TRAUMATOLOGY OF

MAXILLOFACIAL
COMPLEX
Part I

Prof.dr. FARIS FOČO

 TRAUMATOLOGY

INJURY - RANA – vulnus, eris, n.

Open mechanical injury, characterized

by the breakdown of the normal
structure and tissue continue

2
 TRAUMATOLOGY

SOFT TISSUE INJURIES

1. Vulnus contusum – contusion

2. Vulnus lacerum - cleft

3. Vulnus lacerocontusum – laceration

4. Vulnus scissum – swordcut

5. Vulnus punctum – stabwounds

6. Vulnus sclopetarium – gunshot wound

7. Vulnus explosivum - explosive wound

8. Vulnus morsum – bite wound

9. Combustio – burn wound

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus contusum - squashed wound
arises as a result of a blunt, hard object, the edges of the
wound are bent, in the closed areas of the wound,
there are remains of blood clot and / or surrounding
crushed tissue and / or parts of various objects.
The wound area are shallower and deeper parts of the
tissue webs divided.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus lacerum – cleft wound

It strikes with a blunt, hard-toothed object, the edges of the

wound are sharp, partially pricked, in the greater part of the
wound there are deeper parts divided by bridges from the
surrounding tissue.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus lacerocontusum -
laceration

it is caused by the action of a

dull, hard, dirty object, the
edges of the wounds are sharp.

Because of the tension of the

skin, these wounds can often be
replaced by splinters or cutting
wounds.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus scissum – swordcut

It is caused by the action of a sharp bristle object, knife, sheet
metal or glass. The edges are usually smooth, sharp, not
squashed and not bloodshot.

The walls of such wounds are also flat, angular, not squashed
and the bottom is made early.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus secatum - swordcut

It arises directly as a result of the impact of sharp sharp edges-

an ax and the bending of the environment caused by the mass
and the action of the object.
Usually there are flat edges and fairly spaced edges. As a rule
they are deeper than cutting wounds.

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 TRAUMATOLOGY

Vulnus punctum – SOFT TISSUE INJURIES

stabwounds

It is created by the
penetration of a spherical
object into the body (knife,
screwdriver, nails,
needles).
These wounds are
characteristic at great
depth, flat, edges scarce
bleeding into the outer
environment.
Much greater danger is
bleeding into the body's
interior.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus sclopetarium – gunshot wound

It occurs as a result of such projectiles fired from firearms.

Characteristic of them is a small entry wound and a very
large exit wound. Profuse bleeding from the injury,
destruction of tissue abundant.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus explosivum – explosive wound

It occurs as a result of the action of secondary projectiles that

are blown into parts and which, in addition to kinetic energy,
also possess a large amount of heat that flies the tissue
through which it passes. At the same time, the tissues through
which it passes form a slurry.

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 TRAUMATOLOGY

SOFT TISSUE INJURIES

Vulnus morsum – bites injuries

It occurs as a result of the action of the teeth of humans,
animals and insects. The shape of the wound matches the
shape of the tooth.
Possible skin defects depend on the size of the tooth and the
intensity of the injury.

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 TRAUMATOLOGY

• Particular attention should be paid

to the elements that are the basis
of the proper procedure of
inspection and disposal, which are:

1. A (airway),
2. B (bleeding) i
3. C (cervical spine).

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 TRAUMATOLOGY

HIRURŠKA OBRADA RANE

Inspection
Rich wash rash with disinfectant
Eliminating foreign content,
Removal of necrotic tissue and
Establishment of anatomical integrity of appropriate
tissues.
 Provision of sterile surgical field by wetting of the wound
and surrounding by disinfectant means,
 Superfine operation field with sterile compressors,
 Binding of larger blood vessels and primary treatment (6
hours),
 Secondary wound treatment (24 hours),
 Reconstruction by Layers,
 The lining and mucous membrane is spreading with
resorption and the skin with non-rooting tips
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 TRAUMATOLOGY

INDIVIDUAL SUTURES
• The single suture allows for a very precise adaptation of
the wound edges.

• The risk of wound dehiscence is reduced

• The amount of suture in the tissue is also less, and the

blood flow to the area around the wound is less
impeded
• Adverse - The knot stitch takes a lot more time than the
slip stitch, and it consumes significantly more material.

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 TRAUMATOLOGY

INDIVIDUAL SUTURES
Single stitch with
horizontal return
point sec.
ALLGOVER

Free single
stitch with knot
Single stitch with
verical return
stitch sec.
DONATII 16
 TRAUMATOLOGY

EXTENDED SUTURES
• The advantage of a sliding suture lies in the
even wound joining.
• They are used in cases where the wound must
not leak gas or fluid.
• The thread presses both sides of the wound
side by side for the entire length, closing it
tightly.
• Disadvantage - Due to increased tightening,
the supply of blood and nutrients, areas
around the wound, is compromised.
• Sliding seams are performed faster and
material consumption is much less.
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 TRAUMATOLOGY

EXTENDED SUTURES

Twisted and Inverted seam

adapted sliding
Adapted sliding seam
seam

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 TRAUMATOLOGY

EXTENDED SUTURES intradermal

Fig. 1

Fig. 2

Fig. 3
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 TRAUMATOLOGY

KNOTS FOR ENDING OF SUTURES

• The two loops that attach to each other give a

constant knot.
• The first loop, which binds according to the given
circumstances, determines the tension and stability.
• The second loop only fixes the first, so it tightens
tight.
• Bind as few knots as possible, as every seam
material acts as a foreign body.
• End ends are cut off appropriately briefly.

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 TRAUMATOLOGY

Navy knot Surgical knot

Basic knot

Osnovni hirurški čvor

Dvije petlje vezane u
premeće se dvostruko, tako
suprotnom smjeru
da je već relativno siguran.
naliježu jedna na drugu.
To je prednost ovog čvora.
Krajevi konca leže
Nedostaci su količina
paralelno. Povlačenjem
utrošenog materijala i veća
konca čvor se sve više
zapremina.
zateže, što mu daje 21
stabilnost.
 TRAUMATOLOGY

WOUND HEALING

TWO PHASES: 1. EARLY

2. LATE

EARLY PHASE LATE PHASE

1. The granulation tissue
1.Creation of granulation tissue, matures into a connective

2.Maturation of the tissues and 2. Epithelium becomes more

layer squamous epithelium of
3.Changes in the epithelium of the mucous membranes or skin
skin or mucosa in terms of layer
formation, 22
 TRAUMATOLOGY

WOUND HEALING

COMPLICATIONS

Complications can occur at any stage and always end

up creating a scar.

They can be caused by many etiological factors such

as:
• Anemia,
• Hypoproteinemia
• Diabetes,
• Intoxication,
• Avitaminosis and
• Infection.
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 WAR WOUND
SURGICAL TREATMENT

1. Detailed inspection and definitive hemostasis

2. Removal of foreign contents, soft tissue and bone
necrectomy
3. Treatment of wound edges to healthy tissue
4. Definitive wound care at depth, possibly
ostesynthesis, placement of drainage,
5. Fork immobilization by mounting rails by type of
mono or intermaxillary immobilization
6. Moderate compression bandage,
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TRAUMATOLOGY OF
MAXILLOFACIAL
COMPLEX
Part II

Prof.dr. FARIS FOČO

 PRELOM, PRIJELOM – fractura,
ae, f.
Break of bone or cartilage continuity

- INCOMPLETE - COMPLETE

Fractura incompleta Fractura completa

• It only engages the • The fracture line includes

compact and spreads all layers of bone, both
in spongiosis where it external and internal (both
ends, compacts and spongi)
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FACE BONES

- 2 Nazal
- 2 Lakrimal
- 2 Vomer
- 2 Maxille
- 2 Zigoma
- 2 Palatin
-1 Mandibula
- 13 bone total

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CRANIUM BONES

- 1 Frontal
- 1 Okcipital
- 2 Etmoidal
- 2 Sfeniod
- 2 Parijetal
- 2 Temporal
- 10 BONE TOTAL

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 Etiological
factors

Tendecy Trauma

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 TENDER, PREDISPOSITION
REDUCED BONE RESISTANCE

GENERAL PHYSIOLOGICAL LOCAL

CONDITIONS
•MISCELLANEOUS FORMS OF
BONE DISEASES •ERUPTION OF THE DENTAL CYSTS
•RAHITIS LOWER THIRD MOLAR MALIGNE PROCESSES
•OSTEOMALATION •SPACE BETWEEN CANINUS AND
OSTEOMIELITISI
•OSTEITIS OF FIBROS MENTALE OPEN
•OSTEITIS RAREFICANS •COLUMNS OF THE LOWER JAW
•AVITAMINOSIS •FRONT WALL OF THE SINUS
•KAHEXI •ZYGOMATIC REGION
•OSTEOGENESIS IMPERFECTA
•HYPERTHYREOIDISMUS

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TRAUMATOLOGIJA

Fight
Animals Traffic
bites   accident

Spontaneous TRAUMA Fire

  injuries weapon

Cold
Fall weapon
Sports
injuries

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 SIGNS OR SYMPTOMS

SUBJECTIVE SYMPTOMS OBJECTIVE Cardinal SYMPTOMS

1. PAIN (Dolor) 1. ENLARGEMENT (Tumor)
2. DYSFUNCTION(Functio laesa)
3. EDEM (Oedema)
4. PALPABLE SENSITIVITY
5. MALOCLUSION
6. DEFORMATION
7. ABNORMAL MOBILITY
8. CREPITATION
9. TRISMUS
10.HEAT (Calor)
11.COLORIZE (Rubor) 32
 LINE OF FRACTURE

A favorable fracture line -

the direction of its delivery
does not allow the
dislocation of the patrol.

A favorable fracture line

reduces or prevents
subsequent dislocation
and allows far better
conditions for healing
fracture and the
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production of callus.
 LINE OF FRACTURE

Unfavorable fracture line - the

direction of its release allows the
dislocation of the patrol. The strength
of some muscles or a group of
muscles that pull fractured fragments
comes to expression.
This fracture line prevents the
intimate contact of the wound
surfaces of broken fragments, which
compromises healing, which is the
first rule in a series of rules for
healing fractures and the creation34 of
callus.
 m. temporalis

m. maseter

m. temporalis

MUSCLE CLOSERS m. maseter

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 m.pterygoideus lat.

m.mylohyoideus

m.pterygoideus med.

m.pterygoideus med.

m.geniohyoideus
m.digastricus

MUSCLES OPENING
m.pterygoideus lat. AND CLOSING
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 MUSCLES OPENING

m.mylohyoideus m.mylohyoideus

m.geniohyoideus m.digastricus

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 TREATMENT OF FRACTURES

(Repositio) IMMOBILIZATION
(Immobilisatio)

Restoring broken parts to To do something immobile,

their original, normal make the fractured parts of the
position. jaws immobile.

Active - performed by the Temporary - performed in the

patient himself with jaw entirety of facilitating patient
closure movements transport

Passive - by MEDIKUS, Definitive - makes the Medicus

hands or instruments drawn. for therapeutic purposes.
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FORMING OF CALLUS Bone fracture leads to
disruption of blood vessels
and the creation of
hematoma in the line of
fracture.

Without hematoma there

are no conditions for the
formation of callus.

The release of histamine

and acetylcholine, which
dilate blood vessels,
increases blood supply, a
greater breakdown of bone
marrow, and an increase in
protein concentration,
leading to a decrease in
blood pH from 7.4 to 5.639
FORMING OF CALLUS

Creating a sterile
inflammation,

Granulation tissue replaces

with the hematoma

Fibrin coagulates, there is a

rise in connective tissue, on
the outside of the fracture

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 FORMING OF CALLUS

In the period
between the 10th
and 14th. days, a
soft (soft) callus
was created and
we call it FIBROS
KALUS

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FORMING OF CALLUS
At the end of the third
week (20-25 days),
mature fibrocartylaginous
tissue is replaced by
bone tissue.

Calcium carbonate and

calcium phosphate salts
are deposited and
precipitated, which results
in the formation of hard
callus.
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COMPLICATIONS BONE HEALING

EARLY COMPLICATIONS

LATE COMPLICATIONS

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 COMPLICATIONS BONE HEALING

EARLY COMPLICATIONS

•HEMORRHAGE

•INFECTION

•GANGGRENOUS TEETH

•NERVOUS LESION

•GENERAL DISADVANTAGE OF THE PATIENT

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•CHRONIC DISEASES
 COMPLICATIONS BONE HEALING

LATE COMPLICATIONS

• PSEUDOARTHROSIS

• SCAR DEFORMATION

• OSTEOMYELITIS TISSUE REACTION TO

OSTEOSYNTHESIS

• TM ANKYLOSIS MATERIAL

• GROWTH DISTURBANCE FACIAL BONES

AND JAW 45