Oral and maxillofacial injuries
Introduction
Introduction to oral and maxillofacial injuries Maxillofacial injuries are often accompanied by tooth damage. Broken tooth fragments can also scatter into adjacent tissues, increasing tissue damage, and bringing calculus and bacteria into deep tissues, causing wound infection. Teeth on the jaw fracture line occasionally cause an infection of the bone and affect the healing of the fracture. When the fracture is displaced, it can cause the displacement of the teeth and the occlusion relationship, which is the main sign for the diagnosis of jaw fracture. In the treatment of jaw fractures, it is often necessary to use the teeth for ligation and fixation. The oral and maxillofacial region is located at the upper end of the respiratory tract. When the injury occurs, the respiratory tract can be affected by tissue displacement or swelling, tongue fall, blood clots and secretions blocking the respiratory tract. The oral cavity is also the entrance to the digestive tract. After the injury, the oral cavity often loses its normal function, and dysfunction such as eating and language occurs. The maxillofacial part is connected to the brain and the lower part of the neck. When the upper jaw or the upper third of the face is damaged, it is easy to have craniocerebral injury, such as concussion, brain contusion, skull base fracture and so on. basic knowledge The proportion of illness: the incidence rate is about 0.05%-0.08% Susceptible people: no specific population Mode of infection: non-infectious Complications: Dental trauma Oral and maxillofacial soft tissue injury Oral and maxillofacial cysts Oral and maxillofacial infections
Cause
Causes of oral and maxillofacial injuries
Can be divided into obstructive asphyxia and inhalation asphyxia
(1) Obstructive asphyxia:
1 foreign body obstruction: such as blood clots, bone fragments, tooth fragments and various foreign bodies can block the respiratory tract and suffocate.
2 tissue displacement: when the comminuted fracture of the jaw humerus or the simultaneous fracture of the mandibular body, the fracture segment of the anterior part of the mandible is affected by the descending muscle group (the genioglossus, the genioglossus and the mandibular ligament) Pulling the whole tongue, shifting the whole tongue backwards and backwards, pressing the epiglottis and causing suffocation. In the case of an open transverse fracture of the maxilla, the maxillary bone is displaced backwards and downwards due to factors such as gravity and impact soft muscles, which block the pharyngeal cavity and cause suffocation.
3 airway stenosis: the bottom of the mouth, the base of the tongue and the neck after the injury, the hematoma formed in these parts, severe tissue-reactive swelling can compress the upper respiratory tract and suffocate. In the case of facial burns, it should also be noted that it may inhale hot gases and cause edema on the inner wall of the trachea, resulting in suffocation caused by narrow lumen.
4 flap-like obstruction: the inspiratory barrier caused by the injured mucosal flap covering the pharyngeal valve.
(2) Inhalation asphyxia: A comatose wounded person who directly inhales blood, saliva, vomit or foreign body into the trachea, bronchus or even alveolar suffocation.
Prevention
Oral and maxillofacial injury prevention
There is no specific prevention of the disease, mainly to reduce the injury, there will be no soft tissue contusion.
What aspects of oral and maxillofacial injuries should be used to prevent infection:
1 Oral and maxillofacial debridement is the most important method to prevent infection. The wounds of oral and maxillofacial injuries are often contaminated by bacteria, dust, etc. Therefore, debridement should be performed as soon as possible when conditions are available. Foreign matter such as sediment in the wound should be completely removed to remove the necrotic tissue.
2 If it is estimated that the wound may be infected, the debridement should not be strictly sutured, and drainage should be placed.
3 If the wound has already been infected, it should be treated with wet compresses, and then treated later. The wound should not be sutured.
4 Because there are many sinus in the oral and maxillofacial region, and there are bacteria in the sinus sinus, when the penetrating wound is treated, the wound on the inner side of the sinus is sutured first, then fully washed, and then the muscle layer and the skin wound are sutured.
5 If there is no debridement condition after injury, such as wild, etc., the wound should be bandaged early, so as not to continue to pollute the medical and medical education network.
6 After the injury, antibiotics should be applied as soon as possible to prevent infection. The medication should follow the principle of sufficient amount, time and synergy; due to the large amount of anaerobic bacteria in the oral cavity, anti-anaerobic drugs such as metronidazole should be used routinely.
7 After wound debridement, the wound should be kept clean. If there is skin wound, it should be wrapped with sterile gauze; if there is intraoral wound, it should be rinsed regularly and used with tincture (such as 1-2% sodium bicarbonate solution, iodine complex, 0.5% chlorhexidine, etc.).
8 Oral and maxillofacial trauma may occur with tetanus infection, so routine intramuscular injection of tetanus antitoxin 1500U.
Complication
Oral and maxillofacial injury complications Complications, oral trauma, oral and maxillofacial soft tissue injury, oral and maxillofacial cysts, oral and maxillofacial space infection
Maxillofacial injuries are often accompanied by tooth damage. Broken tooth fragments can also scatter into adjacent tissues, increasing tissue damage, and bringing calculus and bacteria into deep tissues, causing wound infection. Teeth on the jaw fracture line occasionally cause an infection of the bone and affect the healing of the fracture.
There are many sinus in the maxillofacial region, and there are a certain number of bacteria in the sinus. For example, the wound is connected with these sinuses, which is easy to cause infection. It is a common complication of oral and maxillofacial soft tissue injury.
Symptom
Oral and maxillofacial injury symptoms common symptoms, shortness of breath, irritability, upset, nose flaps, blood pressure, drop, hairpin
The prodromal symptoms are irritability, sweating, nose flapping, inhalation longer than exhalation, or throat squeaking. In severe cases, cyanosis, three-concave signs (upper sternal insufflation, supraclavicular fossa, and intercostal space) Breathing is rapid and superficial; followed by weak pulse, fast pulse, decreased blood pressure, and dilated pupil. If you do not rescue in time, you can cause coma, stop your heartbeat and die.
Examine
Examination of oral and maxillofacial injuries
1. Pay attention to the presence of respiratory tract obstruction, cleft lip, irritability, and nasal agitation.
2. Check pulse, blood pressure and pupil changes.
3. Find out the cause of asphyxia, whether the tissue is displaced due to injury or foreign body, blood clots, secretions block the respiratory tract, whether the local hematoma or edema is oppressed to block the respiratory tract, and whether secretions, blood or vomit are inhaled into the trachea.
4. Pay special attention to comatose patients when checking.
Diagnosis
Diagnosis and differentiation of oral and maxillofacial injuries
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis:
Oral Candidiasis: It is an oral mucosal disease caused by fungal Candida infection. In recent years, due to the widespread clinical application of antibiotics and immunosuppressive agents, dysbacteriosis or decreased immunity has occurred, and viscera, skin, and mucous membranes have been infected by fungi.
Oral lichen planus: an inflammatory disease affecting the surface of the skin and mucous membranes, presumably caused by damage to epithelial basal cells mediated by autoreactive T lymphocytes, clinical and histopathological findings are very similar to graft versus host response .
