FACIAL INJURIES

Dept Of Surgery, School of Medicine North Sumatra University

 Surgical Cases

Emergency Elective

Non Injury Injuries

Traffic

Industrial

Home

Job
 75 %
Emergency

Injury

Traffic

Head Injuries

Face

Soft Tissue

Aesthetic
Preventive :
Hard Tissue

• Helmet/seatbelt Function + Aesthetic

• Traffic law 1992

• Insurance
 Facial Injuries
► Outer surface body with
the most exposure and
attention by another
people.
► Event small size if located
in special area, need more
attention (PALNOLI).
► Mechanical force  facial
injuries followed by :
- Head injuries
- Orthopedic injuries
- Hollow organ injuries
- etc.
 EMERGENCY MANAGEMENT
► Severe injuries (+ multiple injuries)
- Clear the airway
- Clear the airway Breath Resuscitation
- Clear the airway
► MANAGEMENT PRIORITY  TRI AGE
1. Clear airway : - blood
- teeth
- foreign body
2. Control hemoirhase : - a. Maxill ext
- a. Tempor. Superficial
- a. Angularis
3. Treat shock/Fluid Resuscitation
 Evaluate

* Bulbis oculi  vision

* Other injuries :
P
- evaluation (GCS) R

- thorax inj. I
O
Life saving - abdom. inj. R

- orthopedic fracture I
T
- Spinal inj. Y
 Type of Facial Injuries
1. Soft tissue injuries  psychosocial aspect
Aim : - Appearance/deformity/
aesthetic complaint

2. Hard tissue injuries (Maxilofacial Fracture)

Aim : - Function ; mastication & facial
aesthetic
 SOFT TISSUE
1. Aesthetic Triangle.
A matter of milimeter
(PALNOLI)
2. Primary suture 24 hours
(Friedrich  6 hours)
3. Anesthesi : local +
Adrenaline
4. Atraumatic suture
off : - in 5 days
- eye lid 3 days
- be care full when
pull out suture
 Scarr Line
► Wound healing min. 6
months.
► Wound edge tension :
3 weeks
► Granulation tissue
 Skin graft
 ASEPSIS

Exposure Debridement

Soft
Non Tissue
Tissue
Tensil Preservation
Injuries

Aproksimation Hemostasis

Atraumatic
 MAXILOFACIAL FRACTURE
► Force mechanism
* Insp : - asimetri  oedem !
* Palp : - bone continuity
- upper & lower jaw (MALLOCCLUSION + )
* Ro- : - Water’s position (mento occip. view)
- Pan-oral view (PANOREX)
- CT Scan
* Th :
- Reduction & MM ficsation (wiring)
- Temporary fixation :
BARTON’S BANDAGE
- Liquid/soft meal
- Oral hygiene
 TYPES
1. NASAL FX.
- Pain, bleeding, nasal breathing
- Ro : fx & deviation
- Th : * Evacuate haematome & seroma
* Reduction 48 hours or after
oedema withdraw
- Compl. : Haematoma
Breath obstruction AESTHETIC

Nasal deformity
 2. MANDIBLE FRACTURE

► Physical inspection : X – PHOTO:panorex

- painfull
- cannot open mouth MALLOCCLUSION
- hypersalivation
- oedema & echimosis
- deformities
- crepitatio
► Location

► Types : - green stick  Fx. line : - horrizontal

- simple
- compound - vertical
- complex
- comminuted
- impacted
 Treatment
Teeth
condition
Reduction

Class 1 Class 2 Class 3

Open Close

Internal Fixation Maxilo Mandible

(MINIPLATE) Fixation (MMF)

• Orbital & Naso Orbital Ethmoid

• Fronto Basilar fx.
• Panfacial fx.
• TM. Joint Dislocation
► Fixation fx :

Wiring,

Arch Bar,

Mini Plate & Screw.

 3. MAXILA FRACTURE
Displacement : Post & Downword
Le Fort

I. Maxila +
II. Maxila + III. Orbita +
Periform
Opertura Nasal Bone Nasal Bone

CRANIOFACIAL
UPPER LEVEL PIRAMIDAL NOE FX
DISJUNCTION

• Th : - Reduction ; * MM Fixation (wiring)

* Miniplate
 4. ZYGOMA FRACTURE

Clinical : - cheek flat X – Ray : * waters

- okymosis orbita & subconjunctive * CT Scan
- diplopia * Tomogram orbit
- enophthalmos Th. : - conservative  oral
- anesthesi n. linfro orbital hygenie fixation

- trouble open/close mouth

TM JOINT.

Dislocation
 RESUME
► FACIAL INJURIES :
1. SOFT TISSUE SPECIAL ATTENTION
PALNOLI.
SCAR AESTHETIC COMPLAINT !
2. HARD TISSUE :
* MAXILOFACIAL FRACTURE
- DIAGNOSE MALLOCCLUTION (+)
- TREATMENT ; REDUCTION & FIXATION
(MMF)

BK SEPT 03