management of maxillofacial trauma.ppt

7/27/2019 Management of maxillofacial trauma.ppt

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Maxillofacial trauma

Management oftraumatized patient


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Is the patient fully conscious? And able to maintain

adequate airway?

Semiconscious or unconscious patient rapidly suffocatebecause of inability to cough and adopt a posture that

held tongue forward

Sequel of facial injury

Obstruction of airway

asphyxia

Cerebral hypoxia

Brain damage/ death


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Immediate treatment of airway obstruction in

facial injured patient

Clearing of blood clot and mucous of the mouth andnares and head position that lead to escape ofsecretions (sit-up or side position)

Removal of foreign bodies as a broken denture oravulsed teeth which can be inhaled and ensuring thepatency of the mouth and oropharynex

Controlling the tongue position in case of symphesialbilateral fracture of mandible and when voluntarycontrol of intrinsic musculature is lost

Maintaining airway using artificial airway inunconscious patient with maxillary fracture or bynasophryngeal tube with periodic aspiration

Lubrication of patients lips and continuoussupervision


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Circulation

Circulatory collapse leads to lowblood pressure, increasing pulse rateand diminished capillary filling at the

periphery

Patient resuscitationRestoration of cardio-respiratory function

Shock managementReplacement of lost fluid


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Neurological deficient

Rapid assessment of neurological disability is madeby noting the patient response on four points scale:

A Response appropriately, is Aware

V Response to verbal stimuli

P Response to painful stimuli

U Does not responds, Unconscious


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Exposure

All trauma patient must be fullyexposed in a warm environment todisclose any other hidden injuries

When the airway is adequatelysecured the second survey of thewhole body is to be carried out for:

Accurate diagnosis

Maintenance of a stable state

Determination of priorities in treatment

Appropriate specialist referral


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Head injury

Many of facial injury pat ients sustain head

in jury in part icular the mid face injur ies

Open

Closed

it is ranged from Mild concussion to braindeath


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Abdomen and pelvis

In addition to direct injuries, loss ofcirculating blood into peritoneal

cavity or retroperitonial space is lifethreatening, indicated by physical

signs and palpation, percussion andauscultation

Management: Diagnostic peritoneal lavage (DPL) to

detect blood, bowel content, urine

Emergency laprotomy


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Extremity trauma

Fracture of extremities in particularthe femur can be a significant causeof occult blood loss. Straighteningand reduction of gross deformity is

part of circulation control

Cardinal features of extremities injury Impaired distal perfusion (risk of

ischemia) Compartment syndrome (limb loss) Traumatic amputation


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Prevention of infection


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Prevention of infectionFractures of jaw involving teeth bearing areas

are compound in nature and midface fracture

may go high, leading to CSF leaks(rhinorrhoea, otorrhoea) and risk of meningitis,

and in case of perforation of cartilaginous

auditory canal

Diagnosis:

Laboratory investigation, CT and MRI scan

Management: Dressing of external wounds

Closure of open wounds

Reposition and immobilization of the fractures

Repair of the dura matter

Antibacterial prophylaxis (as part of the general management

(Eljamal, 1993)


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Control of pain

Displaced fracture may cause severe pain but

strong analgesic ( Morphine and its derivatives)must be avoided as they depress cough reflex,

constrict pupils as they may mask the signs of

increasing intracranial pressure

Management:

Non-steroidal anti-inflammatory drugs canbe prescribed (Diclofenac acid)

Reduction of fracturesedation


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management of maxillofacial trauma.ppt

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