Oral and maxillofacial injury

Oral and maxillofacial injury

Features
1 Abundance of blood vessels
benefit: the ability of resistance of
infection
the ability of reparation are
stronger

shortcoming: bleed swelling asphyxia

 bleeding

 There are many blood

vessels on the oral and
maxillofacial tissues
 External carotid artery
 Lingual artery 5
4
 External maxillary artery 3
 Internal maxillary artery 12
 Superficial temporal artery
2 the tooth in the jaw
disadvantage
fragments of teeth scatter to adjacent

tissues the second injury

calculi and bacteria enter deep tissues
infection of wounds
caries infection of bone affect

coalesce of fracture
 2 the tooth in the jaw

Advantage
 Disturbance of occlusion relationship is
important factor to diagnose the fracture
 Restoration of natural occlusion is the
standard of reduction
 Teeth can be used as points of
attachment for fixation appliances
Teeth use for mobilization and reduction
 3 easily complicate injury of
head
 Concussion of the brain
 Cerebral contusion
 Extradural hematoma
 Cerebrospinal fluid escape
4 sometimes complicate injury
of neck
 Severe injury can cause paraplegia
 5 easily cause asphyxia
 Because of blockage of blood clot,
secretion,swelling,tongue-backward,
foreign bodies,displacement of tissues
6 influence on eating ,drinking
and oral health
 When we treat the patient who had
suffered injury,we should cleanse oral
cavity to prevent infection of wounds
 7 easily cause infection

 Infection of a wound depends on the presence

of pathogenic bacteria in the wound in
sufficient number to overcome the resistance
of the tissues
 There are numberless of bacteria in the oral
cavity
 Wounds that contain a foreign body,and
especially sticks,dirt or clothing,are more likely
to be infected than those that do not
 8 abnormity of face

 Resulted from swelling ,displacement of

tissues or injury of major organ
 It is very important to recover the
outline of the patient
 treatment of emergency
 Itis fundamental principle to save lives
before treating the local wounds
 The patients who suffered injury may
have some complications which are
fatal,for example :asphyxia,shock,head
injuries .
 treatment of emergency

1 asphyxia
obstructive asphyxia
inhalation asphyxia
 obstructive asphyxia
 The blockage usually is refer to blood
clot,vomit,displacement of
tissues,tongue-backward
Treatment
remove the blockage timely
tug the tongue to the normal position
insert ventilation conductor
Pull the tongue outwards
Press the fragment of maxilla upwards
 inhalation asphyxia
 Blood,saliva,vomit
can be inhaled to
trachea or lung which caused asphyxia
Treatment tracheotomy
 We could use tracheotomy,then
aspirate blood,saliva,secretion and so
on
 2 bleeding
 Itis key to prevent bleeding
immediately

 Digitalpressure on the facial

or Superficial temporal artery
can arrest it temporarily but 5
the bleeding point should be 4
ligated as soon as possible 3
1 2
Prevent bleeding
3 shock

traumatic shock
treatment principle: keep silence
relieve pain
prevent bleeding
supply liquid
 3 shock

hemorrhagic shock

treatment principle: supply blood

volume
 4 prophylaxia infection
 Inthe early stage, we must carry out
debridement
 Antibiotic should be performed
 debridement
Definition
Itis a fundamental treatment of
prophylaxia infection
There are three steps
 debridement

1 cleaning wounds

2 trim wounds

3 suture wounds
 debridement

1 cleaning wounds

 remove foreign bodies with enough

liquid
 Then painted with an antiseptic
solution
 debridement

2 trim wounds
principle: reserve tissues as possible
as you can
trim edge of wounds
before trimming, remove
foreign bodies further
 debridement

3 suture wounds
 Ifthere is no infection,we should
suture wound within 48 hours.if there
is obvious infection,we suture
wounds after preventing the
infection
 injury of soft tissues

abrasion wounds
contusion wounds
incised and puncture wounds
lacerated wounds
bite wounds
 abrasion wounds

features skin abrasion

few bleeding
dirts or debrises or else foreign

bodies on the surface of wounds

 abrasion wounds

treatment principle

cleanse the surface

remove the foreign bodies
avoid infection
contusion wounds

features
skin and deep tissues suffer injury
no open wounds
the colour of local skin change
swell and pain
 contusion wounds
treatment principle
prevent bleeding
relieve pain
avoid infection
prompt absorption of swelling
recover functions
incised and puncture wounds

features
skin and soft tissues have cleft
surface of wounds are small
bacteria or dirts or debrises enter the
deep tissues
treatment principle: debridement
 lacerated wounds

features
tissues is lacerated
bleeding is more
pain is intense
condition is severe
easily complicate shock
 lacerated wounds
treatment principle

first: cleanse the wounds

second: reduce tissues
third: suture tissues
 bite wounds
 Easily cause infection
Fractures of the jaw
 Etiology
 bare fist
 automobile accidents
 Falls

 injuries during extraction of teeth (especially

impacted mandibular third molars)
 Fractured line of the maxilla
 Le fort Ⅰ: lower level fracture of the maxilla, located superior of alveolar
process
 Le fort Ⅱ: middle level fracture of the maxilla, traversing nasal root, interior
and basal wall of the fossa orbitalis, crevice between the zygoma and
maxilla, lateral wall of maxilla to pterygoid process
 Le fort Ⅲ: superior level fracture, going through nasal root, fossa orbitalis,
crevice between the zygoma and coronale to pterygoid process
 Split fracture: going through palate from alveolar process to soft palate
 complicated fracture: two or more than two kinds of fracture
Symptom of the maxillo fracture
 Fractured block moving
 Malocclusion
 Orbital and around affection
 Head injury, such as fracture of skull base,
and Cerebrospinal fluid escape
 Location of the mandibular
fracture
 the mental central region
 The mental foramen region
 The region of Angle
 The neck at the condyle and the coronoid process
 Symptom of the madibular
fracture
Fractured block moving
 Deformity and malocclusion
 abnormal mobility
 Trismus, or restricted opening of the jaw
 Numbness of the lower lip
Pain
 Treatment
 Replacement
 Principle: correct occlusion
 Fixation
 Operative methods: opening replacement and
fixation
 Solid interior fixation is advocated, because of
profiting early functional exercise
 Between occlusive fixation sometimes is needed
 Thank
you