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1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

2. MAXILLOFACIAL INJURIES
• FUNCTION
“APPEARANCE”
• SMELL
• EAT
• SEE
• HEAR
• TALK
• BREATHE
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

3. MAXILLOFACIAL INJURIES
TRAUMA: PHYSICAL FORCE RESULTS IN INJURY
F = mv2
ETIOLOGY
• ASSAULTS
• FALL
• INDUSTRIAL ACCIDENTS
• RTA
• SPORTS INJURIES
• WAR INJURIES
GK / MAXFAC
SDM DHARWAD
www.indiandentalacademy.com

4. MAXILLOFACIAL INJURIES
SERIOUS TRAUMA: DEATH
TRIMODAL DISTRIBUTION
• SECONDS TO MINUTES
• MINUTES TO HOURS
(GOLDEN HOUR)
• AFTER DAYS
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

5. MAXILLOFACIAL INJURIES
GOLDEN HOUR
COMPLICATIONS
UNRECOGNIZED SERIOUS
AIRWAY
CERVICAL SPINE
HAEMORRHAGE
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

6. MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
BREATHING
CIRCULATION
DEFORMITY
EXPOSURE
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

7. MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
• SUCTION
• CHIN LIFT - JAW THRUST
• AIRWAYS
• CRICO / TRACHY
• OXYGEN
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

8. MAXILLOFACIAL INJURIES
GOLDEN HOUR
BREATHING
CHEST INJURY
• Pneumothorax
• Cardiac tamponade
• Ruptured diaphragm
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

9. MAXILLOFACIAL INJURIES
GOLDEN HOUR
CIRCULATION
I.V. ACCESS
TRANSFUSION
Hypovolemia- SHOCK
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

10. MAXILLOFACIAL INJURIES
GOLDEN HOUR: CIRCULATION
Hypovolemic shock
• Tachycardia
• Hypotension
• Cold clammy skin
• Loss of peripheral pulse
• Falling urinary output
• Confusion & disorientation
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

11. MAXILLOFACIAL INJURIES
GOLDEN HOUR
DISABILITY
Patient’s response ‘AVPU’
Awake
Verbal stimuli
Painful stimuli
Unconscious
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

12. MAXILLOFACIAL INJURIES
DIAGNOSIS & TREATMENT PLAN
Eye witness report
Clinical diagnosis (ABCDE)
Neurological examination
- G.C.S
- Cranial Nerves
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

13. EYE
OPENING
MOTOR
RESPONSE
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VERBAL RESPONSE
GK / MAXFAC
SDM DHARWAD

14. MAXILLOFACIAL INJURIES
Secondary survey
ABDOMEN
Occult blood sequestration
Tenderness / acute abdomen
Gastric decompression (N.G tube)
Direct peritoneal lavage
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

15. MAXILLOFACIAL INJURIES
Secondary survey
EXTREMITIES
Reduced perfusion
Traumatic amputation
Compartmental Syndrome
Site for major blood loss
(1-6 units)
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

16. MAXILLOFACIAL INJURIES
EXTRA-ORAL EXAMINATION
Inspection
•
Swelling
•
Hematoma
•
Skin lacerations / defects
•
Facial nerve
•
Mouth opening
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

17. MAXILLOFACIAL INJURIES
EXTRA-ORAL EXAMINATION
Palpation
•
Tenderness
•
Crepitation
•
Contour irregularities (step)
•
Depressed / Penetrating
bone
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

18. MAXILLOFACIAL INJURIES
EXTRA-ORAL EXAMINATION
Soft tissues
(contusion
tissue loss)
Foreign bodies
Nerves
Ducts
Blood vessels
(remember tetanus)
www.indiandentalacademy.com
(NOSE / EAR / EYE)
GK / MAXFAC
SDM DHARWAD

19. MAXILLOFACIAL INJURIES
INTRA-ORAL EXAMINATION
Inspection
• Asymmetry, Swelling
• Bleeding, Hematoma
• Occlusal plane / Step deformity
• Mucosal lacerations
• Teeth: fracture
avulsion
dislocation
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

20. MAXILLOFACIAL INJURIES
INTRA-ORAL EXAMINATION
Palpation
• Bimanual
• Tenderness
• # line / Step deformity
• Crepitation
• Teeth movement, Number
• Missing parts
• Sensory distribution V1 - V3
www.indiandentalacademy.com
( SALIVARY GLANDS / TONGUE / PALATE )
GK / MAXFAC
SDM DHARWAD

21. MAXILLOFACIAL INJURIES
RADIOGRAPHIC EXAMINATION
(based on clinical examination)
Plain radiographs
Location & Severity of fractures
Radio-opaque foreign bodies
CT scans
Intra-cranial injuries
Orbital & naso-ethmoidal
injuries
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

22. MAXILLOFACIAL INJURIES
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Control of infection
antibiotics
Surgical planning
GK / MAXFAC
SDM DHARWAD
www.indiandentalacademy.com

23. MAXILLOFACIAL INJURIES
Classification of fractures
1)Relation to overlying soft tissues
Closed / Simple
Open / Compound
Complicated
2)Type of fracture
Green stick
Single
Multiple
Comminuted
www.indiandentalacademy.com
( oblique / transverse / sagittal & degree of dislocation )
GK / MAXFAC
SDM DHARWAD

24. MAXILLOFACIAL INJURIES
Classification of fractures
3) Anatomical Location
Additional features
•
Pathologic
•
Atrophic
•
Impacted
•
Direct / indirect (contra-coup)
•
Blow out / in
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

25. T
hank You
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