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1、口腔颌面部损伤,Dr. Steve GF Shen Oral and Maxillofacial Surgery School of Stomatology Shanghai Ninth Peoples Hospital Shanghai Second Medical University,Oral & Maxillofacial Trauma,Chapter 7,10/5/2018,2,Vocabulary,10/5/2018,3,Vocabulary,10/5/2018,4,Vocabulary,10/5/2018,5,Vocabulary,10/5/2018,6,Vocabulary,1
2、0/5/2018,7,Definition of trauma,trauma noun C or U severe emotional shock and pain caused by an extremely upsetting experience: the trauma of marriage breakdown He had psychotherapy to help him deal with his childhood traumas. SPECIALIZED a severe injury, usually caused by a violent attack or an acc
3、ident,(from Cambridge Advanced Learners Dictionary),10/5/2018,8,Section 1 Introduction,War,Incidence,Traffic Accident,Sports,Falling,Bustup,Labor injury,10/5/2018,9,Financial Loss,致伤人数,No of traffic accident,Traffic Accident,10/5/2018,10,Traffic Accident,10/5/2018,11,Combined injury to other viscera
4、 -Fatal to lifeDamage to maxillofacial structureStomatognathic dysfunctionFacial esthetic problemPsychological trauma,Effect of Trauma on the Human Body,10/5/2018,12,1. Rich blood supply,Section 2 Characteristics of OMF Trauma,10/5/2018,13,Debridement Time: 24 48 h,Tend to hematoma, edema,Respirator
5、ytract,Asphyxia,Ability to anti-infection, regeneration,Wound healing,1. Rich blood supply,10/5/2018,14,Cerebral concussionCerebral contusionIntracranial hematomaSkull base fracture,Increase infectious incidenceMalocclusion caused - DiagnosisOcclusion regained - Treatment,2. Relationship btw tooth &
6、 OMF trauma,3. Cranio-cerebral trauma,10/5/2018,15,Mouth opening, mastication, swallowing,4. Cervical trauma,5. Effect on breathing,6. Effect of on digastric system,Bleeding Paralysis 瘫痪,Leading difficulty breathing,diet,worse oral hygiene,Asphyxia 窒息,10/5/2018,16,7. Multi-sinus- contamination,Infec
7、tion,Oral cavity Nasal cavity Pharyngeal cavity Orbit Paranasal sinus,Bacteria Temp Humidity,10/5/2018,17,8. Damage to specific structure,Parotid Gland Facial N. Trigeminal N.,Salivary fistula Facial paralysis Regional numbness,10/5/2018,18,9. Facial Defect,Facial contour Psychological trauma,10/5/2
8、018,19,Evaluate trauma soon Identify the key trauma, manage the fatal first Careful history taking, thorough physical exam Rescue in time Management in order,General Rules,Section 3 Rescue,10/5/2018,20,1. Prevention of Asphyxia,Section 3 Rescue,10/5/2018,21,Dysphoria, sweating, inhaling respiration
9、Difficult to inhale, hypopnea, nasal alar movement, labial cyanosis Three concave signs、Rapid breathing, weak pulse, decreased BP Pupils diluted, No reflection to light,1.1 Clinical features of asphyxia,Prodrome,10/5/2018,22,1.2 Etiology of Asphyxia,Foreign body obstruction,Inspiratory Asphyxia,Low
10、Airway,Swelling Foreign body Blood, saliva Vomit,Upper airway,Tissue dislocation,Obstructive Asphyxia,10/5/2018,23,1.3 Rescue of Asphyxia,Clear foreign body in upper airway Suspend maxilla Intubation Hold the tongue out,Obstructive Asphyxia,10/5/2018,24,2. Hemostasia,Two steps：,Judge bleeding situat
11、ion Choose the way to stop bleeding,Section 3 Rescue,10/5/2018,25,2.1 Judge bleeding situation,Three categories,Arterial Capillary Venous,Based on origin,10/5/2018,26,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,10/5/2018,27,3. Anti-shock treatment,(2) Purpose of anti-shock,(1) Definit
12、ion & Classification,Traumatic shock Exsanguine shock 20% Body weight Toxic shock Infectious shock,Restore circulation,10/5/2018,28,(4) Principles of Treatment,(3) Features of Shock,Early stage: Dysphoria, quick & superficial breath, sweating, paleness Middle stage: Tingle to supression, emotional f
13、aint, unconsciousness, decrease BP, labial paleness Late stage: weaker pulsation, unmeasurable BP, hyponuria, anuria 30ml/h,Hemostasis, blood transfusion, pain control, fluid transfusion, sedation,10/5/2018,29,(1) Judgement,4. Combined Craniocerebral Injuries,Consciousness, pulse, BP, respiration, p
14、upil,(2) Early discovery, early management,Retrograde obliviscence Cerebral concussion Intermediate wake-up Extradural hematoma Cerebral fluid leak Skull base fracture,10/5/2018,30,10/5/2018,31,Debridement Wound closure Antibiotics,5. Prevention of Infection,6. Bandage & Transportation,10/5/2018,32,
15、Section 4 Soft Tissue Trauma,10/5/2018,33,Abrasions 擦伤 Contusions 挫伤 Contusions & Lacerations 挫裂伤 Incised & Puncture Wound 切割伤及刺伤 Bite Wound 咬伤,Types of injuries,Section 4 Soft Tissue Trauma,10/5/2018,34,Character: Irregular wound edge, foreign body, pain, oozing & yellowish plasma oozing Management
16、: Debridement, remove foreign body, Dry wound, drain when infected,1. Abrasions,Property: rough surface,Epidermis & superficial dermis,10/5/2018,35,1. Abrasions,10/5/2018,36,2. Contusions,Charater: petechia, swelling, pain Management: Hemostasis Pain-killer Prevention of infection Hematoma resorption Re-establishment of function,Property: blunt material & fell to hard object,Subdermal tissue (no open wound),10/5/2018,37,Property: Blunt object with high mechanical force,
