INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES • FUNCTION
“APPEARANCE”
• SMELL
• EAT
• SEE
• HEAR
• TALK
• BREATHE www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES TRAUMA: PHYSICAL FORCE RESULTS IN INJURY
F = mv2 ETIOLOGY • ASSAULTS • FALL • INDUSTRIAL ACCIDENTS • RTA • SPORTS INJURIES • WAR INJURIES GK / MAXFAC SDM DHARWAD
www.indiandentalacademy.com
MAXILLOFACIAL INJURIES SERIOUS TRAUMA: DEATH TRIMODAL DISTRIBUTION • SECONDS TO MINUTES • MINUTES TO HOURS (GOLDEN HOUR) • AFTER DAYS
www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR
COMPLICATIONS UNRECOGNIZED SERIOUS
AIRWAY CERVICAL SPINE HAEMORRHAGE www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR
AIRWAY BREATHING CIRCULATION DEFORMITY EXPOSURE www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR AIRWAY • SUCTION • CHIN LIFT - JAW THRUST • AIRWAYS • CRICO / TRACHY • OXYGEN
www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR BREATHING CHEST INJURY • Pneumothorax • Cardiac tamponade • Ruptured diaphragm www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR
CIRCULATION I.V. ACCESS TRANSFUSION Hypovolemia- SHOCK
www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR: CIRCULATION
Hypovolemic shock • Tachycardia • Hypotension • Cold clammy skin • Loss of peripheral pulse • Falling urinary output • Confusion & disorientation www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES GOLDEN HOUR DISABILITY Patient’s response ‘AVPU’ Awake Verbal stimuli Painful stimuli Unconscious www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES DIAGNOSIS & TREATMENT PLAN Eye witness report Clinical diagnosis (ABCDE) Neurological examination
- G.C.S - Cranial Nerves www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
EYE OPENING
MOTOR RESPONSE
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VERBAL RESPONSE
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES Secondary survey ABDOMEN Occult blood sequestration Tenderness / acute abdomen Gastric decompression (N.G tube) Direct peritoneal lavage www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES Secondary survey EXTREMITIES Reduced perfusion Traumatic amputation Compartmental Syndrome Site for major blood loss (1-6 units) www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES EXTRA-ORAL EXAMINATION
Inspection •
Swelling
•
Hematoma
•
Skin lacerations / defects
•
Facial nerve
•
Mouth opening
www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES EXTRA-ORAL EXAMINATION
Palpation •
Tenderness
•
Crepitation
•
Contour irregularities (step)
•
Depressed / Penetrating bone www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES EXTRA-ORAL EXAMINATION
Soft tissues
(contusion
tissue loss) Foreign bodies Nerves Ducts Blood vessels
(remember tetanus)
www.indiandentalacademy.com (NOSE / EAR / EYE)
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES INTRA-ORAL EXAMINATION
Inspection • Asymmetry, Swelling • Bleeding, Hematoma • Occlusal plane / Step deformity • Mucosal lacerations • Teeth: fracture avulsion dislocation www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES INTRA-ORAL EXAMINATION
Palpation • Bimanual • Tenderness • # line / Step deformity • Crepitation • Teeth movement, Number • Missing parts • Sensory distribution V1 - V3 www.indiandentalacademy.com
( SALIVARY GLANDS / TONGUE / PALATE )
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES RADIOGRAPHIC EXAMINATION (based on clinical examination) Plain radiographs Location & Severity of fractures Radio-opaque foreign bodies
CT scans Intra-cranial injuries Orbital & naso-ethmoidal injuries www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES Primary management (ABCDE) Neurological assessment (GCS) Control of pain analgesics Control of infection antibiotics Surgical planning
GK / MAXFAC SDM DHARWAD
www.indiandentalacademy.com
MAXILLOFACIAL INJURIES Classification of fractures 1)Relation to overlying soft tissues Closed / Simple Open / Compound Complicated
2)Type of fracture Green stick Single Multiple Comminuted
www.indiandentalacademy.com ( oblique / transverse / sagittal & degree of dislocation )
GK / MAXFAC SDM DHARWAD
MAXILLOFACIAL INJURIES Classification of fractures
3) Anatomical Location Additional features •
Pathologic
•
Atrophic
•
Impacted
•
Direct / indirect (contra-coup)
•
Blow out / in www.indiandentalacademy.com
GK / MAXFAC SDM DHARWAD
Thank You
Leader in continuing dental education www.indiandentalacademy.com
www.indiandentalacademy.com