to specific structure8. Damage to specific structureParotid GlandParotid GlandFacial N. Facial N. Trigeminal N.Trigeminal N.Salivary fistulaSalivary fistulaFacial paralysisFacial paralysisRegional numbnessRegional numbness2024/7/25179. Facial Defect9. Facial Defect Facial contour Facial contour Psychological traumaPsychological trauma2024/7/2518Evaluate trauma soonEvaluate trauma soonIdentify the key trauma, Identify the key trauma, manage the fatal firstmanage the fatal firstCareful history taking, Careful history taking, thorough physical examthorough physical examRescue in timeRescue in timeManagement in orderManagement in orderGeneral RulesGeneral RulesSection 3 RescueSection 3 Rescue2024/7/25191. Prevention of Asphyxia1. Prevention of AsphyxiaSection 3 Rescue2024/7/2520DysphoriaDysphoria, sweating, inhaling respiration, sweating, inhaling respirationDifficult to inhale, Difficult to inhale, hypopneahypopnea, nasal , nasal alaralar movement,  movement, labial cyanosislabial cyanosisThree concave signsThree concave signs、、、、Rapid breathing, weak pulse, Rapid breathing, weak pulse, decreased BPdecreased BPPupils diluted, No reflection to lightPupils diluted, No reflection to light1.1 Clinical features of asphyxia1.1 Clinical features of asphyxiaProdrome2024/7/25211.21.2   Etiology of AsphyxiaEtiology of Asphyxia   Foreign body obstructionForeign body obstructionInspiratoryInspiratory Asphyxia AsphyxiaLow Low AirwayAirwaySwellingSwellingForeign bodyForeign bodyBlood, salivaBlood, salivaVomitVomitUpper Upper airwayairwayTissue Tissue dislocationdislocation   Obstructive AsphyxiaObstructive Asphyxia2024/7/25221.31.3   Rescue of AsphyxiaRescue of AsphyxiaClear foreign body in upper Clear foreign body in upper airwayairwaySuspend maxillaSuspend maxillaIntubationIntubationHold the tongue outHold the tongue outObstructive Obstructive Asphyxia Asphyxia 吸入性窒息吸入性窒息气管切开术气管切开术2024/7/2523   2. 2. HemostasiaHemostasia   Two stepsTwo steps：：Judge bleeding situationJudge bleeding situationChoose the way to stop bleedingChoose the way to stop bleedingSection 3 Rescue2024/7/25242.12.1   Judge bleeding situationJudge bleeding situationThree categoriesArterialCapillaryVenousBased on origin2024/7/2525压迫止血压迫止血指压止血法指压止血法包扎止血法包扎止血法填塞止血法填塞止血法结扎止血法结扎止血法药物止血法药物止血法2.22.2   Methods of hemostat Methods of hemostat 2024/7/25263. Anti-shock treatment3. Anti-shock treatment(2)(2) Purpose of anti-shockPurpose of anti-shock(1)(1) Definition & ClassificationDefinition & Classification Traumatic shockTraumatic shockExsanguineExsanguine shock shock >20% Body weight>20% Body weightToxic shockToxic shockInfectious shockInfectious shock Restore circulationRestore circulation2024/7/2527(4)(4) Principles of TreatmentPrinciples of Treatment (3)(3) Features of ShockFeatures of ShockEarly stage: Early stage: DysphoriaDysphoria, quick & superficial breath, , quick & superficial breath, sweating, palenesssweating, palenessMiddle stage: Tingle to Middle stage: Tingle to supressionsupression, emotional faint, , emotional faint, unconsciousness, decrease BP, labial palenessunconsciousness, decrease BP, labial palenessLate stage: weaker pulsation, Late stage: weaker pulsation, unmeasurableunmeasurable BP, BP, hyponuriahyponuria, , anuriaanuria <30ml/h <30ml/hHemostasisHemostasis, blood transfusion, pain control, , blood transfusion, pain control, fluid transfusion, sedationfluid transfusion, sedation2024/7/2528(1)(1) JudgementJudgement4. Combined 4. Combined CraniocerebralCraniocerebral Injuries InjuriesConsciousness, pulse, BP, respiration, pupilConsciousness, pulse, BP, respiration, pupil(2) Early discovery, early management(2) Early discovery, early managementRetrograde Retrograde obliviscenceobliviscenceCerebral concussionCerebral concussionIntermediate wake-upIntermediate wake-upExtraduralExtradural hematomahematomaCerebral fluid leakCerebral fluid leakSkull base fractureSkull base fracture2024/7/25292024/7/2530DebridementWound closureAntibiotics5. Prevention of Infection5. Prevention of Infection6. Bandage & Transportation6. Bandage & Transportation2024/7/2531Section 4  Soft Tissue Trauma2024/7/2532Abrasions Abrasions 擦伤擦伤ContusionsContusions挫伤挫伤Contusions & LacerationsContusions & Lacerations挫裂伤挫裂伤Incised & Puncture WoundIncised & Puncture Wound切割伤及刺伤切割伤及刺伤 Bite WoundBite Wound 咬伤咬伤 Types of injuriesTypes of injuriesSection 4  Soft Tissue Trauma2024/7/2533Character:Character:Character: Irregular wound edge, foreign body,  Irregular wound edge, foreign body,  Irregular wound edge, foreign body, pain, oozing & yellowish plasma oozingpain, oozing & yellowish plasma oozingpain, oozing & yellowish plasma oozingManagement:Management:Management:     DebridementDebridementDebridement, remove foreign , remove foreign , remove foreign body, Dry wound, drain when infectedbody, Dry wound, drain when infectedbody, Dry wound, drain when infected1. Abrasions1. AbrasionsProperty:Property:Property: rough surface rough surface rough surfaceEpidermis & superficial dermisEpidermis & superficial dermisEpidermis & superficial dermis2024/7/25341. Abrasions1. Abrasions2024/7/25352. Contusions2. ContusionsCharaterCharater:  : petechiapetechia, swelling, pain, swelling, painManagement:Management:   l lHemostasisHemostasisl lPain-killerPain-killerl lPrevention of infectionPrevention of infectionl lHematomaHematoma   resorptionresorptionl lRe-establishment of functionRe-establishment of functionProperty: blunt material & fell to Property: blunt material & fell to hard objecthard objectSubdermalSubdermal tissue (no open wound) tissue (no open wound)2024/7/2536Property: Blunt object with high Property: Blunt object with high mechanical forcemechanical force3. Contusions & Lacerations3. Contusions & LacerationsCharacterCharacterllI Irregular wound edge, saw-toothedrregular wound edge, saw-toothedllBig lacerationBig lacerationllw/wow/wo necrotic tissue & open fractures necrotic tissue & open fracturesManagementManagementllDebridementDebridementllWound ClosureWound ClosureSoft tissueSoft tissueSoft tissue2024/7/25373. Contusions & Lacerations3. Contusions & Lacerations2024/7/2538Property: Sharp object or instrumentsProperty: Sharp object or instruments4. Incised & Puncture Wound4. Incised & Puncture WoundCharaterCharater llRegular wound edgeRegular wound edgellBleedingBleedingllSmall access, but deep woundSmall access, but deep woundManagementManagementllDebridementDebridementllWound closureWound closureSoft tissueSoft tissueSoft tissue2024/7/2539Property: Animal (Wolf, dog, Bear) or human beingsProperty: Animal (Wolf, dog, Bear) or human beingsCharacterCharacterllTooth tracedTooth tracedllHeavy contaminationHeavy contaminationllTend to infectionTend to infectionManagementManagementllThorough Thorough debridementdebridementllInfection controlInfection controlllSkin graft after granular tissue regeneratedSkin graft after granular tissue regeneratedllVaccination of Tetanus, RabiesVaccination of Tetanus, Rabies5. Bite Wound5. Bite Wound2024/7/2540DefinitionDefinitionDebridementDebridement            Main Entry: Main Entry: Main Entry: de·bride·mentde·bride·mentde·bride·ment                    Pronunciation:Pronunciation:Pronunciation:     di-'brEd-m&ntdi-'brEd-m&ntdi-'brEd-m&nt,  ,  , dAdAdA-, -"-, -"-, -"mäntmäntmänt,  ,  , dA-brEd-'mändA-brEd-'mändA-brEd-'mänFunction:Function:Function:     nounnounnounEtymology:Etymology:Etymology: French  French  French débridementdébridementdébridement, , , from from from débriderdébriderdébrider to remove adhesions, to remove adhesions, to remove adhesions, literally, to unbridle, from Middle French literally, to unbridle, from Middle French literally, to unbridle, from Middle French desbriderdesbriderdesbrider, , , from from from des- des- des- de- + de- + de- + bride bride bride bridle, from Middle High German bridle, from Middle High German bridle, from Middle High German brIdelbrIdelbrIdel -- more at  -- more at  -- more at BRIDLEBRIDLEBRIDLE: the surgical removal of lacerated, devitalized, or contaminated tissue: the surgical removal of lacerated, devitalized, or contaminated tissue: the surgical removal of lacerated, devitalized, or contaminated tissue2024/7/2541Protocol1. wash wound1. wash wound TimeTime：：6--12h6--12h Solution: soap water, saline, hydrogen dioxideSolution: soap water, saline, hydrogen dioxideDebridementDebridement3. Closure3. Closure2. Clean wound2. Clean wound Removal of foreign bodyRemoval of foreign body Trimming of necrotic tissue Trimming of necrotic tissue2024/7/25422024/7/2543Cheek injuriesCheek injuriesPalate injuriesPalate injuriesInjuries at other regionsInjuries at other regionsManagement of soft Management of soft tissuretissure injuries injuriesTongue injuries Tongue injuries Length maintain, longitudinal closureLength maintain, longitudinal closureIndependent closure, but tongue suture dominationIndependent closure, but tongue suture dominationBig needle with big, depth suturing or Big needle with big, depth suturing or matricmatric suturing suturing2024/7/2544Management of soft Management of soft tissuretissure injuries injuries2024/7/25452024/7/2546Section 5   Injury of Teeth and Dental Alveolar Process2024/7/25471. Tooth injuries1. Tooth injuries 1.1 Contusion of Teeth1.1 Contusion of TeethEtiology: Etiology: Extrinsic force Extrinsic force blunt tooth injuriesblunt tooth injuries　　　　Periodontal ligaments or dental pulpPeriodontal ligaments or dental pulpCharacter: Character: llExtrusion of toothExtrusion of toothllMobilityMobilityllPercussion & Toothache when chewingPercussion & Toothache when chewingManagementManagementllTooth restTooth restllTooth groundTooth groundllSimple Simple ligationligation2024/7/25481. Tooth injuries1. Tooth injuries 1.2 1.2 LuxationLuxation of Teeth of TeethClassificationClassificationCharacterCharacterllTooth dislocated or exfoliatedTooth dislocated or exfoliatedManagementManagementllTooth protection priorityTooth protection priorityllReductionReductionllFixationFixationllReimplantationReimplantationPartial Partial luxationluxationComplete Complete luxationluxation- Tooth dislocation- Tooth dislocation- Semi - Semi luxationluxation- Intrusive movement- Intrusive movement2024/7/2549Gingival or labial swelling, lacerationGingival or labial swelling, lacerationAdjacent teeth or alveolar process Adjacent teeth or alveolar process movement when one affected tooth movement when one affected tooth touchedtouchedFragment dislocation, MalocclusionFragment dislocation, MalocclusionIn accordance with tooth In accordance with tooth luxationluxation or or fracturefracture2. Fracture of Alveolar Process2. Fracture of Alveolar ProcessCharactersCharacters2024/7/2550llExtrinsic force to dental alveolar process, Extrinsic force to dental alveolar process, mainly to upper jawmainly to upper jawllReduction under LAReduction under LAllArch bar appliedArch bar applied2. Fracture of Alveolar Process2. Fracture of Alveolar ProcessEtiologyEtiologyManagement Management 2024/7/25512. Fracture of Alveolar Process2. Fracture of Alveolar Process2024/7/2552Stainless steel wire Stainless steel wire ligationligation, Arch bars, Arch bars2024/7/2553Questions1.1.Describe the characteristics of OMF Trauma?Describe the characteristics of OMF Trauma?2.2.Describe the etiology, clinical features and management Describe the etiology, clinical features and management of asphyxia.of asphyxia.3.3.Describe the ways of Describe the ways of hemastasishemastasis. .4.4.What is What is debridementdebridement? ?5.5.Describe the common site of dental alveolar process Describe the common site of dental alveolar process fracture, and their clinical manifestation.fracture, and their clinical manifestation.2024/7/2554ReferenceReference1.1.LJ Peterson, et al : Contemporary Oral & Maxillofacial LJ Peterson, et al : Contemporary Oral & Maxillofacial Surgery. 4th ed. Surgery. 4th ed. MosbyMosby.  . MissorriMissorri. 2003. 20032.2.W Booth, et al: Maxillofacial Surgery. W Booth, et al: Maxillofacial Surgery. VolVol 1, 2. 1st ed.  1, 2. 1st ed. Churchill Livingstone. London. 1999Churchill Livingstone. London. 19993.3.邱蔚六主编邱蔚六主编邱蔚六主编邱蔚六主编. .口腔颌面外科学口腔颌面外科学口腔颌面外科学口腔颌面外科学.  . 第第第第5 5版版版版.  . 人民卫生出版社人民卫生出版社人民卫生出版社人民卫生出版社.  . 200420042024/7/2555THE ENDTHE END2024/7/2556。