BDS 10025 Maxillofacial Trauma 5 PDF

BDS 10025 Maxillofacial trauma 5 Aims & objectives Aims: The aim of this lecture is to detail the clinical, diagnostic and management aspects of soft tissue injuries of the orofacial region Objectives: On completion of this lecture, the student should be able to: • Understand the clinical manifest...

BDS 10025 Maxillofacial trauma 5 Aims & objectives Aims: The aim of this lecture is to detail the clinical, diagnostic and management aspects of soft tissue injuries of the orofacial region Objectives: On completion of this lecture, the student should be able to: • Understand the clinical manifestations of soft tissue injuries of the orofacial region • Understand the principles of management of soft-tissue injuries Wound healing is a process involving : Inflammatory – Proliferative – Remodeling/Maturation Primary Intention Wound Healing Primary healing occurs when tissue edges are closed by stitches / staples / steri-strips → little tissue loss → quick & easy wound healing Secondary Intention Wound Healing wound has lots of lost tissue/ gaping edges It is different from 1ry intention in: • Longer repair and healing time • Greater chances of scarring • Increased chance of infections Tertiary Intention Wound Healing Delayed/secondary closure when delayed closing is needed To allow for drainage for example This type of wound healing process creates more scar tissue. An abrasion is caused by friction between an object and the surface of the soft tissue. - denudes the epithelial layer - may involve the terminal endings of nerve fibers → painful. - minor bleeding from capillaries may occur & managed by applying gentle pressure. • Proper debridement of the wounds is essential (saline irrigation, betadine) • Deep abrasions may need LA to use a surgical scrub brush • Topical application of an antibiotic ointment is sufficient. re-epithelialization will occur under the scab (crust of dried blood and serum that develops after an injury to soft tissue) The dentist may create abrasions iatrogenically When the shank of a rotating bur touches the oral mucosa or when a gauze pack or other fabric (e.g., absorbent triangular pads) abrades the mucosa during removal from the mouth. Management : the oral epithelium regenerates rapidly, and no treatment other than routine oral hygiene is indicated. Contusion (bruise) subcutaneous/submucosal hemorrhage without a break in the soft tissue surface caused by blunt object trauma / seen with dentoalveolar injuries or facial fractures. - may point out underlying facial osseous fractures (only in this case intervention is needed) - management of a contusion → ice / pressure to decrease hematoma formation early on - body resorbs the hemorrhage by time - areas of ecchymosis (purplish discoloration turns; blue, green, and yellow) before fading. Contusion caused by dentoalveolar trauma, may have communication with intraoral cavity ➔ systemic antibiotics are needed because coagulated blood is an ideal culture medium. Contusion (bruise) A laceration is a tear in the epithelial and subepithelial tissues. caused by a sharp object; if not sharp causes a jagged laceration (may be iatrogenic) May be superficial or extend deep into tissue lacerations within the vestibule can be overlooked unless the lips are properly retracted Soft tissue wounds associated with dentoalveolar trauma are always treated after the management of the hard tissue injury. Surgical management of lacerations after adequate anesthetizing of the region : (1) Cleansing (2) Debridement (minimal removal of contused and devitalized tissue from a wound and the removal of jagged pieces of surface tissue to enable linear closure) (3) Hemostasis (4) Closure. • Pulsed irrigation has been shown to be more effective in removing debris than is a constant flow of irrigation. • If any bleeding vessels are identified (in deep lacerations), they are clamped and tied with ligatures or cauterized. Labial artery may be involved in vertical lip lacerations (it must be clamped and tied/cauterized) • Not every laceration in the oral cavity must be closed with sutures. • Deep lacerations are closed with absorbable material such as polyglactin (Vicryl) overlying skin is closed with fine nonabsorbable material such as 5/0-6/0 Prolene • Intraoral wounds may be closed with Vicryl or silk. It is important when repairing a lip laceration to ensure that it is accurately lined up to avoid an ugly step on healing. Tongue lacerations usually bleed extensively and require suturing of the underlying muscle layer as well Palatal injuries are common when an object slips into the palatal mucosa iatrogenically or when patients place nails/ tools in their mouths Children may fall with toys / pencils in their mouths • Lacerations of the gingiva /alveolar mucosa / floor of mouth → closed in one layer ; mucosal • Lacerations of the tongue / lip that involves muscle → multi-layer closure resorbable sutures to close the muscle layers then mucosal suturing Systemic antibiotics should only be considered in deep multilayer lacerations. Tetanus shots should be considered; if in doubt refer to the physician. Facial skin sutures should be removed 4 to 6 days postoperatively. When removing a suture, it should be cut and then pulled in a direction that does not cause the wound to gape. Types of sutures: Non- resorbable : Natural (Silk/ cotton), synthetic (Prolene/ Nylon) For surface suturing (mucosal / skin) Resorbable : Natural (catgut/ collagen), synthetic (polyglycolic/polyglactin) For suturing of deep structures muscle/tendons Suturing techniques 1- Interrupted most commonly used each suture is independent 2- Continuous Rapid technique of closure loosening of one suture will affect the others 3-Continuous with lock 4-Mattress (vertical or horizontal) Suturing techniques 5- Subcuticular suturing provides better esthetic results in skin suturing but is not an easy technique Nerve injury Neurotemesis usually requires surgical nerve repair/grafting to increase chances of complete recovery Burns are described according to their depth and extent. They may be caused by fires/ chemical burns / consequence of RTA Superficial (first-degree burn) Partial thickness (second degree burn) Full thickness (third-degree burn) Management of superficial external burns: - Run under cool water - Apply burn ointment for isolation and moisturization (MEBO) - Apply sterile vaselinized gauze in larger burns To sum it all up …. • Soft tissue injuries in the maxillofacial region are common findings • Iatrogenic injuries (physical , thermal, chemical) are common and their management is quite simple • Deep injuries may cause neural injury / blood vessel severance which require professional surgical intervention • Management of lip injuries must reposition the vermilion border to avoid ugly postoperative stepping in the lip Aims & objectives Aims: The aim of this lecture is to detail the clinical, diagnostic and management aspects of soft tissue injuries of the orofacial region Objectives: On completion of this lecture, the student should be able to: • Understand the clinical manifestations of soft tissue injuries of the orofacial region • Understand the principles of management of soft-tissue injuries Further reading Students are advised to review any relevant teaching provided in the first year. In addition they are advised to read relevant sections of the following texts: • Kerawala C, Newlands C. Oral and Maxillofacial Surgery. Oxford University Press, 2010 pp 26-30 • Brennan et al. Maxillofacial Surgery Volume 1. Elsevier 2017 pp 200-219 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087220/pdf /abd-91-05-0614.pdf