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Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy
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Maxillofacial trauma evaluation and management (nx power lite) /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Maxillofacial Trauma Evaluation and Management www.indiandentalacademy.com
  • 3. Maxillofacial Trauma www.indiandentalacademy.com
  • 4. Maxillofacial Injuries • Treatment divided into following phases Emergency or initial care Early care Definitive care Secondary care or revision www.indiandentalacademy.com
  • 5. Emergency Care • • • • • Preserve the airway Control of hemorrhage Prevent or control shock C-Spine stabilization Control of life-threatening injuries head injuries, chest injuries, compound limb fractures, intra-abdominal bleeding www.indiandentalacademy.com
  • 6. Emergency Care • Evaluate the airway Existence & identification of obstruction Manually clear of fractured teeth, blood clots, dentures Endotracheal intubation & packing of oronasal airway www.indiandentalacademy.com
  • 7. Emergency Care • Airway Management Maintain an intact airway Protect airway in jeopardy Provide an airway • C-Spine injury may be present • Altered level of consciousness is the most common cause of upper airway obstruction www.indiandentalacademy.com
  • 8. Airway Management • Chin lift to open intact airway • Intubation Oral: C-spine injury absent on X ray Nasotracheal intubation: C-spine injury suspected or certain • Surgical Airway Cricothyroidotomy Tracheosotomy www.indiandentalacademy.com
  • 9. Emergency Care • Extensive vascularity of head & neck may lead to massive blood loss Monitor vital signs closely Intravenous infusion • Penetrating injuries need to be explored Arteriogram Esophagram www.indiandentalacademy.com
  • 10. Treatment of Blood Loss & Shock • Hemorrhage most common cause of shock after injury • Multiple injury patients have hypovolemia • Goal is to restore organ perfusion www.indiandentalacademy.com
  • 11. Treatment of Blood Loss & Shock • External bleeding controlled by direct pressure over bleeding site • Gain prompt access to vascular system with IV catheters • Fluid replacement Ringer’s Lactate Normal saline Transfusion www.indiandentalacademy.com
  • 12. Stabilization of associated injuries • C-spine injury is primary concern with all maxillofacial trauma victims Any patient with injury above clavicle or head injury resulting in unconscious state Any injury produced by high speed Signs/symptoms of C-Spine injury Neurologic deficit Neck pain www.indiandentalacademy.com
  • 13. Stabilization of associated injuries • C-spine injury suspected  Avoid any movement of spinal column  Establish & maintain proper immobilization until vertebral fractures or spinal cord injuries ruled out Lateral C-spine radiographs CT of C-spine Neurologic exam www.indiandentalacademy.com
  • 14. Head/Neck/C-Spine Stabilization www.indiandentalacademy.com
  • 15. Lateral C-Spine Film www.indiandentalacademy.com
  • 16. C-spine CTs www.indiandentalacademy.com
  • 17. Early Care Emergency care has stabilized patient Initial stabilization of fractures Debridement & dressing of soft tissues Elective tracheostomy Physical exam & history Laboratory tests Complete head & neck examination Diagnosis of maxillofacial injuries www.indiandentalacademy.com
  • 18. Diagnosis of Maxillofacial Injuries • Inspection • Palpation • Diagnostic Imaging Plain films CT Stereolithography (where available) www.indiandentalacademy.com
  • 19. Diagnosis of Maxillofacial Injuries • INSPECTION Hemorrhage Otorrhea Rhinorrhea Contour deformity Ecchymosis Edema Continuity defects Malocclusion www.indiandentalacademy.com
  • 20. Inspection Sublingual ecchymosis Step defects, ridge discontinuity, malocclusion www.indiandentalacademy.com
  • 21. Diagnosis of Maxillofacial Injuries • PALPATION “Step” Defect Crepitus Bony segments Subcutaneous emphysema Mobility www.indiandentalacademy.com
  • 22. Diagnosis of Maxillofacial Injuries • DIAGNOSTIC IMAGING Panorex Plain films CT Stereolithography www.indiandentalacademy.com
  • 23. www.indiandentalacademy.com
  • 24. CT Scans www.indiandentalacademy.com
  • 25. 3D CT www.indiandentalacademy.com
  • 26. Stereolithography www.indiandentalacademy.com
  • 27. Definitive Care • Soft Tissue Injuries Contusions Abrasions Lacerations www.indiandentalacademy.com
  • 28. Soft tissue injury Facial lacerations not complicated by associated injury can be managed in an ER setting Large extensive facial and scalp lacerations are preferably closed in an operating room environment www.indiandentalacademy.com
  • 29. Soft tissue injury • Hemostasis • Debridement • Approximate wound edges Sutures Steristrips • Dressings • Antibiotics/Tetanus www.indiandentalacademy.com
  • 30. Facial lacerations www.indiandentalacademy.com
  • 31. Associated Soft Tissue Injury • Lacrimal System • Parotid Duct • Facial Nerve Surgical repair if posterior to vertical line drawn from outer canthus of eye www.indiandentalacademy.com
  • 32. Associated Soft Tissue Injury Remember to think in 3D for there are always other structures involved! www.indiandentalacademy.com
  • 33. Mandibular Fractures • Mandible is second most common fractured facial bone • 50% of mandibular fractures are multiple  Examine patient and radiographs closely and suspect additional fractures www.indiandentalacademy.com
  • 34. Mandibular Fractures • Clinical Signs and Symptoms  Tenderness & pain  Malocclusion  Ecchymosis in floor of mouth  Mucosal lacerations  Step defects inferior border  CN V3 Disturbances www.indiandentalacademy.com
  • 35. Mandibular Fractures • Treatment depends on fracture site and amount of segment displacement • Closed reduction Application of arch bars Placement into intermaxillary fixation (IMF) • Open Reduction Internal wire fixation Bone plates www.indiandentalacademy.com
  • 36. Closed Reduction with IMF www.indiandentalacademy.com
  • 37. Open Reduction www.indiandentalacademy.com
  • 38. Open Reduction www.indiandentalacademy.com
  • 39. Midface Fractures • • • • • • • LeFort I Transverse Maxillary Lefort II Pyramidal Lefort III Craniofacial Dysjunction Zygomatic Complex Orbital Floor Nasal Fractures Naso-orbital/Ethmoid www.indiandentalacademy.com
  • 40. Midface Fractures • Three buttresses allow face to absorb force  Nasomaxillary (medial) buttress  Zymaticomaxillary (lateral) buttress  Pyterigomaxillary (posterior) buttress www.indiandentalacademy.com
  • 41. Lefort Classification • Weakest areas of midfacial complex when assaulted from a frontal direction at different levels (Rene’ Lefort, 1901) Lefort I: above the level of teeth Lefort II: at level of nasal bones Lefort III: at orbital level www.indiandentalacademy.com
  • 42. Lefort Classification Provides uniform method to describe the level of major fracture lines Allows references regarding the probable points of stability for surgical treatment Does not incorporate vertical or segmental fractures, comminution or bone loss www.indiandentalacademy.com
  • 43. Lefort I Fracture Transverse Maxillary www.indiandentalacademy.com
  • 44. Lefort II Fracture Pyramidal www.indiandentalacademy.com
  • 45. Lefort III Fracture Craniofacial Dysjunction www.indiandentalacademy.com
  • 46. Facial Examination • Evaluate for laceration • Obvious depression in skull • Asymmetry • Discharge from nose or ear  Assume CSF leak • Palpation to note bone discontinuity  Bimanually in systematic manner www.indiandentalacademy.com
  • 47. Facial Examination • Evaluate mandibular opening • Palpation of buccal vestibule Crepitus of lateral antral wall • Occlusion evaluated Absence and quality of dentition noted • Ecchymosis common finding • Pharynx evaluated for laceration & bleeding www.indiandentalacademy.com
  • 48. Facial Examination • Orbits evaluated  Periorbital edema and ecchymosis  Gross visual acuity determined  Diplopia  Pupillary size & shape  Subconjunctival hemorrhage  Funduscopic evaluation www.indiandentalacademy.com
  • 49. Facial Examination • Orbits evaluated  Lid lacerations  Attachment of medial canthal tendon Rounding of lacrimal lake Increased intercanthal distance Epiphora  Prompt Ophthamology consult www.indiandentalacademy.com
  • 50. Facial Examination Orbits Evaluated www.indiandentalacademy.com
  • 51. Facial Examination Palpation of Midface/bridge of nose www.indiandentalacademy.com
  • 52. Radiographic Evaluation • Plain Films Lateral Skull Waters View Posteroanterior view of skull Submental vertex • CT Scan 1.5 mm cuts axial and coronal views www.indiandentalacademy.com
  • 53. Radiographic Evaluation Lateral skull Water’s View www.indiandentalacademy.com
  • 54. Radiographic Evaluation CT Scan 3D CT www.indiandentalacademy.com
  • 55. Radiographic Evaluation Stereolithography allows actual model of defect. A nice reconstruction tool to use if available www.indiandentalacademy.com
  • 56. Treatment of Midface Fractures • Once patient’s condition stabilized, no need to rush to surgery  Address rapidly developing edema  Formulate treatment plan  Observe sequelae in the case of orbital injuries www.indiandentalacademy.com
  • 57. Diagnosis of Lefort I Fractures • Direction of force • Maxilla displaced posteriorly and inferiorly  Open bite deformity • Hypoesthesia of infraorbital nerve • Malocclusion • Mobility of maxilla  Noted by grasping maxillary incisors www.indiandentalacademy.com
  • 58. Treatment of Lefort I Fractures  Direct exposure of all involved fractures  Reduction and anatomic realignment of the maxillary buttresses to reestablish Anterior projection Transverse width Occlusion  Restoration of occlusion using IMF  Internal fixation using miniplate fixation www.indiandentalacademy.com
  • 59. Treatment of Lefort I Fractures www.indiandentalacademy.com
  • 60. Diagnosis of Lefort II and III • Clinical evaluation provides only a rough impression since swelling hides the underlying bony structures • Plain film radiographs and axial and coronal CT images are the basis for precise diagnosis & treatment plan www.indiandentalacademy.com
  • 61. Diagnosis Lefort II and III • Bilateral periorbital edema & ecchymosis • Step deformity palpated infraorbital & nasofrontal area • CSF rhinorrhea • Epistaxis www.indiandentalacademy.com
  • 62. Treatment of Lefort II and III • Fractures should be treated as early as the general condition of the patient allows • Team approach to treatment Neurosurgery Ophthamology ENT Plastic surgery Oral/Maxillofacial surgery www.indiandentalacademy.com
  • 63. Treatment of Lefort II and III • Intubation must not interfere with ability to use IMF • Exposure & visualization of all fractures Approaches to inferior rim Infraorbital Subciliary Transconjunctival Mid lower lid Coronal approach Gingivobuccal incision www.indiandentalacademy.com
  • 64. Fractures Teeth and occlusion are the key to reconstruction and provide the foundation upon which other facial structures are built www.indiandentalacademy.com
  • 65. Treatment of Lefort II and III Severely comminuted fractures preliminary approximation may be performed with wire Establishment of the correct occlusion Correct reconstruction of the outer facial frame for proper facial dimensions Correct position for nasoethmoidal complex www.indiandentalacademy.com
  • 66. Treatment of Lefort II and III Reestablishment of the correct intercanthal distance Infraorbital rim fixated Orbit is reconstructed Occlusion unit with IMF is fixated www.indiandentalacademy.com
  • 67. Lefort II & III Reconstruction www.indiandentalacademy.com
  • 68. Lefort II & III Reconstruction www.indiandentalacademy.com
  • 69. Nasal-Orbital-Ethmoid (NOE) Fractures  Usually not isolated event  Frequently associated with multiple midface fractures  Secondary to traumatic insult to radix area of nose  Low resistance to directional force 35-80 gm necessary to produce fracture www.indiandentalacademy.com
  • 70. Nasal-Orbital-Ethmoid Fractures • Diagnosis Ophthalmalogic evaluation Document visual acuity Pupillary response to light Neurologic evaluation Frontal lobe contusion Glasgow coma scale – Increase in ICP and need for monitoring www.indiandentalacademy.com
  • 71. Nasal-Orbital-Ethmoid Fractures • Nasal fracture Comminuted with posterior displacement Widened nasal bridge Splaying of nasal complex  Epistaxis  Severe periorbital edema & ecchymosis  Subconjunctival hemorrhage www.indiandentalacademy.com
  • 72. Nasal-Orbital-Ethmoid Fractures • Clinical signs & symptoms  Traumatic telecanthus Difficult to measure due to edema – Average 33-34 mm Can measure interpupillary distance and divide in half for approximate intercanthal distance – Average 60-65 mm  Damage to lacrimal apparatus-epiphora  CSF leak www.indiandentalacademy.com
  • 73. Nasal-Orbital-Ethmoid Fractures • Radiographic examination  CT - definitive imaging modality Axial images supplemented with coronal Plain films to fail demonstrate the degree and location of fractures secondary to overlapping of bony architecture www.indiandentalacademy.com
  • 74. Nasal-Orbital-Ethmoid Fractures CT Scans www.indiandentalacademy.com
  • 75. Nasal Fractures • Depression or angulation • Periorbital ecchymosis • Epistaxis • Tenderness • Crepitus • Septal deviation • Septal hematoma www.indiandentalacademy.com
  • 76. Nasal Hemorrhage • Nasal packing • Merocel sponge • Nasopharyngeal balloon  Epistat  Foley catheter www.indiandentalacademy.com
  • 77. Nasal-Orbital-Ethmoid Fractures • Nasal fractures  Rule out septal hematoma  Remove clots with suction, incise and drain if present to prevent septal necrosis  Closed reduction for simple fractures  Open reduction for severely displaced fractures www.indiandentalacademy.com
  • 78. Nasal-Orbital-Ethmoid Fractures Nasal Fractures • Treatment  Restoration of form and function  Proper reduction of nasal fractures  Correction of medial canthal ligament disruption  Correction of lacrimal system injuries www.indiandentalacademy.com
  • 79. Nasal-Orbital-Ethmoid Fractures • Surgical considerations  Definitive surgery as soon as possible after: Appropriate consultations Definitive radiographic imaging Significant edema allowed to resolve www.indiandentalacademy.com
  • 80. Nasal-Orbital-Ethmoid Fractures • Surgical considerations The final phase involves reduction of the NOE and nasal bone fractures Access to NOE through existing lacerations, bicoronal flap, or local incisions www.indiandentalacademy.com
  • 81. Nasal-Orbital-Ethmoid Fractures • Lacrimal system injury When the medial canthal ligament has been injured or displaced, damage to the lacrimal system should be assumed Nasolacrimal duct is often damaged within its bony course Epiphora: Need to evaluate patency of the nasolacrimal system www.indiandentalacademy.com
  • 82. Nasal-Orbital-Ethmoid Fractures Surgical Reduction www.indiandentalacademy.com
  • 83. Nasal-Orbital-Ethmoid Fractures Surgical Reduction www.indiandentalacademy.com
  • 84. Gunshot wound management • Advanced trauma life support  Primary survey ABC’s C-Spine stabilization Neurological assessment  Secondary survey Determine extent of injury  Definitive treatment www.indiandentalacademy.com
  • 85. Animal Bites  Hemostasis  Debridement  Approximate wound edges  Dressings  Antibiotics/Tetanus Augmentin www.indiandentalacademy.com
  • 86. www.indiandentalacademy.com

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