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    BIMC Update Presentation

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    Wahyu
    This document summarizes a seminar on maxillofacial trauma management. It discusses the etiology and mechanisms of facial injuries, anatomy of the craniomaxillofacial region, common fracture sites including the frontal bone, orbit, nose, ethmoid, maxilla, zygoma, and mandible. It outlines signs and symptoms of different fracture types based on radiological findings. The presentation emphasizes the importance of emergency airway management and bleeding control for maxillofacial trauma patients. Definitive treatment includes open reduction and internal fixation of fractures.

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    BIMC Update Presentation

    Uploaded by

    Wahyu
    27 views25 pages
    This document summarizes a seminar on maxillofacial trauma management. It discusses the etiology and mechanisms of facial injuries, anatomy of the craniomaxillofacial region, common fracture sites including the frontal bone, orbit, nose, ethmoid, maxilla, zygoma, and mandible. It outlines signs and symptoms of different fracture types based on radiological findings. The presentation emphasizes the importance of emergency airway management and bleeding control for maxillofacial trauma patients. Definitive treatment includes open reduction and internal fixation of fractures.

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    Mohon informasi jurnal

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    This document summarizes a seminar on maxillofacial trauma management. It discusses the etiology and mechanisms of facial injuries, anatomy of the craniomaxillofacial region, common fracture sites including the frontal bone, orbit, nose, ethmoid, maxilla, zygoma, and mandible. It outlines signs and symptoms of different fracture types based on radiological findings. The presentation emphasizes the importance of emergency airway management and bleeding control for maxillofacial trauma patients. Definitive treatment includes open reduction and internal fixation of fractures.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    27 views25 pages

    BIMC Update Presentation

    Uploaded by

    Wahyu
    This document summarizes a seminar on maxillofacial trauma management. It discusses the etiology and mechanisms of facial injuries, anatomy of the craniomaxillofacial region, common fracture sites including the frontal bone, orbit, nose, ethmoid, maxilla, zygoma, and mandible. It outlines signs and symptoms of different fracture types based on radiological findings. The presentation emphasizes the importance of emergency airway management and bleeding control for maxillofacial trauma patients. Definitive treatment includes open reduction and internal fixation of fractures.

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    of 25

    Seminar dan Workshop Keperawatan, Denpasar 19 Mei 2019

    Update Management Emergency


    Maxillofacial Trauma
    DR. Dr. Nyoman P Riasa, SpBP-RE(K)
    Plastic Reconstructive & Aesthetic
    Surgeon
    Etiology & Trauma Mechanism
    • Traffic Accident, pedestrian
    • Sport Injury
    • Assault
    Facial Anatomy

    Facial (Craniomaxillofacial: CMF)


    • Craniofacial: Upper third (area above the sup. orbital margin)
    • Maxillofacial: Middle third (area between the sup. Orbital margin
    and occlusal plane)
    • Mandibulofacial :Lower third (Mandible –TMJ)
    CMF Fracture Sites
    Frontal,Orbital,Nasoethmoid Fractures
    Frontal Sinus

    Radiology: Signs:
     Nasoethmoid: periorbital haematoma,
    Occipitomental/ epistaxis, displaced nasal bone, deviated
    frontal & lateral nasal septum, CSF rhinorrhoea, transverse
    cleft in glabellar region
     Orbits: Diplopia, enopthalmos, proptosis,
    restriction of ocular movement
    CT-Scan
    • Orbital floor fracture
    • Nasoethmoid fracture

    Courtesy: Dr Riasa Courtesy: Dr Riasa


    Blow out fracture

    Courtesy: Dr Riasa Courtesy: Dr Riasa


    Maxillary Fractures

     Maxilla:
    LeFort I: swelling of upper lip & cheek,
    mobile maxilla, teeth gagged
    posteriorly
     Occipitomental LeFort II, III: facial oedema (severe in III),
    periorbital haematoma, elongation of
    & lateral the face (dished), mobile maxilla, teeth
    gagged posteriorly
    Zygomatic Fractures

     Submentovertical

    Four legged stool fr.


    Tripod fracture
     Occipitomental
    450
    Signs:
     Zygomatic complex: periorbital
    oedema/haematoma, infraorbital anesthesia,
    step deformities/ flattening of the cheek
     Zygomatic arch: Depression over arch,
    restriction of mandibular movement
    • Zygomatic Fracture
    • Early and Late Fracture

    Courtesy: Dr Riasa
    Courtesy: Dr Riasa
    Courtesy: Dr Riasa Courtesy: Dr Riasa
    Mandible-TMJ Fractures

    Signs:
    Orthopantomogram & Tenderness, bruishing-swelling,
    PA/Towne`s, bleeding from mouth or ear or both,
    Lateral oblique & PA anaesthesia of lower lip, crepitus &
    mobile fracture, malocclusion or
    inability to close the teeth.
    • Airway compromized:
    - Bilateral subcondylar fractures + Internal
    displacement
    - Fractures & Collapsed mandible
    • Bilateral subcondyle fracture
    • Lateral overiding

    Courtesy: Dr Riasa Courtesy: Dr Riasa


    • Occlusion
    Plain X-Ray

    Courtesy: Dr Riasa Courtesy: Dr Riasa Courtesy: Dr Riasa


    Courtesy: Dr Riasa Courtesy: Dr Riasa
    Soft Tissue Injury (Facial Wounds)
    • Eyebrow
    • Lip
    • Nose
    • Cheek
    Emergency Management
    • CMF: high vascular zone.
    • Proximity to the brain, cervical spine and
    airway
    • ABC (Airway, Breathing, Circulation)
    • Airway & cervical spine control: highest
    priority in initial assessment of CMF injuries
    Airway
    Alcohol/drug intoxication Supine position
    Blood
    Head injury (altered
    pharyngeal or laryngeal Nausea, Vomiting Intracranial tension
    reflexes)
    Aspiration
    • Tongue position,
    • Blood,
    • Broken teeth, AIRWAY Bleeding, Salivation
    • Dentures,
    • Foreign bodies, Compromized
    • Avulsed tissue,
    • Vomitus  Displacement of
    maxilla or mandibula
    Hematoma, Decrease airway posteriorly
    Edema of glottis patency  collapsed mandible
    (laryngo-tracheal injuries) (multiple mandibular fr.)
    Airway Assesment & Management
    Unconscious
    Look C-Spine Blood, vomitus,dentures...
    High - Pain
    Clear Up Oral
    velocity - Altered -Jaw thrust & Nasal Aperture
    trauma swallowing -Chin lift
    (involving - Ineffective -Position
    mandible) reflex Bag-valve-mask
    ventilation

    Conventional Surgical
    definitive airway
    Listen Auscultation of
    larynx
    Tracheal tug,
    stridor airway (Cricothyr
    (Orotracheal, otomy,
    Palpation of Collaps, nasotracheal tracheosto
    Feel trachea Deviation intubation) my

    Adequate oxygenation, uninterrupted saturation monitoring


    Circulation & Bleeding Control
    • Arteries: ethmoid, ophthalmic, vidian branch of
    internal carotid, maxillary
    • Differentiate: oral bleeding (laceration, tears) &
    skull base bleeding
    • Hemorrhagic shock (1,4%)
    • Purpose: reduced blood lost & protect the airway
    • Pressure packing, manual fracture reduction,
    balloon tamponade, angiography embolization,
    direct ECA ligation
    • Two large bore IV lines
    Bleeding Control
    Clear up airway/Suctioning

    Bleeding Source Identification

    Nasal Oral Scalp, face

    Anterior Posterior Bone fractures Mucosa/soft tissue

    Nasal Ballock / Manual Sutures


    packing balloon reposition
    tampoon

    Persistent Bleeding ECA ligation, embolization


    Thank You

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