Trauma wajah

Dr William AL Pandeirot, SpB

Bagian Bedah FK
Uncen/RSUD Jayapura
Vaskularisasi muka
Vaskularisasi muka
Vascular patterns of the
face
N Fasialis
N. Fasialis
N.Fasialis
N.Trigeminalis
N. Trigerminalis
 History
Alteration in the way the teeth meet.
Pain site(s), aggravating, relieving
factors,severity.
Numbness of skin, mucosa and teeth.
Alteration in ability to speak,
swallow,chew open mouth.
Disturbances of vision :
blurring,double vision.
 Reduced patency of oral and nasal
airway.
Hearing disturbance.
Abnormal sounds from the jaw
joints.
Neck problems.
 Examination
Scalp, frontal bones and supraorbital
ridges.
Orbits and nasoethmoidal region (traumatic
telecanthus and saddle nose deformity)
External auditory meati, zygomatic arches
and infraorbital margins.
Zygomatic buttreses, alar regions and
upper teeth.
TMJ, mandible and lower teeth.
 Asymmetry
Step defects
Discontinuity
Crepitus
Tenderness
Neurological deficits (sensory and
motoric)
Missing and mobile teeth.
Mobility of the mid face.
 Orbits
Visual acuity,diplopia.
Exophthalmus/Enophthalmus
(retrobulbar hematom,blow out
fracture)
Telecanthus.
Corneal abrasions, conjungtival
tears and eyelid laceration.
 Nose
Asymmetry
Deformity in all three dimensions
Bilateral or unilateral epistaxis
Possible leak of cerebrospinal fluid
(bethadine test)
Septal haematoma or disruption
Anosmia or paranosmia
Crepitus
 Midface (zygomatico-
maxillary)
Malocclusion
Maxilla moving
Malar flattening
Downsloping palpebral fissure
Infraorbital nerve paresthesis
 Mandible
Malocclusion
Tenderness and step-offs (palpation)
Swelling and bruising
Lower lip paresthesias (infra
alveolar nerve)
Hematomas in the floor of the mouth
Open bite, trismus (mandibular
condyle)
 Maxilla
Anterior open bite, malocclusion
Mobility of maxilla(floating)
Epistaxis
Elongation of the face.
Lefort I :pyriform rim
Lefort II : nasal root (nasofrontal
suture)
Lefort III (craniofacial disarticulation)
:zygomatocofrontal suture
 Nasoorbital ethmoidal
(NOE)
Saddle nose deformity
Traumatic telecanthus
Avulsion of medial canthal ligaments
Radiologic examinations
Skull X-rays (AP/Lateral)
Waters/reverse Waters
Submentovertex view
Panoramic radiographs (Panorex)
CT-Scann
Three Dimension CT-Scann.
Foto (AP/Lat/Waters)
 Management
Depends on : organised,teamwork.
Maintain airway + secure cervical
spine.
Bilateral parasymphyseal fracture
(immediate stabilization/pulling the
tongue anterior)
 Closed reduction
Gillies procedure
MMF (IDW-ivy loop,arch bar)
Circumferential wiring.
Barton bandages.
 Open reduction
Approach :
bicoronair.infracilliar,ginggivobuccal.
Delayed untill patient has been
stabilized.
Bony repair (10 days to 2 weeks)
IMF/plate and screw with or without
MMF.
 Soft tissue abrasions and
laceration
High-priced real estate
Anatomic landmarks ( white skin roll,
vermilion border,brow eyes)
Cleanse the wound with normal saline
Explore the injury to its full depth
Beware facial nerve and parotid gland
and duct injury!!
Layered closure
 Soft tissue as soon as possible.
Lacrimal duct
:Dacryocystorhinostomy/repair of
Stensen duct.
Retrobulbar hematoma: emergency
evacuation
Stensons duct rupture
Scalp loss
Soft tissue laceration
Windshield injury