口腔颌面部损伤口腔颌面部损伤

Dr. Steve GF ShenDr. Steve GF Shen

Oral and Maxillofacial SurgeryOral and Maxillofacial Surgery

School of StomatologySchool of Stomatology

Shanghai Ninth People’s HospitalShanghai Ninth People’s Hospital

Shanghai Second Medical UniversityShanghai Second Medical University

Oral & Maxillofacial TraumaOral & Maxillofacial Trauma

Chapter 7Chapter 7

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VocabularyVocabulary

abrasionabrasion 擦伤擦伤adjacent toothadjacent tooth 邻牙邻牙alaralar 鼻翼的鼻翼的antibioticsantibiotics 抗生素抗生素anti-infectionanti-infection 抗感染抗感染anuriaanuria 无尿无尿arch bararch bar 牙弓夹板牙弓夹板arterialarterial 动脉的动脉的asphyxiaasphyxia 窒息窒息bandagebandage 绑带绑带

bite woundbite wound 咬伤咬伤blood supplyblood supply 血供血供bustupbustup 斗殴斗殴capillarycapillary 毛细血管的毛细血管的cerebralcerebral 脑的脑的cerebral fluidcerebral fluid 脑脊液脑脊液cervicalcervical 颈的颈的concussionconcussion 震荡震荡contaminatecontaminate 污染污染contusioncontusion 挫伤挫伤

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VocabularyVocabulary

cyanosiscyanosis 发绀发绀debridementdebridement 清创术清创术alveolar processalveolar process 齿槽突齿槽突dental pulpdental pulp 牙髓牙髓devitalizedevitalize 失活失活dysfunctiondysfunction 功能异常功能异常dysphoriadysphoria 烦躁不安烦躁不安edemaedema 水肿水肿estheticesthetic 美学的美学的exfoliateexfoliate 脱落脱落

exsanguineexsanguine 失血的失血的extraduralextradural 硬脑膜外的硬脑膜外的extrinsic forceextrinsic force 外力外力extrusionextrusion 突出的突出的facial nervefacial nerve 面神经面神经foreign bodyforeign body 异物异物fracturefracture 骨折骨折gingivalgingival 牙龈的牙龈的hematomahematoma 血肿血肿hemostasiahemostasia 止血，止血法止血，止血法

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VocabularyVocabulary

hemostathemostat 止血钳止血钳hyponuriahyponuria 少尿少尿hypopneahypopnea 低通气低通气incised woundincised wound 切割伤切割伤inhaleinhale 吸气吸气inspiratory asphyxiainspiratory asphyxia 吸入性窒息吸入性窒息intracranialintracranial 颅内的颅内的intubationintubation 插管插管laceratelacerate 撕裂撕裂lacerationlaceration 撕裂撕裂

ligationligation 结扎结扎luxationluxation 脱位脱位malocclusionmalocclusion 咬合错乱咬合错乱mandiblemandible 下颌骨下颌骨masticationmastication 咀嚼咀嚼maxillamaxilla 上颌骨上颌骨maxillofacialmaxillofacial 颌面的颌面的mouth openingmouth opening 张口度张口度nasal cavitynasal cavity 鼻腔鼻腔obliviscenceobliviscence 遗忘遗忘

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VocabularyVocabulary

obstructive asphyxiaobstructive asphyxia 阻塞性窒息阻塞性窒息occlusionocclusion 咬合咬合oral cavityoral cavity 口腔口腔oral hygieneoral hygiene 口腔卫生口腔卫生orbitorbit 眼眶眼眶pain-killerpain-killer 止痛剂止痛剂paralysisparalysis 瘫痪瘫痪paranasal sinusparanasal sinus 副鼻窦副鼻窦parotid glandparotid gland 腮腺腮腺percussionpercussion 叩诊叩诊

periodontal periodontal ligamentligament

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

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VocabularyVocabulary

respiratoryrespiratory 呼吸的呼吸的salivasaliva 涎液，唾液涎液，唾液salivarysalivary 涎液的涎液的shockshock 休克休克skull baseskull base 颅底颅底stomatognathicstomatognathic 口颌的口颌的subdermalsubdermal 皮下的皮下的swallowswallow 吞咽吞咽sweatsweat 出汗出汗tetanustetanus 破伤风破伤风

toothachetoothache 牙疼牙疼toxic shocktoxic shock 中毒性休克中毒性休克transportationtransportation 运输，搬运运输，搬运traumatrauma 损伤，外伤损伤，外伤trigeminal nervetrigeminal nerve 三叉神经三叉神经unconsciousnessunconsciousness 神志不清神志不清upper airwayupper airway 上呼吸道上呼吸道vaccinationvaccination 接种疫苗接种疫苗venousvenous 静脉的静脉的visceraviscera 内脏内脏

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Definition of traumaDefinition of trauma

trauma  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)

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Section 1 IntroductionSection 1 IntroductionSection 1 IntroductionSection 1 Introduction

WarWarWarWar

IncidenceIncidence

Traffic AccidentTraffic Accident

Sports

FallingFallingBustupBustupLabor injuryLabor injury

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Traffic AccidentTraffic Accident

0

10

20

30

40

50

60

70

80

Financial Loss No of Injured No of Accident

1993

1997

2001

0

10

20

30

40

50

60

70

80

Financial Loss No of Injured No of Accident

1993

1997

2001

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Combined injury to other viscera -Fatal to lifeCombined injury to other viscera -Fatal to life

Damage to maxillofacial structureDamage to maxillofacial structure

Stomatognathic dysfunctionStomatognathic dysfunction

Facial esthetic problemFacial esthetic problem

Psychological traumaPsychological trauma

Combined injury to other viscera -Fatal to lifeCombined injury to other viscera -Fatal to life

Damage to maxillofacial structureDamage to maxillofacial structure

Stomatognathic dysfunctionStomatognathic dysfunction

Facial esthetic problemFacial esthetic problem

Psychological traumaPsychological trauma

Effect of Trauma on the Human BodyEffect of Trauma on the Human Body

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1. Rich blood supply1. Rich blood supply

Section 2 Characteristics of Section 2 Characteristics of OMF TraumaOMF Trauma

Section 2 Characteristics of Section 2 Characteristics of OMF TraumaOMF Trauma

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Debridement Time: 24 – 48 hDebridement Time: 24 – 48 h

Tend to

hematoma, edema

Tend to

hematoma, edemaRespiratory

tractRespiratory

tractAsphyxiaAsphyxia

Ability to anti-infection,

regeneration

Ability to anti-infection,

regenerationWound healingWound healing

1. Rich blood supply1. Rich blood supply1. Rich blood supply1. Rich blood supply

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Cerebral concussion

Cerebral contusion

Intracranial hematoma

Skull base fracture

Cerebral concussion

Cerebral contusion

Intracranial hematoma

Skull base fracture

Increase infectious incidence

Malocclusion caused - Diagnosis

Occlusion regained - Treatment

Increase infectious incidence

Malocclusion caused - Diagnosis

Occlusion regained - Treatment

2. Relationship btw tooth & OMF trauma2. Relationship btw tooth & OMF trauma2. Relationship btw tooth & OMF trauma2. Relationship btw tooth & OMF trauma

3. Cranio-cerebral trauma3. Cranio-cerebral trauma3. Cranio-cerebral trauma3. Cranio-cerebral trauma

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Mouth opening,

mastication, swallowing

Mouth opening,

mastication, swallowing

4. Cervical trauma4. Cervical trauma4. Cervical trauma4. Cervical trauma

5. Effect on breathing5. Effect on breathing5. Effect on breathing5. Effect on breathing

6. Effect of on digastric system6. Effect of on digastric system6. Effect of on digastric system6. Effect of on digastric system

Bleeding

Paralysis 瘫痪Bleeding

Paralysis 瘫痪

Leading difficulty breathingLeading difficulty breathing

dietdiet

worse oral hygieneworse oral hygiene

Asphyxia 窒息Asphyxia 窒息

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7. Multi-sinus7. Multi-sinus- contamination- contamination

7. Multi-sinus7. Multi-sinus- contamination- contamination

Infection Infection

Oral cavity

Nasal cavity

Pharyngeal

cavity

Orbit

Paranasal sinus

Oral cavity

Nasal cavity

Pharyngeal

cavity

Orbit

Paranasal sinus

Bacteria

Temp

Humidity

Bacteria

Temp

Humidity

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8. Damage to specific structure8. Damage to specific structure8. Damage to specific structure8. Damage to specific structure

Parotid Gland

Facial N.

Trigeminal N.

Parotid Gland

Facial N.

Trigeminal N.

Salivary fistula

Facial paralysis

Regional numbness

Salivary fistula

Facial paralysis

Regional numbness

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9. Facial Defect9. Facial Defect9. Facial Defect9. Facial Defect

Facial contour

Psychological trauma

Facial contour

Psychological trauma

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Evaluate trauma soon

Identify the key trauma,

manage the fatal first

Careful history taking,

thorough physical exam

Rescue in time

Management in order

Evaluate trauma soon

Identify the key trauma,

manage the fatal first

Careful history taking,

thorough physical exam

Rescue in time

Management in order

General RulesGeneral Rules

Section 3 RescueSection 3 RescueSection 3 RescueSection 3 Rescue

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1. Prevention of Asphyxia1. Prevention of Asphyxia1. Prevention of Asphyxia1. Prevention of Asphyxia

Section 3 RescueSection 3 Rescue

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Dysphoria, sweating, inhaling respiration

Difficult to inhale, hypopnea, nasal alar movement, labial cyanosis

Three concave signs 、 Rapid breathing, weak pulse, decreased BP

Pupils diluted, No reflection to light

Dysphoria, sweating, inhaling respiration

Difficult to inhale, hypopnea, nasal alar movement, labial cyanosis

Three concave signs 、 Rapid breathing, weak pulse, decreased BP

Pupils diluted, No reflection to light

1.1 Clinical features of asphyxia1.1 Clinical features of asphyxia1.1 Clinical features of asphyxia1.1 Clinical features of asphyxia

Prodrome

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1.21.2 Etiology of AsphyxiaEtiology of Asphyxia1.21.2 Etiology of AsphyxiaEtiology of Asphyxia

Foreign body obstruction Foreign body obstruction

Inspiratory AsphyxiaInspiratory Asphyxia

Low AirwayLow Airway

Swelling

Foreign body

Blood, saliva

Vomit

Swelling

Foreign body

Blood, saliva

Vomit

Upper airwayUpper airway

Tissue dislocation Tissue dislocation

Obstructive AsphyxiaObstructive Asphyxia

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1.31.3 Rescue of AsphyxiaRescue of Asphyxia1.31.3 Rescue of AsphyxiaRescue of Asphyxia

Clear foreign body in upper airwaySuspend maxillaIntubationHold the tongue out

Clear foreign body in upper airwaySuspend maxillaIntubationHold the tongue out

Obstructive

Asphyxia

Obstructive

Asphyxia

吸入性窒息 气管切开术

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2. Hemostasia 2. Hemostasia 2. Hemostasia 2. Hemostasia

Two steps ：Two steps ：

Judge bleeding situation

Choose the way to stop bleeding

Judge bleeding situation

Choose the way to stop bleeding

Section 3 RescueSection 3 Rescue

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2.12.1 Judge bleeding situationJudge bleeding situation2.12.1 Judge bleeding situationJudge bleeding situation

Three categories

Arterial

Capillary

Venous

Based on origin

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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

2.22.2 Methods of hemostat Methods of hemostat 2.22.2 Methods of hemostat Methods of hemostat

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3. Anti-shock treatment3. Anti-shock treatment3. Anti-shock treatment3. Anti-shock treatment

(2) Purpose of anti-shock(2) Purpose of anti-shock

(1) Definition & Classification (1) Definition & Classification Traumatic shock

Exsanguine shock >20% Body weight

Toxic shock

Infectious shock

Traumatic shock

Exsanguine shock >20% Body weight

Toxic shock

Infectious shock

Restore circulation Restore circulation

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(4) Principles of Treatment (4) Principles of Treatment

(3) Features of Shock(3) Features of ShockEarly 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 <30ml/h

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 <30ml/h

Hemostasis, blood transfusion, pain control,

fluid transfusion, sedation

Hemostasis, blood transfusion, pain control,

fluid transfusion, sedation

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(1) Judgement(1) Judgement

4. Combined Craniocerebral Injuries4. Combined Craniocerebral Injuries4. Combined Craniocerebral Injuries4. Combined Craniocerebral Injuries

Consciousness, pulse, BP, respiration, pupilConsciousness, pulse, BP, respiration, pupil

(2) Early discovery, early management(2) Early discovery, early managementRetrograde obliviscence Cerebral concussion

Intermediate wake-up Extradural

hematoma

Cerebral fluid leak Skull base fracture

Retrograde obliviscence Cerebral concussion

Intermediate wake-up Extradural

hematoma

Cerebral fluid leak Skull base fracture

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Debridement

Wound closure

Antibiotics

5. Prevention of Infection5. Prevention of Infection5. Prevention of Infection5. Prevention of Infection

6. Bandage & Transportation6. Bandage & Transportation6. Bandage & Transportation6. Bandage & Transportation

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Section 4 Soft Tissue TraumaSection 4 Soft Tissue Trauma

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Abrasions 擦伤

Contusions 挫伤

Contusions & Lacerations 挫裂伤

Incised & Puncture Wound 切割伤及刺伤

Bite Wound 咬伤

Abrasions 擦伤

Contusions 挫伤

Contusions & Lacerations 挫裂伤

Incised & Puncture Wound 切割伤及刺伤

Bite Wound 咬伤

Types of injuriesTypes of injuries

Section 4 Soft Tissue TraumaSection 4 Soft Tissue Trauma

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Character:Character: Irregular wound edge, foreign body, Irregular wound edge, foreign body,

pain, oozing & yellowish plasma oozingpain, oozing & yellowish plasma oozing

Management:Management: Debridement, remove foreign Debridement, remove foreign

body, Dry wound, drain when infectedbody, Dry wound, drain when infected

Character:Character: Irregular wound edge, foreign body, Irregular wound edge, foreign body,

pain, oozing & yellowish plasma oozingpain, oozing & yellowish plasma oozing

Management:Management: Debridement, remove foreign Debridement, remove foreign

body, Dry wound, drain when infectedbody, Dry wound, drain when infected

1. Abrasions1. Abrasions

Property:Property: rough surface rough surfaceProperty:Property: rough surface rough surface

Epidermis & superficial dermisEpidermis & superficial dermisEpidermis & superficial dermisEpidermis & superficial dermis

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1. Abrasions1. Abrasions

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2. Contusions2. Contusions

Charater: petechia, swelling, painCharater: petechia, swelling, pain

Management:Management: HemostasisHemostasis Pain-killerPain-killer Prevention of infectionPrevention of infection Hematoma resorptionHematoma resorption Re-establishment of functionRe-establishment of function

Property: blunt material & fell to Property: blunt material & fell to

hard objecthard object

Subdermal tissue (no open wound)Subdermal tissue (no open wound)

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Property: Blunt object with high

mechanical force

Property: Blunt object with high

mechanical force

3. Contusions & Lacerations3. Contusions & Lacerations

Character Irregular wound edge, saw-toothed Big laceration w/wo necrotic tissue & open fractures

Management Debridement Wound Closure

Character Irregular wound edge, saw-toothed Big laceration w/wo necrotic tissue & open fractures

Management Debridement Wound Closure

Soft Soft

tissuetissueSoft Soft

tissuetissue

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3. Contusions & Lacerations3. Contusions & Lacerations

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Property: Sharp object or instrumentsProperty: Sharp object or instruments

4. Incised & Puncture Wound4. Incised & Puncture Wound

Charater Regular wound edge Bleeding Small access, but deep wound

Management Debridement Wound closure

Charater Regular wound edge Bleeding Small access, but deep wound

Management Debridement Wound closure

Soft tissueSoft tissueSoft tissueSoft tissue

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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

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

5. Bite Wound5. Bite Wound

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DefinitionDefinitionDefinitionDefinition

DebridementDebridement

Main Entry: de·bride·ment Main Entry: de·bride·ment

Pronunciation:Pronunciation: di-'brEd-m&nt, dA-, -"mänt, dA-brEd-'män di-'brEd-m&nt, dA-, -"mänt, dA-brEd-'män

Function:Function: nounnoun

Etymology:Etymology: French French débridement, débridement, from from débrider débrider to remove adhesions, to remove adhesions,

literally, to unbridle, from Middle French literally, to unbridle, from Middle French desbrider, desbrider, from from des- des- de- + de- +

bride bride bridle, from Middle High German bridle, from Middle High German brIdelbrIdel -- more at -- more at BRIDLEBRIDLE

: the surgical removal of lacerated, devitalized, or contaminated tissue: the surgical removal of lacerated, devitalized, or contaminated tissue

Main Entry: de·bride·ment Main Entry: de·bride·ment

Pronunciation:Pronunciation: di-'brEd-m&nt, dA-, -"mänt, dA-brEd-'män di-'brEd-m&nt, dA-, -"mänt, dA-brEd-'män

Function:Function: nounnoun

Etymology:Etymology: French French débridement, débridement, from from débrider débrider to remove adhesions, to remove adhesions,

literally, to unbridle, from Middle French literally, to unbridle, from Middle French desbrider, desbrider, from from des- des- de- + de- +

bride bride bridle, from Middle High German bridle, from Middle High German brIdelbrIdel -- more at -- more at BRIDLEBRIDLE

: the surgical removal of lacerated, devitalized, or contaminated tissue: the surgical removal of lacerated, devitalized, or contaminated tissue

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ProtocolProtocol

1. wash wound Time ： 6--12h Solution: soap water, saline, hydrogen

dioxide

1. wash wound Time ： 6--12h Solution: soap water, saline, hydrogen

dioxide

DebridementDebridement

3. Closure3. Closure

2. Clean wound Removal of foreign body

Trimming of necrotic tissue

2. Clean wound Removal of foreign body

Trimming of necrotic tissue

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Cheek injuriesCheek injuries

Palate injuriesPalate injuries

Injuries at other regionsInjuries at other regions

Cheek injuriesCheek injuries

Palate injuriesPalate injuries

Injuries at other regionsInjuries at other regions

Management of soft tissure injuriesManagement of soft tissure injuries

Tongue injuries Tongue injuries Tongue injuries Tongue injuries Length maintain, longitudinal closureLength maintain, longitudinal closure

Independent closure, but tongue suture dominationIndependent closure, but tongue suture domination

Big needle with big, depth suturing or matric suturingBig needle with big, depth suturing or matric suturing

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Management of soft tissure injuriesManagement of soft tissure injuries

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Section 5 Injury of Teeth Section 5 Injury of Teeth and Dental Alveolar Processand Dental Alveolar Process

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1. Tooth injuries 1. Tooth injuries

1.1 Contusion of Teeth1.1 Contusion of TeethEtiology: Extrinsic force blunt tooth injuries

　 Periodontal ligaments or dental

pulp

Etiology: Extrinsic force blunt tooth injuries

　 Periodontal ligaments or dental

pulpCharacter: Extrusion of tooth Mobility Percussion & Toothache when chewing

Management Tooth rest Tooth ground Simple ligation

Character: Extrusion of tooth Mobility Percussion & Toothache when chewing

Management Tooth rest Tooth ground Simple ligation

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1. Tooth injuries 1. Tooth injuries

1.2 Luxation of Teeth1.2 Luxation of TeethClassificationClassification

Character Tooth dislocated or exfoliated

Management Tooth protection priority Reduction Fixation Reimplantation

Character Tooth dislocated or exfoliated

Management Tooth protection priority Reduction Fixation Reimplantation

Partial luxationPartial luxation

Complete luxationComplete luxation

- Tooth dislocation

- Semi luxation

- Intrusive movement

- Tooth dislocation

- Semi luxation

- Intrusive movement

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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

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

2. Fracture of Alveolar Process2. Fracture of Alveolar Process

CharactersCharacters

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Extrinsic force to dental alveolar process, mainly to upper jaw

Extrinsic force to dental alveolar process, mainly to upper jaw

Reduction under LA Arch bar applied Reduction under LA Arch bar applied

2. Fracture of Alveolar Process2. Fracture of Alveolar Process

EtiologyEtiology

Management Management

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2. Fracture of Alveolar Process2. Fracture of Alveolar Process

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Stainless steel wire ligation, Arch barsStainless steel wire ligation, Arch bars

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QuestionsQuestions

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.

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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ReferenceReferenceReferenceReference

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. 邱蔚六主编 .口腔颌面外科学 . 第 5 版 . 人民卫生出版社 . 2004

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. 邱蔚六主编 .口腔颌面外科学 . 第 5 版 . 人民卫生出版社 . 2004

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THE ENDTHE END