口腔頜面部損傷Dr.SteveGFShenOralandMaxillofacialSurgerySchoolofStomatologyShanghaiNinthPeople’sHospitalShanghaiSecondMedicalUniversityOral&MaxillofacialTraumaChapter7口腔頜面部損傷Vocabularyabrasion擦傷adjacenttooth鄰牙alar鼻翼的antibiotics抗生素anti-infection抗感染anuria無尿archbar牙弓夾板arterial動脈的asphyxia窒息bandage綁帶bitewound咬傷bloodsupply血供bustup斗毆capillary毛細血管的cerebral腦的cerebralfluid腦脊液cervical頸的concussion震蕩contaminate污染contusion挫傷2024/11/12口腔頜面部損傷Vocabularycyanosis發(fā)紺debridement清創(chuàng)術(shù)alveolarprocess齒槽突dentalpulp牙髓devitalize失活dysfunction功能異常dysphoria煩躁不安edema水腫esthetic美學的exfoliate脫落exsanguine失血的extradural硬腦膜外的extrinsicforce外力extrusion突出的facialnerve面神經(jīng)foreignbody異物fracture骨折gingival牙齦的hematoma血腫hemostasia止血，止血法2024/11/13口腔頜面部損傷Vocabularyhemostat止血鉗hyponuria少尿hypopnea低通氣incisedwound切割傷inhale吸氣inspiratoryasphyxia吸入性窒息intracranial顱內(nèi)的intubation插管lacerate撕裂laceration撕裂ligation結(jié)扎luxation脫位malocclusion咬合錯亂mandible下頜骨mastication咀嚼m(xù)axilla上頜骨maxillofacial頜面的mouthopening張口度nasalcavity鼻腔obliviscence遺忘2024/11/14口腔頜面部損傷Vocabularyobstructiveasphyxia阻塞性窒息occlusion咬合oralcavity口腔oralhygiene口腔衛(wèi)生orbit眼眶pain-killer止痛劑paralysis癱瘓paranasalsinus副鼻竇parotidgland腮腺percussion叩診periodontalligament牙周韌帶petechia瘀斑，瘀點pharyngealcavity咽腔plasma血漿psychological心理的psychotherapy精神療法rabies狂犬病regenerate再生reimplantation再植rescue營救，搶救2024/11/15口腔頜面部損傷Vocabularyrespiratory呼吸的saliva涎液，唾液salivary涎液的shock休克skullbase顱底stomatognathic口頜的subdermal皮下的swallow吞咽sweat出汗tetanus破傷風toothache牙疼toxicshock中毒性休克transportation運輸，搬運trauma損傷，外傷trigeminalnerve三叉神經(jīng)unconsciousness神志不清upperairway上呼吸道vaccination接種疫苗venous靜脈的viscera內(nèi)臟2024/11/16口腔頜面部損傷Definitionoftraumatrauma

noun[CorU]severeemotionalshockandpaincausedbyanextremelyupsettingexperience:

thetraumaofmarriagebreakdown

Hehadpsychotherapytohelphimdealwithhischildhoodtraumas.SPECIALIZEDasevereinjury,usuallycausedbyaviolentattackoranaccident(fromCambridgeAdvancedLearner'sDictionary)2024/11/17口腔頜面部損傷Section1IntroductionWarIncidenceTrafficAccidentSportsFallingBustupLaborinjury2024/11/18口腔頜面部損傷24萬14.2萬人10億元1993年1997年2001年30萬19萬人18.5億元75.5萬54.6萬人3.09bRMBFinancialLoss致傷人數(shù)NooftrafficaccidentTrafficAccident2024/11/19口腔頜面部損傷TrafficAccident2024/11/110口腔頜面部損傷

Combinedinjurytootherviscera-Fataltolife

Damagetomaxillofacialstructure

Stomatognathicdysfunction

Facialestheticproblem

PsychologicaltraumaEffectofTraumaontheHumanBody2024/11/111口腔頜面部損傷1.RichbloodsupplySection2CharacteristicsofOMFTrauma2024/11/112口腔頜面部損傷DebridementTime:24–48hTendto hematoma,edemaRespiratorytractAsphyxiaAbilitytoanti-infection,regenerationWoundhealing1.Richbloodsupply2024/11/113口腔頜面部損傷

Cerebralconcussion

Cerebralcontusion

Intracranialhematoma

Skullbasefracture

Increaseinfectiousincidence

Malocclusioncaused-Diagnosis

Occlusionregained-Treatment2.Relationshipbtwtooth&OMFtrauma3.Cranio-cerebraltrauma2024/11/114口腔頜面部損傷Mouthopening,mastication,swallowing4.Cervicaltrauma5.Effectonbreathing6.EffectofondigastricsystemBleedingParalysis 癱瘓LeadingdifficultybreathingdietworseoralhygieneAsphyxia窒息2024/11/115口腔頜面部損傷7.Multi-sinus

-contamination

InfectionOralcavityNasalcavityPharyngealcavityOrbitParanasalsinusBacteriaTempHumidity2024/11/116口腔頜面部損傷8.DamagetospecificstructureParotidGlandFacialN.TrigeminalN.SalivaryfistulaFacialparalysisRegionalnumbness2024/11/117口腔頜面部損傷9.FacialDefect

FacialcontourPsychologicaltrauma2024/11/118口腔頜面部損傷EvaluatetraumasoonIdentifythekeytrauma,managethefatalfirstCarefulhistorytaking,thoroughphysicalexamRescueintimeManagementinorderGeneralRulesSection3Rescue2024/11/119口腔頜面部損傷1.PreventionofAsphyxiaSection3Rescue2024/11/120口腔頜面部損傷Dysphoria,sweating,inhalingrespirationDifficulttoinhale,hypopnea,nasalalarmovement,labialcyanosisThreeconcavesigns、Rapidbreathing,weakpulse,decreasedBPPupilsdiluted,Noreflectiontolight1.1ClinicalfeaturesofasphyxiaProdrome2024/11/121口腔頜面部損傷1.2

EtiologyofAsphyxia

ForeignbodyobstructionInspiratoryAsphyxiaLowAirwaySwellingForeignbodyBlood,salivaVomitUpperairwayTissuedislocation

ObstructiveAsphyxia2024/11/122口腔頜面部損傷1.3

RescueofAsphyxiaClearforeignbodyinupperairwaySuspendmaxillaIntubationHoldthetongueoutObstructiveAsphyxia吸入性窒息氣管切開術(shù)2024/11/123口腔頜面部損傷

2.HemostasiaTwosteps：JudgebleedingsituationChoosethewaytostopbleedingSection3Rescue2024/11/124口腔頜面部損傷2.1

JudgebleedingsituationThreecategoriesArterialCapillaryVenousBasedonorigin2024/11/125口腔頜面部損傷壓迫止血指壓止血法包扎止血法填塞止血法結(jié)扎止血法藥物止血法2.2

Methodsofhemostat2024/11/126口腔頜面部損傷3.Anti-shocktreatment(2)

Purposeofanti-shock(1)

Definition&Classification

TraumaticshockExsanguineshock

>20%BodyweightToxicshockInfectiousshock

Restorecirculation2024/11/127口腔頜面部損傷(4)

PrinciplesofTreatment

(3)

FeaturesofShockEarlystage:Dysphoria,quick&superficialbreath,sweating,palenessMiddlestage:Tingletosupression,emotionalfaint,unconsciousness,decreaseBP,labialpalenessLatestage:weakerpulsation,unmeasurableBP,hyponuria,anuria<30ml/hHemostasis,bloodtransfusion,paincontrol,fluidtransfusion,sedation2024/11/128口腔頜面部損傷(1)

Judgement4.CombinedCraniocerebralInjuriesConsciousness,pulse,BP,respiration,pupil(2)Earlydiscovery,earlymanagementRetrogradeobliviscence CerebralconcussionIntermediatewake-up ExtraduralhematomaCerebralfluidleak Skullbasefracture2024/11/129口腔頜面部損傷2024/11/130口腔頜面部損傷DebridementWoundclosureAntibiotics5.PreventionofInfection6.Bandage&Transportation2024/11/131口腔頜面部損傷

Section4SoftTissueTrauma2024/11/132口腔頜面部損傷Abrasions 擦傷Contusions 挫傷Contusions&Lacerations 挫裂傷Incised&PunctureWound 切割傷及刺傷BiteWound

咬傷TypesofinjuriesSection4SoftTissueTrauma2024/11/133口腔頜面部損傷Character:Irregularwoundedge,foreignbody,pain,oozing&yellowishplasmaoozingManagement:Debridement,removeforeignbody,Drywound,drainwheninfected1.AbrasionsProperty:roughsurfaceEpidermis&superficialdermis2024/11/134口腔頜面部損傷1.Abrasions2024/11/135口腔頜面部損傷2.ContusionsCharater:petechia,swelling,painManagement:

HemostasisPain-killerPreventionofinfectionHematomaresorptionRe-establishmentoffunctionProperty:bluntmaterial&felltohardobjectSubdermaltissue(noopenwound)2024/11/136口腔頜面部損傷Property:Bluntobjectwithhighmechanicalforce3.Contusions&LacerationsCharacterIrregularwoundedge,saw-toothedBiglacerationw/wonecrotictissue&openfracturesManagementDebridementWoundClosureSofttissue2024/11/137口腔頜面部損傷3.Contusions&Lacerations2024/11/138口腔頜面部損傷Property:Sharpobjectorinstruments4.Incised&PunctureWoundCharater

RegularwoundedgeBleedingSmallaccess,butdeepwoundManagementDebridementWoundclosureSofttissue2024/11/139口腔頜面部損傷Property:Animal(Wolf,dog,Bear)orhumanbeingsCharacterToothtracedHeavycontaminationTendtoinfectionManagementThoroughdebridementInfectioncontrolSkingraftaftergranulartissueregeneratedVaccinationofTetanus,Rabies5.BiteWound2024/11/140口腔頜面部損傷DefinitionDebridement

MainEntry:de·bride·ment

Pronunciation:di-'brEd-m&nt,dA-,-"m?nt,dA-brEd-'m?n

Function:

noun

Etymology:Frenchdébridement,fromdébridertoremoveadhesions,literally,tounbridle,fromMiddleFrenchdesbrider,fromdes-de-+bridebridle,fromMiddleHighGermanbrIdel--moreatBRIDLE

:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue2024/11/141口腔頜面部損傷Protocol1.washwound

Time：6--12h

Solution:soapwater,saline,hydrogendioxideDebridement3.Closure2.Cleanwound

Removalofforeignbody Trimmingofnecrotictissue2024/11/142口腔頜面部損傷2024/11/143口腔頜面部損傷CheekinjuriesPalateinjuriesInjuriesatotherregionsManagementofsofttissureinjuriesTongueinjuriesLengthmaintain,longitudinalclosureIndependentclosure,buttonguesuturedominationBigneedlewithbig,depthsuturingormatricsuturing2024/11/144口腔頜面部損傷Managementofsofttissureinjuries2024/11/145口腔頜面部損傷2024/11/146口腔頜面部損傷Section5InjuryofTeethandDentalAlveolarProcess2024/11/147口腔頜面部損傷1.Toothinjuries

1.1ContusionofTeethEtiology:Extrinsicforce blunttoothinjuries

PeriodontalligamentsordentalpulpCharacter:ExtrusionoftoothMobilityPercussion&ToothachewhenchewingManagementToothrestToothgroundSimpleligation2024/11/148口腔頜面部損傷1.Toothinjuries

1.2LuxationofTeethClassificationCharacterToothdislocatedorexfoliatedManagementToothprotectionpriorityReductionFixationReimplantationPartialluxationCompleteluxation-Toothdislocation-Semiluxation-Intrusivemovement2024/11/149口腔頜面部損傷Gingivalorlabialswelling,lacerationAdjacentteethoralveolarprocessmovementwhenoneaffec