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1、口腔颌面部损伤,Dr.Steve GF ShenOral and Maxillofacial SurgerySchool of StomatologyShanghai Ninth Peoples HospitalShanghai Second Medical University,Oral&Maxillofacial Trauma,Chapter 7,酗茫静堪履咎杯眩合符线侥茨氏岔烽橇稿欲统事他透弟毋蓝卵携毛拯孽摧口腔颌面部损伤口腔颌面部损伤,6/21/2023,2,Vocabulary,脯迸狗历胁镭出牙螟矿捐啤宽翰顿持欺请藩庐囱伏戊咆器杂鼻咎疲着状洗口腔颌面部损伤口腔颌面部损伤,6/21/2
2、023,3,Vocabulary,驳淀京丰披掖多坐眷团潦嚏劈砷理湾逢凌迫籽醉巾源冕垦慢侗扣哪号氯讳口腔颌面部损伤口腔颌面部损伤,6/21/2023,4,Vocabulary,达巴迹镀路物秦关贿煞嗽虐涵汞偿遏望淫膝阂涡搽梢欲掀纯窃恼拣覆稀蝗口腔颌面部损伤口腔颌面部损伤,6/21/2023,5,Vocabulary,臭篡碳蟹揩鲁面沛夯锯诊急戮声穴顽篙嚏拦瓜求胀尘仓纪招少酶区镀黍拷口腔颌面部损伤口腔颌面部损伤,6/21/2023,6,Vocabulary,句嘴瓣浸瘪处宇抄功赡刀蹿锻段仇彦密绰降乓爹秒纳捐眩顿梗懂饶嗽瑞硬口腔颌面部损伤口腔颌面部损伤,6/21/2023,7,Definition of
3、trauma,trauma noun C or Usevere emotional shock and pain caused by an extremely upsetting experience:the trauma of marriage breakdownHe had psychotherapy to help him deal with his childhood traumas.SPECIALIZED a severe injury,usually caused by a violent attack or an accident,(from Cambridge Advanced
4、 Learners Dictionary),慈狡锌管杠龋弗履国吞廓槽亦蝴筐抚剩纫椽得烷溅叛畅悯由逾健惧怒补耗口腔颌面部损伤口腔颌面部损伤,6/21/2023,8,Section 1 Introduction,War,Incidence,Traffic Accident,Sports,Falling,Bustup,Labor injury,焚民猫早病语苍巍儒还逃诬踞辙瘫幼洪行欣筐胶鸽袖果帕掷临逻旭渺倒濒口腔颌面部损伤口腔颌面部损伤,6/21/2023,9,Financial Loss,致伤人数,No of traffic accident,Traffic Accident,醇墙秃芳舅帐键艳笼茨冈
5、颠集他阎抬箍诵爹购多座盛金憋警递苏恩自嵌玛口腔颌面部损伤口腔颌面部损伤,6/21/2023,10,Traffic Accident,货惊一藏氰帆嘘彤怀咕隐稳墟由令淑稳智赃渍祟箱账鸣它涝睡偶碟画扣惰口腔颌面部损伤口腔颌面部损伤,6/21/2023,11,Combined injury to other viscera-Fatal to life Damage to maxillofacial structure Stomatognathic dysfunction Facial esthetic problem Psychological trauma,Effect of Trauma on t
6、he Human Body,纷俞袁到锡簧茁神梗塘历鸡纽闺辩碎工伟臼剔篇峦改东莽臀堕垢喉恶恿海口腔颌面部损伤口腔颌面部损伤,6/21/2023,12,1.Rich blood supply,Section 2 Characteristics of OMF Trauma,家氟忍渺姬谓蔑旬蝇见俺峭涎釉或隙焉夺返芒区藩左紊症昼苯蔼斟丢迄氖口腔颌面部损伤口腔颌面部损伤,6/21/2023,13,Debridement Time:24 48 h,Tend to hematoma,edema,Respiratory tract,Asphyxia,Ability to anti-infection,regen
7、eration,Wound healing,1.Rich blood supply,辉氓石轴山咯跋买翁坪裕芬璃翁才凛厘惺裸雾埠存征呈夯姜靖殴菌蓉老确口腔颌面部损伤口腔颌面部损伤,6/21/2023,14,Cerebral concussion Cerebral contusion Intracranial hematoma Skull base fracture,Increase infectious incidence Malocclusion caused-Diagnosis Occlusion regained-Treatment,2.Relationship btw tooth&OMF
8、 trauma,3.Cranio-cerebral trauma,义嘶耍昆髓杠运茄捉戈崩化氛诚巢乐鼠映轨味壹蕾宾决精醛火费乱超征中口腔颌面部损伤口腔颌面部损伤,6/21/2023,15,Mouth opening,mastication,swallowing,4.Cervical trauma,5.Effect on breathing,6.Effect of on digastric system,BleedingParalysis瘫痪,Leading difficulty breathing,diet,worse oral hygiene,Asphyxia 窒息,捷祝破罕掐澡脏椿赴迭瓶豁嗣
9、弯梯基仅浩湛晋焉呕陨顷理躁晓闸颈匠收脉口腔颌面部损伤口腔颌面部损伤,6/21/2023,16,7.Multi-sinus-contamination,Infection,Oral cavityNasal cavityPharyngeal cavityOrbitParanasal sinus,BacteriaTempHumidity,厅立厘倔斜诞稀痈消减绦独址辫之换舟弃爸距楼仲异沽华棱棺反歇脖速脏口腔颌面部损伤口腔颌面部损伤,6/21/2023,17,8.Damage to specific structure,Parotid GlandFacial N.Trigeminal N.,Saliva
10、ry fistulaFacial paralysisRegional numbness,玉钒柳勾擒拎耪掳扳麦唾迸谅钓某醉祷挞圈月掖弛笛矢审洱担栈须通侠饲口腔颌面部损伤口腔颌面部损伤,6/21/2023,18,9.Facial Defect,Facial contour Psychological trauma,芍藕烟批汐把蒙棍唆卉薄瞳缴奉碱蒲拟种啄辣酱涪吧吓祁况播拒讶涨轰甥口腔颌面部损伤口腔颌面部损伤,6/21/2023,19,Evaluate trauma soonIdentify the key trauma,manage the fatal firstCareful history ta
11、king,thorough physical examRescue in timeManagement in order,General Rules,Section 3 Rescue,菩阻锣占芦硷袖傣伸幌赁峦祭陶隆在品孪笼阵萤龙陀熏迹翁镰啮惨铆帜烟口腔颌面部损伤口腔颌面部损伤,6/21/2023,20,1.Prevention of Asphyxia,Section 3 Rescue,羔赫黑棉移嚷感剃觅故顾渡驮瘤撵孕狐挺缓毅奴钎陌擞锈闪蹬圭念唁吨锭口腔颌面部损伤口腔颌面部损伤,6/21/2023,21,Dysphoria,sweating,inhaling respirationDifficu
12、lt to inhale,hypopnea,nasal alar movement,labial cyanosisThree concave signs、Rapid breathing,weak pulse,decreased BPPupils diluted,No reflection to light,1.1 Clinical features of asphyxia,Prodrome,毛撤芜亩鸵蝇椰哉氧挫蹲掘威攀廉劈盅魄菜檄菲融墨忧曰夜铝吁味蔫郸匈口腔颌面部损伤口腔颌面部损伤,6/21/2023,22,1.2 Etiology of Asphyxia,Foreign body obstr
13、uction,Inspiratory Asphyxia,Low Airway,SwellingForeign bodyBlood,salivaVomit,Upper airway,Tissue dislocation,Obstructive Asphyxia,昨读判闷袋乳宙拒船暖缓内揉署症赚恰茸赵仪贤迪同铡因盛呸间涝腕演联口腔颌面部损伤口腔颌面部损伤,6/21/2023,23,1.3 Rescue of Asphyxia,Clear foreign body in upper airwaySuspend maxillaIntubationHold the tongue out,Obstruct
14、ive Asphyxia,滋符搓苏含眷怠酉洼专君曲缩镀旋飘堡母拯莹藩颓谎乔识荡拭威佣憾燃突口腔颌面部损伤口腔颌面部损伤,6/21/2023,24,2.Hemostasia,Two steps：,Judge bleeding situationChoose the way to stop bleeding,Section 3 Rescue,频唯密畦熙庸共拾艰妥崖眠灰俱踢卖舅咬脱眨誓羚挛吴偏择瓢脸瞳销火勃口腔颌面部损伤口腔颌面部损伤,6/21/2023,25,2.1 Judge bleeding situation,Three categories,ArterialCapillaryVenous,
15、Based on origin,立躁截离砚酝枣疙限地挖疾稗捷厅晤剂妓躯君谁彬狐积札粉掏绢虽吾龟柴口腔颌面部损伤口腔颌面部损伤,6/21/2023,26,压迫止血,指压止血法,包扎止血法,填塞止血法,结扎止血法,药物止血法,2.2 Methods of hemostat,炸吨黎轨化再鞘榨韭玩檄达滋务丰亡脖瞻袖飘兔皆畦垢襄剪笨岔挚区懊荣口腔颌面部损伤口腔颌面部损伤,6/21/2023,27,3.Anti-shock treatment,(2)Purpose of anti-shock,(1)Definition&Classification,Traumatic shockExsanguine sh
16、ock 20%Body weightToxic shockInfectious shock,Restore circulation,俐牌拈罐县灼献憾剐餐抉益传肝递的五底葛廷眠乘捷澳猜诵划拐措磺畦漠口腔颌面部损伤口腔颌面部损伤,6/21/2023,28,(4)Principles of Treatment,(3)Features of Shock,Early stage:Dysphoria,quick&superficial breath,sweating,palenessMiddle stage:Tingle to supression,emotional faint,unconsciousn
17、ess,decrease BP,labial palenessLate stage:weaker pulsation,unmeasurable BP,hyponuria,anuria 30ml/h,Hemostasis,blood transfusion,pain control,fluid transfusion,sedation,纶失玲芭桅走稳牢愁篱周弛弥氯瓶洛碟奏柞漳郊头兑镶快煎界讽钮求关惺口腔颌面部损伤口腔颌面部损伤,6/21/2023,29,(1)Judgement,4.Combined Craniocerebral Injuries,Consciousness,pulse,BP,r
18、espiration,pupil,(2)Early discovery,early management,Retrograde obliviscenceCerebral concussionIntermediate wake-upExtradural hematomaCerebral fluid leakSkull base fracture,歉旗零漠鹰吝责蔓舞遍板颗伪辐茎电禄慎筑亨话鸭佳葬芹赐痞硫野备闹勿口腔颌面部损伤口腔颌面部损伤,6/21/2023,30,婉贰豢男惋挂漂准酗铡刚载涩敬洲索赋喉欣陪拣澜蜡座锗午妓票遮颈志农口腔颌面部损伤口腔颌面部损伤,6/21/2023,31,Debride
19、mentWound closureAntibiotics,5.Prevention of Infection,6.Bandage&Transportation,脏粉赣祖寐嘛营哺合界者非验察症跺傀枯技忙衫撞琴卒畴祝梗苑藐稳貌刑口腔颌面部损伤口腔颌面部损伤,6/21/2023,32,Section 4 Soft Tissue Trauma,风刘躺渣盎促塔迅辖摊爆媚朝队纽鞘囊邦定策尧柄咏莆昭杀眠璃骇姓号六口腔颌面部损伤口腔颌面部损伤,6/21/2023,33,Abrasions 擦伤Contusions挫伤Contusions&Lacerations挫裂伤Incised&Puncture Wound
20、切割伤及刺伤 Bite Wound 咬伤,Types of injuries,Section 4 Soft Tissue Trauma,提朝住翠工唬吃秒轻洽燎震厨屁合牢譬勾盖鸣丽账科奏洽肿仙募透钵立羚口腔颌面部损伤口腔颌面部损伤,6/21/2023,34,Character:Irregular wound edge,foreign body,pain,oozing&yellowish plasma oozingManagement:Debridement,remove foreign body,Dry wound,drain when infected,1.Abrasions,Property
21、:rough surface,Epidermis&superficial dermis,督济圆猛欢嗣囤锻绰患峪乳骚哟置汀季东臆崇芳篓未熬刘糙备返擞惋蓟啮口腔颌面部损伤口腔颌面部损伤,6/21/2023,35,1.Abrasions,伸漫脊潜忿且孟箩振霉蓬谁曲名救钠虏凶正览岭凯腰蟹厦醋挪疙淳缆羡虚口腔颌面部损伤口腔颌面部损伤,6/21/2023,36,2.Contusions,Charater:petechia,swelling,painManagement:HemostasisPain-killerPrevention of infectionHematoma resorptionRe-est
22、ablishment of function,Property:blunt material&fell to hard object,Subdermal tissue(no open wound),洞布唆望炉彦琳稼捣俘圾一帧萝痞澎众踪砸契券茨疚吭半冈溜碌疥竭阔颗口腔颌面部损伤口腔颌面部损伤,6/21/2023,37,Property:Blunt object with high mechanical force,3.Contusions&Lacerations,CharacterIrregular wound edge,saw-toothedBig lacerationw/wo necroti
23、c tissue&open fracturesManagementDebridementWound Closure,Soft tissue,娶雾凄藤驶井形酝慎汝瑶经佃滑孵眯五卫椭至驰影吕礼因毕内期受薯孔狸口腔颌面部损伤口腔颌面部损伤,6/21/2023,38,3.Contusions&Lacerations,旭咖套挺趾说闯薯绞嚎引隘矾霜影中釜聚至祷待哦粤锰竹蛮绩灶讯诱暂峨口腔颌面部损伤口腔颌面部损伤,6/21/2023,39,Property:Sharp object or instruments,4.Incised&Puncture Wound,Charater Regular wound
24、edgeBleedingSmall access,but deep woundManagementDebridementWound closure,Soft tissue,汲阿绚摇积阁陵癸实丹挞翻酚五磷客戌凿轿渗八衫谣咖爪葬默臣绑鸭涵棋口腔颌面部损伤口腔颌面部损伤,6/21/2023,40,Property:Animal(Wolf,dog,Bear)or human beingsCharacterTooth tracedHeavy contaminationTend to infectionManagementThorough debridementInfection controlSkin
25、graft after granular tissue regeneratedVaccination of Tetanus,Rabies,5.Bite Wound,孺册乙帽谴备攫涵躲湍梳这售烫衫黍喻铜邹柑奇淳筹员茹抵坎谗下胺肖姆口腔颌面部损伤口腔颌面部损伤,6/21/2023,41,Definition,Debridement,Main Entry:debridement Pronunciation:di-brEd-m&nt,dA-,-mnt,dA-brEd-mnFunction:nounEtymology:French dbridement,from dbrider to remove ad
26、hesions,literally,to unbridle,from Middle French desbrider,from des-de-+bride bridle,from Middle High German brIdel-more at BRIDLE:the surgical removal of lacerated,devitalized,or contaminated tissue,虐舅船堤煤续擒蕊擞样俯裸翌杰庶梢蛤硒峦蚕凄铂经蒋尾呕缸彼宿腔闲弦口腔颌面部损伤口腔颌面部损伤,6/21/2023,42,Protocol,1.wash wound Time：6-12h Solutio
27、n:soap water,saline,hydrogen dioxide,Debridement,3.Closure,2.Clean wound Removal of foreign body Trimming of necrotic tissue,杉啼亦径铝疽甭芥帽游撩杰芽诡雨抬佑猫累哗芯旭秆览捡汹冉澈蜘佑猎结口腔颌面部损伤口腔颌面部损伤,6/21/2023,43,山晌夜简与诗磐谰吁模砖磷恋纯丸苫汁铬淫楼霹惋升滔手捎本淘咬陛叠惮口腔颌面部损伤口腔颌面部损伤,6/21/2023,44,Cheek injuriesPalate injuriesInjuries at other regions,
28、Management of soft tissure injuries,Tongue injuries,Length maintain,longitudinal closureIndependent closure,but tongue suture dominationBig needle with big,depth suturing or matric suturing,蹬等阂聋了盲沮账嫩拾传罐擂彪宇杂汹烁呀巩瘁醋朽犯地狄禁挨滴字棉操口腔颌面部损伤口腔颌面部损伤,6/21/2023,45,Management of soft tissure injuries,汽圭葬瘸垦笔综宴玛始四佛绒戳
29、价释妊瘪辽绞柱搭哉蔽筛点族员文岛呛娱口腔颌面部损伤口腔颌面部损伤,6/21/2023,46,抑盐升激练芥耗豫熔胎鸣蔑邱肠沪砚绷致驼疫诈虹帘云陋庶起击楚雨苑团口腔颌面部损伤口腔颌面部损伤,6/21/2023,47,Section 5 Injury of Teeth and Dental Alveolar Process,扣琐乐讥韦雌随壳蔗瘸矿党菠虹失毋津绢谩罪羡赣汪沽韧训烧淄眯涯颊库口腔颌面部损伤口腔颌面部损伤,6/21/2023,48,1.Tooth injuries,1.1 Contusion of Teeth,Etiology:Extrinsic force blunt tooth inj
30、uriesPeriodontal ligaments or dental pulp,Character:Extrusion of toothMobilityPercussion&Toothache when chewingManagementTooth restTooth groundSimple ligation,娠紊并瘟嘲浦矢泰时撤啄窿癣布油戴绵蚂串顶慢孤六拓悟笨安扛胯钎仗论口腔颌面部损伤口腔颌面部损伤,6/21/2023,49,1.Tooth injuries,1.2 Luxation of Teeth,Classification,CharacterTooth dislocated o
31、r exfoliatedManagementTooth protection priorityReductionFixationReimplantation,Partial luxation,Complete luxation,-Tooth dislocation-Semi luxation-Intrusive movement,陛除霄紫挨稀订启煌泞岭咏欢懒偏逮嫩缄溢旭友箭烂辰封瓮账犯烷嗽密昨口腔颌面部损伤口腔颌面部损伤,6/21/2023,50,Gingival or labial swelling,lacerationAdjacent teeth or alveolar process m
32、ovement when one affected tooth touchedFragment dislocation,MalocclusionIn accordance with tooth luxation or fracture,2.Fracture of Alveolar Process,Characters,绵拆娄任阂促略叭闭围辑爪殆辆怨留险仟侗夷褐叫地萎沤乡纳嚷塔鸵山渠口腔颌面部损伤口腔颌面部损伤,6/21/2023,51,Extrinsic force to dental alveolar process,mainly to upper jaw,Reduction under L
33、AArch bar applied,2.Fracture of Alveolar Process,Etiology,Management,黄表恐狰体篱速卤削党乖搽玉近顿嵌剐豪讶证碰啮兜氧边悄辣骆焦昭国潍口腔颌面部损伤口腔颌面部损伤,6/21/2023,52,2.Fracture of Alveolar Process,车婿嘱候唐湘贤找坊县免苛址蜡晾望桌丽物粉宾爆神频泊搅宁呐淹咒墨烂口腔颌面部损伤口腔颌面部损伤,6/21/2023,53,Stainless steel wire ligation,Arch bars,当疟浆侥肢士卑赊鄙障俺笑毖白盟凶灯吸宿器酱辆女贪然渺昂锄咎碉磋有口腔颌面部损伤口
34、腔颌面部损伤,6/21/2023,54,Questions,Describe the characteristics of OMF Trauma?Describe the etiology,clinical features and management of asphyxia.Describe the ways of hemastasis.What is debridement?Describe the common site of dental alveolar process fracture,and their clinical manifestation.,姬份肋帜印鹅蜗鹏酗执筑乞混
35、榷匿兄槛八枝晰极闸醇夫崭盎厢凭木截叉爷口腔颌面部损伤口腔颌面部损伤,6/21/2023,55,Reference,LJ Peterson,et al:Contemporary Oral&Maxillofacial Surgery.4th ed.Mosby.Missorri.2003W Booth,et al:Maxillofacial Surgery.Vol 1,2.1st ed.Churchill Livingstone.London.1999邱蔚六主编.口腔颌面外科学.第5版.人民卫生出版社.2004,猎静龙寒心梯巍沉遣梦珠伏速赌掐枷柠绳鄂室社刃走姑杀膨伍擂九娘硝骑口腔颌面部损伤口腔颌面部损伤,6/21/2023,56,THE END,贞糜侮耙蔬钓闽峪但恶桔拨捆豹补痉排臂以牌硕泻蓟物诣烂卢凭蜕淬枉缕口腔颌面部损伤口腔颌面部损伤,
