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1、口腔颌面部损伤口腔颌面部损伤口腔颌面部损伤口腔颌面部损伤Dr. Dr. Steve GF ShenSteve GF ShenOral and Maxillofacial Oral and Maxillofacial SurgerySurgerySchool of StomatologySchool of StomatologyShanghai Ninth Peoples HospitalShanghai Ninth Peoples HospitalShanghai Second Medical UniversityShanghai Second Medical UniversityOral &
2、 Maxillofacial TraumaOral & Maxillofacial TraumaChapter 7Chapter 72024/8/11VocabularyVocabularyabrasionabrasion擦伤擦伤擦伤擦伤adjacenttoothadjacenttooth邻牙邻牙邻牙邻牙alaralar鼻翼的鼻翼的鼻翼的鼻翼的antibioticsantibiotics抗生素抗生素抗生素抗生素anti-infectionanti-infection抗感染抗感染抗感染抗感染anuriaanuria无尿无尿无尿无尿archbararchbar牙弓夹板牙弓夹板牙弓夹板牙弓夹板art
3、erialarterial动脉的动脉的动脉的动脉的asphyxiaasphyxia窒息窒息窒息窒息bandagebandage绑带绑带绑带绑带bitewoundbitewound咬伤咬伤咬伤咬伤bloodsupplybloodsupply血供血供血供血供bustupbustup斗殴斗殴斗殴斗殴capillarycapillary毛细血管的毛细血管的毛细血管的毛细血管的cerebralcerebral脑的脑的脑的脑的cerebralfluidcerebralfluid脑脊液脑脊液脑脊液脑脊液cervicalcervical颈的颈的颈的颈的concussionconcussion震荡震荡震荡震荡c
4、ontaminatecontaminate污染污染污染污染contusioncontusion挫伤挫伤挫伤挫伤2024/8/12VocabularyVocabularycyanosiscyanosis发绀发绀发绀发绀debridementdebridement清创术清创术清创术清创术alveolarprocessalveolarprocess齿槽突齿槽突齿槽突齿槽突dentalpulpdentalpulp牙髓牙髓牙髓牙髓devitalizedevitalize失活失活失活失活dysfunctiondysfunction功能异常功能异常功能异常功能异常dysphoriadysphoria烦躁不安
5、烦躁不安烦躁不安烦躁不安edemaedema水肿水肿水肿水肿estheticesthetic美学的美学的美学的美学的exfoliateexfoliate脱落脱落脱落脱落exsanguineexsanguine失血的失血的失血的失血的extraduralextradural硬脑膜外的硬脑膜外的硬脑膜外的硬脑膜外的extrinsicforceextrinsicforce外力外力外力外力extrusionextrusion突出的突出的突出的突出的facialnervefacialnerve面神经面神经面神经面神经foreignbodyforeignbody异物异物异物异物fracturefractu
6、re骨折骨折骨折骨折gingivalgingival牙龈的牙龈的牙龈的牙龈的hematomahematoma血肿血肿血肿血肿hemostasiahemostasia止血，止血法止血，止血法止血，止血法止血，止血法2024/8/13VocabularyVocabularyhemostathemostat止血钳止血钳止血钳止血钳hyponuriahyponuria少尿少尿少尿少尿hypopneahypopnea低通气低通气低通气低通气incisedwoundincisedwound切割伤切割伤切割伤切割伤inhaleinhale吸气吸气吸气吸气inspiratoryasphyxiainspirat
7、oryasphyxia吸入性窒息吸入性窒息吸入性窒息吸入性窒息intracranialintracranial颅内的颅内的颅内的颅内的intubationintubation插管插管插管插管laceratelacerate撕裂撕裂撕裂撕裂lacerationlaceration撕裂撕裂撕裂撕裂ligationligation结扎结扎结扎结扎luxationluxation脱位脱位脱位脱位malocclusionmalocclusion咬合错乱咬合错乱咬合错乱咬合错乱mandiblemandible下颌骨下颌骨下颌骨下颌骨masticationmastication咀嚼咀嚼咀嚼咀嚼maxilla
8、maxilla上颌骨上颌骨上颌骨上颌骨maxillofacialmaxillofacial颌面的颌面的颌面的颌面的mouthopeningmouthopening张口度张口度张口度张口度nasalcavitynasalcavity鼻腔鼻腔鼻腔鼻腔obliviscenceobliviscence遗忘遗忘遗忘遗忘2024/8/14VocabularyVocabularyobstructiveasphyxiaobstructiveasphyxia阻塞性窒息阻塞性窒息阻塞性窒息阻塞性窒息occlusionocclusion咬合咬合咬合咬合oralcavityoralcavity口腔口腔口腔口腔oral
9、hygieneoralhygiene口腔卫生口腔卫生口腔卫生口腔卫生orbitorbit眼眶眼眶眼眶眼眶pain-killerpain-killer止痛剂止痛剂止痛剂止痛剂paralysisparalysis瘫痪瘫痪瘫痪瘫痪paranasalsinusparanasalsinus副鼻窦副鼻窦副鼻窦副鼻窦parotidglandparotidgland腮腺腮腺腮腺腮腺percussionpercussion叩诊叩诊叩诊叩诊periodontal ligamentperiodontal ligament牙周韧带牙周韧带petechiapetechia瘀斑，瘀点瘀斑，瘀点pharyngeal cav
10、itypharyngeal cavity咽腔咽腔plasmaplasma血浆血浆psychologicalpsychological心理的心理的psychotherapypsychotherapy精神疗法精神疗法rabiesrabies狂犬病狂犬病regenerateregenerate再生再生reimplantationreimplantation再植再植rescuerescue营救，抢救营救，抢救2024/8/15VocabularyVocabularyrespiratoryrespiratory呼吸的呼吸的呼吸的呼吸的salivasaliva涎液，唾液涎液，唾液涎液，唾液涎液，唾液sal
11、ivarysalivary涎液的涎液的涎液的涎液的shockshock休克休克休克休克skullbaseskullbase颅底颅底颅底颅底stomatognathicstomatognathic口颌的口颌的口颌的口颌的subdermalsubdermal皮下的皮下的皮下的皮下的swallowswallow吞咽吞咽吞咽吞咽sweatsweat出汗出汗出汗出汗tetanustetanus破伤风破伤风破伤风破伤风toothachetoothache牙疼牙疼牙疼牙疼toxicshocktoxicshock中毒性休克中毒性休克中毒性休克中毒性休克transportationtransportation运
12、输，搬运运输，搬运运输，搬运运输，搬运traumatrauma损伤，外伤损伤，外伤损伤，外伤损伤，外伤trigeminalnervetrigeminalnerve三叉神经三叉神经三叉神经三叉神经unconsciousnessunconsciousness神志不清神志不清神志不清神志不清upperairwayupperairway上呼吸道上呼吸道上呼吸道上呼吸道vaccinationvaccination接种疫苗接种疫苗接种疫苗接种疫苗venousvenous静脉的静脉的静脉的静脉的visceraviscera内脏内脏内脏内脏2024/8/16Definition of traumaDefini
13、tion of traumatraumanounCorUtraumanounCorU1. 1.severeemotionalshockandpaincausedbyansevereemotionalshockandpaincausedbyanextremelyupsettingexperience:extremelyupsettingexperience:the trauma of marriage breakdownthe trauma of marriage breakdownHe had psychotherapy to help him deal with his He had psy
14、chotherapy to help him deal with his childhood traumas.childhood traumas.2. 2.SPECIALIZEDSPECIALIZEDasevereinjury,usuallycausedbyaasevereinjury,usuallycausedbyaviolentattackoranaccidentviolentattackoranaccident(fromCambridgeAdvancedLearnersDictionary)2024/8/17Section 1 IntroductionSection 1 Introduc
15、tionWarWarWarIncidenceIncidenceTrafficAccidentTrafficAccidentSportsFallingFallingBustupBustupLaborinjuryLaborinjury2024/8/18Traffic AccidentTraffic Accident2024/8/110 Combinedinjurytootherviscera-FataltolifeCombinedinjurytootherviscera-FataltolifeCombinedinjurytootherviscera-Fataltolife Damagetomaxi
16、llofacialstructureDamagetomaxillofacialstructureDamagetomaxillofacialstructure StomatognathicStomatognathicStomatognathicdysfunctiondysfunctiondysfunction FacialestheticproblemFacialestheticproblemFacialestheticproblem PsychologicaltraumaPsychologicaltraumaPsychologicaltraumaEffect of Trauma on the
17、Effect of Trauma on the Human BodyHuman Body2024/8/1111.RichbloodsupplySection 2 Characteristics of OMF Section 2 Characteristics of OMF TraumaTrauma2024/8/112DebridementDebridement Time: 24 48 h Time: 24 48 hTend to Tend to hematomahematoma, edema, edemaRespiratoryRespiratory tract tractAsphyxiaAsp
18、hyxiaAbility to anti-infection, Ability to anti-infection, regenerationregenerationWound healingWound healing1.Richbloodsupply1.Richbloodsupply2024/8/113 Cerebral concussionCerebral concussionCerebral concussion Cerebral contusionCerebral contusionCerebral contusion Intracranial Intracranial Intracr
19、anial hematomahematomahematoma Skull base fracture Skull base fracture Skull base fracture Increase infectious incidenceIncrease infectious incidence Malocclusion caused - DiagnosisMalocclusion caused - Diagnosis Occlusion regained - TreatmentOcclusion regained - Treatment2.Relationshipbtwtooth&OMFt
20、rauma2.Relationshipbtwtooth&OMFtrauma3.Cranio-cerebraltrauma3.Cranio-cerebraltrauma2024/8/114Mouth opening, Mouth opening, mastication, swallowingmastication, swallowing4.Cervicaltrauma4.Cervicaltrauma5.Effectonbreathing5.Effectonbreathing6.Effectofondigastricsystem6.EffectofondigastricsystemBleedin
21、gBleedingParalysisParalysis瘫痪瘫痪Leading difficulty breathingLeading difficulty breathingdietdietworse oral hygieneworse oral hygieneAsphyxia Asphyxia 窒息窒息2024/8/1157.Multi-sinus7.Multi-sinus-contamination-contamination InfectionInfectionOral cavityOral cavityNasal cavityNasal cavityPharyngeal Pharyng
22、eal cavitycavityOrbitOrbitParanasalParanasal sinus sinusBacteriaBacteriaTempTempHumidityHumidity2024/8/1168.Damagetospecificstructure8.DamagetospecificstructureParotid GlandParotid GlandFacial N. Facial N. Trigeminal N.Trigeminal N.Salivary fistulaSalivary fistulaFacial paralysisFacial paralysisRegi
23、onal numbnessRegional numbness2024/8/1179.FacialDefect9.FacialDefect Facial contour Facial contour Psychological traumaPsychological trauma2024/8/118Evaluate trauma soonEvaluate trauma soonIdentify the key trauma, Identify the key trauma, manage the fatal firstmanage the fatal firstCareful history t
24、aking, Careful history taking, thorough physical examthorough physical examRescue in timeRescue in timeManagement in orderManagement in orderGeneral RulesGeneral RulesSection 3 RescueSection 3 Rescue2024/8/1191.PreventionofAsphyxia1.PreventionofAsphyxiaSection 3 Rescue2024/8/120Dysphoria,sweating,in
25、halingrespirationDysphoria,sweating,inhalingrespirationDifficulttoinhale,hypopnea,nasalalarmovement,Difficulttoinhale,hypopnea,nasalalarmovement,labialcyanosislabialcyanosisThreeconcavesignsThreeconcavesigns、Rapidbreathing,weakpulse,Rapidbreathing,weakpulse,decreasedBPdecreasedBPPupilsdiluted,Norefl
26、ectiontolightPupilsdiluted,Noreflectiontolight1.1Clinicalfeaturesofasphyxia1.1ClinicalfeaturesofasphyxiaProdrome2024/8/1211.21.2 EtiologyofAsphyxiaEtiologyofAsphyxia ForeignbodyobstructionForeignbodyobstructionInspiratoryInspiratoryAsphyxiaAsphyxiaLowLowAirwayAirwaySwellingSwellingForeignbodyForeign
27、bodyBlood,salivaBlood,salivaVomitVomitUpperUpperairwayairwayTissueTissuedislocationdislocation ObstructiveAsphyxiaObstructiveAsphyxia2024/8/1221.31.3 RescueofAsphyxiaRescueofAsphyxiaClearforeignbodyinupperClearforeignbodyinupperairwayairwaySuspendmaxillaSuspendmaxillaIntubationIntubationHoldthetongu
28、eoutHoldthetongueoutObstructiveObstructiveAsphyxiaAsphyxia吸入性窒息吸入性窒息气管切开术气管切开术2024/8/123 2.Hemostasia2.HemostasiaTwo stepsTwo steps：Judge bleeding situationJudge bleeding situationChoose the way to stop bleedingChoose the way to stop bleedingSection 3 Rescue2024/8/1242.12.1 JudgebleedingsituationJud
29、gebleedingsituationThree categoriesArterialCapillaryVenousBased on origin2024/8/125压迫止血压迫止血指压止血法指压止血法包扎止血法包扎止血法填塞止血法填塞止血法结扎止血法结扎止血法药物止血法药物止血法2.22.2 MethodsofhemostatMethodsofhemostat2024/8/1263.Anti-shocktreatment3.Anti-shocktreatment(2)(2) Purpose of anti-shockPurpose of anti-shock(1)(1) Definition
30、 & ClassificationDefinition & Classification Traumatic shockTraumatic shockExsanguineExsanguine shock shock 20% Body weight20% Body weightToxic shockToxic shockInfectious shockInfectious shock Restore circulationRestore circulation2024/8/127(4)(4) Principles of TreatmentPrinciples of Treatment (3)(3
31、) Features of ShockFeatures of ShockEarly stage: Early stage: DysphoriaDysphoria, quick & superficial breath, , quick & superficial breath, sweating, palenesssweating, palenessMiddle stage: Tingle to Middle stage: Tingle to supressionsupression, emotional faint, , emotional faint, unconsciousness, d
32、ecrease BP, labial palenessunconsciousness, decrease BP, labial palenessLate stage: weaker pulsation, Late stage: weaker pulsation, unmeasurableunmeasurable BP, BP, hyponuriahyponuria, , anuriaanuria 30ml/h 30ml/hHemostasisHemostasis, blood transfusion, pain control, , blood transfusion, pain contro
33、l, fluid transfusion, sedationfluid transfusion, sedation2024/8/128(1)(1) JudgementJudgement4.CombinedCraniocerebralInjuries4.CombinedCraniocerebralInjuriesConsciousness, pulse, BP, respiration, pupilConsciousness, pulse, BP, respiration, pupil(2) Early discovery, early management(2) Early discovery
34、, early managementRetrograde Retrograde obliviscenceobliviscenceCerebral concussionCerebral concussionIntermediate wake-upIntermediate wake-upExtraduralExtradural hematomahematomaCerebral fluid leakCerebral fluid leakSkull base fractureSkull base fracture2024/8/1292024/8/130DebridementWound closureA
35、ntibiotics5.PreventionofInfection5.PreventionofInfection6.Bandage&Transportation6.Bandage&Transportation2024/8/131Section 4 Soft Tissue Trauma2024/8/132Abrasions Abrasions 擦伤擦伤ContusionsContusions挫伤挫伤Contusions & LacerationsContusions & Lacerations挫裂伤挫裂伤Incised & Puncture WoundIncised & Puncture Wou
36、nd切割伤及刺伤切割伤及刺伤 Bite WoundBite Wound 咬伤咬伤 Types of injuriesTypes of injuriesSection 4 Soft Tissue Trauma2024/8/133Character:Character:Character:Irregularwoundedge,foreignbody,Irregularwoundedge,foreignbody,Irregularwoundedge,foreignbody,pain,oozing&yellowishplasmaoozingpain,oozing&yellowishplasmaoozi
37、ngpain,oozing&yellowishplasmaoozingManagement:Management:Management: DebridementDebridementDebridement,removeforeign,removeforeign,removeforeignbody,Drywound,drainwheninfectedbody,Drywound,drainwheninfectedbody,Drywound,drainwheninfected1. Abrasions1. AbrasionsProperty:Property:Property:roughsurface
38、roughsurfaceroughsurfaceEpidermis&superficialdermisEpidermis&superficialdermisEpidermis&superficialdermis2024/8/1341. Abrasions1. Abrasions2024/8/1352. Contusions2. ContusionsCharaterCharater: :petechiapetechia,swelling,pain,swelling,painManagement:Management: l lHemostasisHemostasisl lPain-killerPa
39、in-killerl lPreventionofinfectionPreventionofinfectionl lHematomaHematoma resorptionresorptionl lRe-establishmentoffunctionRe-establishmentoffunctionProperty:bluntmaterial&felltoProperty:bluntmaterial&felltohardobjecthardobjectSubdermaltissue(noopenwound)Subdermaltissue(noopenwound)2024/8/136Propert
40、y: Blunt object with high Property: Blunt object with high mechanical forcemechanical force3. Contusions & Lacerations3. Contusions & LacerationsCharacterCharacterllI Irregular wound edge, saw-toothedrregular wound edge, saw-toothedllBig lacerationBig lacerationllw/wow/wo necrotic tissue & open frac
41、tures necrotic tissue & open fracturesManagementManagementllDebridementDebridementllWound ClosureWound ClosureSoft tissueSoft tissueSoft tissue2024/8/1373. Contusions & Lacerations3. Contusions & Lacerations2024/8/138Property: Sharp object or instrumentsProperty: Sharp object or instruments4. Incise
42、d & Puncture Wound4. Incised & Puncture WoundCharaterCharater llRegular wound edgeRegular wound edgellBleedingBleedingllSmall access, but deep woundSmall access, but deep woundManagementManagementllDebridementDebridementllWound closureWound closureSoft tissueSoft tissueSoft tissue2024/8/139Property:
43、 Animal (Wolf, dog, Bear) or human beingsProperty: Animal (Wolf, dog, Bear) or human beingsCharacterCharacterllTooth tracedTooth tracedllHeavy contaminationHeavy contaminationllTend to infectionTend to infectionManagementManagementllThorough Thorough debridementdebridementllInfection controlInfectio
44、n controlllSkin graft after granular tissue regeneratedSkin graft after granular tissue regeneratedllVaccination of Tetanus, RabiesVaccination of Tetanus, Rabies5. Bite Wound5. Bite Wound2024/8/140DefinitionDefinitionDebridementDebridementMainEntry:debridementMainEntry:debridementMainEntry:debrideme
45、ntPronunciation:Pronunciation:Pronunciation:di-brEd-m&nt,dA-,-mnt,dA-brEd-mndi-brEd-m&nt,dA-,-mnt,dA-brEd-mndi-brEd-m&nt,dA-,-mnt,dA-brEd-mnFunction:Function:Function: nounnounnounEtymology:Etymology:Etymology:FrenchFrenchFrenchdbridement, dbridement, dbridement, fromfromfromdbrider dbrider dbrider
46、toremoveadhesions,toremoveadhesions,toremoveadhesions,literally,tounbridle,fromMiddleFrenchliterally,tounbridle,fromMiddleFrenchliterally,tounbridle,fromMiddleFrenchdesbrider, desbrider, desbrider, fromfromfromdes- des- des- de-+de-+de-+bride bride bride bridle,fromMiddleHighGermanbridle,fromMiddleH
47、ighGermanbridle,fromMiddleHighGermanbrIdelbrIdelbrIdel-moreat-moreat-moreatBRIDLEBRIDLEBRIDLE:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue2024/8/141Protocol
48、1. wash wound1. wash wound TimeTime：6-12h6-12h Solution: soap water, saline, hydrogen dioxideSolution: soap water, saline, hydrogen dioxideDebridementDebridement3. Closure3. Closure2. Clean wound2. Clean wound Removal of foreign bodyRemoval of foreign body Trimming of necrotic tissue Trimming of nec
49、rotic tissue2024/8/1422024/8/143Cheek injuriesCheek injuriesPalate injuriesPalate injuriesInjuries at other regionsInjuries at other regionsManagement of soft tissure injuriesManagement of soft tissure injuriesTongue injuries Tongue injuries Lengthmaintain,longitudinalclosureLengthmaintain,longitudi
50、nalclosureIndependentclosure,buttonguesuturedominationIndependentclosure,buttonguesuturedominationBigneedlewithbig,depthsuturingorBigneedlewithbig,depthsuturingormatricmatricsuturingsuturing2024/8/144Management of soft tissure injuriesManagement of soft tissure injuries2024/8/1452024/8/146Section 5
51、Injury of Teeth and Dental Alveolar Process2024/8/1471. Tooth injuries1. Tooth injuries 1.1 Contusion of Teeth1.1 Contusion of TeethEtiology: Etiology: Extrinsic force Extrinsic force blunt tooth injuriesblunt tooth injuriesPeriodontal ligaments or dental pulpPeriodontal ligaments or dental pulpChar
52、acter: Character: llExtrusion of toothExtrusion of toothllMobilityMobilityllPercussion & Toothache when chewingPercussion & Toothache when chewingManagementManagementllTooth restTooth restllTooth groundTooth groundllSimple Simple ligationligation2024/8/1481. Tooth injuries1. Tooth injuries 1.2 Luxat
53、ion of Teeth1.2 Luxation of TeethClassificationClassificationCharacterCharacterllTooth dislocated or exfoliatedTooth dislocated or exfoliatedManagementManagementllTooth protection priorityTooth protection priorityllReductionReductionllFixationFixationllReimplantationReimplantationPartial Partial lux
54、ationluxationComplete Complete luxationluxation-Toothdislocation-Toothdislocation-Semiluxation-Semiluxation-Intrusivemovement-Intrusivemovement2024/8/149Gingival or labial swelling, lacerationGingival or labial swelling, lacerationAdjacent teeth or alveolar process Adjacent teeth or alveolar process
55、 movement when one affected tooth movement when one affected tooth touchedtouchedFragment dislocation, MalocclusionFragment dislocation, MalocclusionIn accordance with tooth In accordance with tooth luxationluxation or or fracturefracture2. Fracture of Alveolar Process2. Fracture of Alveolar Process
56、CharactersCharacters2024/8/150llExtrinsic force to dental alveolar process, Extrinsic force to dental alveolar process, mainly to upper jawmainly to upper jawllReduction under LAReduction under LAllArch bar appliedArch bar applied2. Fracture of Alveolar Process2. Fracture of Alveolar ProcessEtiology
57、EtiologyManagement Management 2024/8/1512. Fracture of Alveolar Process2. Fracture of Alveolar Process2024/8/152Stainless steel wire ligation, Arch barsStainless steel wire ligation, Arch bars2024/8/153Questions1.1.DescribethecharacteristicsofOMFTrauma?DescribethecharacteristicsofOMFTrauma?2.2.Descr
58、ibetheetiology,clinicalfeaturesandmanagementDescribetheetiology,clinicalfeaturesandmanagementofasphyxia.ofasphyxia.3.3.DescribethewaysofDescribethewaysofhemastasishemastasis. .4.4.WhatisWhatisdebridementdebridement? ?5.5.DescribethecommonsiteofdentalalveolarprocessDescribethecommonsiteofdentalalveol
59、arprocessfracture,andtheirclinicalmanifestation.fracture,andtheirclinicalmanifestation.2024/8/154ReferenceReference1.1.LJPeterson,etal:ContemporaryOral&MaxillofacialLJPeterson,etal:ContemporaryOral&MaxillofacialSurgery.4thed.Surgery.4thed.MosbyMosby. .MissorriMissorri.2003.20032.2.WBooth,etal:MaxillofacialSurgery.WBooth,etal:MaxillofacialSurgery.VolVol1,2.1sted.1,2.1sted.ChurchillLivingstone.London.1999ChurchillLivingstone.London.19993.3.邱蔚六主编邱蔚六主编邱蔚六主编邱蔚六主编. .口腔颌面外科学口腔颌面外科学口腔颌面外科学口腔颌面外科学. .第第第第5 5版版版版. .人民卫生出版社人民卫生出版社人民卫生出版社人民卫生出版社. .200420042024/8/155THE ENDTHE END2024/8/156
