Maxillofacial Trauma and Its Emergency Management Presented by- Dr.Sabrina Farida Chowdhury Dr.Nusrat jahan Mou Dr.Jarin tasnim Disha Dr.Nahidara parveen Dr.Shanjida wasima

Maxillofacial Trauma and Its Emergency Management

Presented by- Dr.Sabrina Farida ChowdhuryDr.Nusrat jahan MouDr.Jarin tasnim DishaDr.Nahidara parveenDr.Shanjida wasima

Maxillofacial Trauma and Its Emergency Management

Maxillofacial Trauma:Definition:Any injury (such as wound) to a living tissue cause by an extrinsic agent

When do we call Trauma an Maxillofacial Emergency??

Maxillofacial Emergency:Situation that requires early management and may complicate affected patients life by affecting his face,brain,cervical spine and airway.

TRAUMA/INJURY:

Facial Trauma is one of the main reason of maxillofacial emergencies. Proportionally male are more prone to trauma than the female(2:1).

Facial trauma may be associated with traumatic brain injury in 15-48%.

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Facial Trauma :

It may result fromInterpersonal Violence 52%RTA 16%Sport injury 19%Fall 11%Industrial accident 2%

Injury:Maxillifacial injuries are of two types:Hard Tissue InjurySoft Tissue Injury

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Hard Tissue injury1.FracturesUpper Third FractuerMidface fractureLower third fracture/Mandibukar Fracture2.Displacement3.Dislocations4.Dento-Alveolar Injury(Tooth Fracture,Tooth Avulsion)

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FractureDefinition: Complte/incomplete break in continuty of bone resulting from execessive application of force

FRACTURES OF FACIAL SKELETAL

Fracture of the upper third of the face:

Fractures of Upper Third of the face

Fractures Of the Middle Third Of the Face: Lefort I ,II , III

Lowerthird Mandible Fracture

Soft Tissue injuriesAbrasionLacerationCntusionHematonaIncised woundPenetrated woundCrush and gunshot injuries

ABRASIONAbrasions Abrasion caused by the frictional violence, due to friction between an object amd surface of the soft tissue. It is presented as raw bleeding areas. The wound is superficial and it denudes the epidermis, occasionally involves the deeper layers. Abrasion involves the terminal nerve endings of many nerve fibres and it can be quite painful. Abrasions may be contaminated depending on the surroundings.

ABRASION(TREATMENT)1. Through cleaning with profuse saline irrigation 2. Removal of the foreign material 3. Gentle scrubbing with the soft brush to remove sticky material to prevent tattooing 4. Use of surgical soap is required to be done prior to dressing 5. Topical application of antibiotic ointment with compression dressing promotes good healing. 6. Superficial abrasions can be covered with topical antibiotic application and left open. Slowly the crust of dried blood and serum will form a scab and it will fall off as the healing takes place.

CONTUSIONContusion is caused by a blow or fall against a hard or blunt object. Blood extravasates in the subcutaneous or sub mucous tissue leading to bluish area or bruise. Subcutaneous bleeding is self limiting. This is without break into the soft tissue surface. Discoloration of the skin or mucosa causes ecchymosis. Important for diagnosis and search for an osseous trauma is mandatory.

CONTUSION(TREATMENT)1. Application of ice pack will help to stop further extravasation of blood. 2.An elastic bandage may be wrapped around a bruised muscle to support the area and decrease swelling

HEMATOMAS Hematomas are localized collection of blood in the subcutaneous or intramuscular or submucosal space. It may be deeply seated or superficial. It can be associated with a fracture or rupture of a vessel or vessels. Careful examination may be repeated and X-ray examination is essential for proper diagnosis and treatment .

HEMATOMA(TREATMENT)1. Most hematomas are reabsorbed 2. Persistent hematoma may require incision and drainage. It can not be aspirated as blood is partially clotted 3. Antibiotic cover should be given to prevent hematoma from getting infection.

LACERATED WOUNDLacerated wounds are most frequent type of soft tissue injuries. Here the tearing of mucosal tissue or skin is seen due to vehicular accidents, low velocity missiles (pistols) or bomb splinters. The margins are contused and lacerated in deep wounds, the muscles are also lacerated and devitalized. There may be associated injury to the underlying vessels, nerves and bone. These wounds are usually highly contaminated with dust, mud, greasy material, bone splinters etc.

LACERATED WOUND(TREATMENT)1. Through cleaning, minimum debridement, removal of foreign bodies and proper suturing as early as possible should be done 2. Closure should be done in multiple layers (muscle, dermis, epidermis, submucosa and mucosal closure).

INCISED WOUNDS Incised wound Incised wounds are caused by a sharp cutting objects such as knife ,dagger,glass piece, tin etc.

INCISED WOUND (TREATMENT) 1.cleaning,exploring,and the bleeding should be stopped. 2.wound closed by primary intension

PENETRATING WOUNDS AND PUNCTURED

WOUNDSPunctured wounds are caused by pointed onjects like knife,bullet,bomb splinter.careful clinical examination and other investigations are required.

CRUSH INJURIESCrush injuries Crush injuries is caused by road accidents and machinary accidents.it damages to the skin ,nerve ,blood vessels,muscle bone is also seen

CRUSH INJURIES(TREATMENT)Tetanus shot will be neccessary as well antibioticsImmediiate medical attention is required.In serious crush injuries injuries,in which compartment syndrome has already set in or is inevitable.immediate surgery will be required to eliminate the pressure on the muscles and nerves

GUNSHOT INJURIESIt is in reality penetrating wounds but are classified separately because of their extensiveness of the wound and special problem arise during their management. They are subclassified as a 1.penetrating wounds 2.perforating wounds 3.avulsion

Emergency Management of a Trauma patient:Advanced trauma life support(commonly abbreviatedATLS) is a training program for medical providers in the management of acutetraumacases, developed by theAmerican College of Surgeons.

ATLS OverviewTriagePrimary SurveyResuscitationAdjunct to primary surveySecondary SurveyAdjuct to secondary surveyDefinitive Care

Triage:The process of categorizing victims or mass casualties based on their need for treatment and resource available.Goal:-prevent avoidable death-To provide initial treatment in a minimal time

Primary Survey:It is the first and important key part of ATLS.It includes~~ABCDEA-Airway Maintainance and Spine ProtectionB-Breathing and VentillationC-Circulation and Heamorrhage ControlD-DisabilityE-Exposure

Airway Maintainance and Spine Protection

Factors That May Compromise the Airway:According to Hutchison et al., there are six specific situations associated with maxillofacial trauma, which can adversely affect the airway.

NO.1

Posterior inferior displacement of a fractured maxilla parallel to the inclined plane of the base of the skull may block the nasopharyngeal airway

NO.2

A bilateral fracture of the anterior mandible may cause the fractured symphysis and the tongue to slide posteriorly and block the oropharynx in the supine patient.

NO.3

Fractured or exfoliated teeth, bone fragments, vomitus, blood, and secretions as well as foreign bodies, such as dentures, debris, and shrapnel, may block the airway anywhere along the oropharynx and larynx.

NO.4

Hemorrhage from distinct vessels in open wounds or severe nasal bleeding from complex blood supply of the nose may also contribute to airway obstruction.

NO.5

Soft tissue swelling and edema because of trauma to the head and neck may cause delayed airway compromise.

NO.6

Trauma of the larynx and trachea may cause swelling and displacement of structures, such as the epiglottis, arytenoid cartilages, and vocal cords, thereby increasing the risk of cervical airway obstruction.

Airway Maintainance: Head Tilt-Chin-Lift Maneuver

Airway MaintainanceOropharyngeal Toileting:By digital exploration or using cotton swabsSuction Nasal Cavity,Oral Cavity and ThroatControl the tongue by Tongue suturingTemporary stabilization of fractureMouth to mouth breathingEndotracheal intubation

Airway MaintainanceJaw Thrust

Surgical:TracheostomyCricothyroidotomy

Spine Protection

Breathing and Ventillation

Breathing and Ventillation

Aim:-is to identify and manage six life-threatening thoracic conditions asAirway Obstruction, TensionPneumothorax MassiveHaemothoraxOpen PneumothoraxFlail chestsegment withPulmonary ContusionandCardiac Tamponade.

Circulation and Heamorrhage Control

Circulation and Heamorrhage ControlIf evacuation time is 1hr,a Fluid line to be established firstUsually Crystalloid solution are preferrableBlood is drawn and sent for grouping and crossmatchingAs soon as possible blood trasfusion is startedVital parameters are monitoredAntibiotics and AnalgesicsAnti tetanous protection

For speedy Recovery:High calorie,High protein dietNasogastric feeding in severe caseVitamin supplement

Secondary Survey

-Definitive Care

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