Asesmen Klinis Trauma Maksilofasial
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This document discusses maxillofacial trauma management by Dr. Robertus Arian. It begins with definitions of plastic surgery and then discusses evaluation and management of maxillofacial trauma through history, physical exam, imaging, and surgical treatment planning. Key points covered include the anatomy of the maxillofacial region, common causes of trauma, approaches to examination including inspection, palpation, and evaluation of cranial nerves and occlusion. Treatment goals of restoring both form and function of the face are also outlined. Overall, the document provides an overview of evaluating and treating maxillofacial trauma from an anatomical and clinical perspective.
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Asesmen Klinis Trauma Maksilofasial
- 1. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Manajemen Klinis Trauma Maksilofasial Sabu Raijua, 16 Agustus 2023 Robertus Arian Datusanantyo (EAN) Plastic Surgeon RSUD Prof. Dr. W. Z. Johannes
- 2. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Apa itu Bedah Plastik? • “Plastik” berasal dari bahasa Yunani “Plasticos” yang artinya membentuk. • Kata “plastik” dalam ilmu bedah (1839); “plastik” sebagai bahan turunan minyak bumi (1905). • The finisher, problem-solving specialty • Without an organ system of its own plastic surgery is based on principles rather than specific procedures in a defined anatomic location (Thorne, 2014) 2
- 5. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Kajian Utama 5 Estetik Rekonstruksi - Kraniofasial - Hand - Genitalia eksterna - Microsurgery & Oncoplasty - Burn and wound - Bedah plastik pediatri
- 6. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Bedah Plastik Estetik Aging face Hidung, bibir, kelopak mata, telinga Estetika payudara Estetika anggota gerak (atas dan bawah) Estetika trunkus Estetika genitalia eksterna laki-laki Estetika genitalia eksterna perempuan 6
- 7. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Bedah Plastik Rekonstruksi Kraniofasial: trauma, ortognatik, kelainan kongenital Hand: trauma, kontraktur, kelainan kongenital Genitalia Eksterna: hipospadia, inkreta, silikonoma Microsurgery & Oncoplasty: eksisi tumor, free flap, revaskularisasi Burn and Wound: luka bakar, luka kronis, keloid Pediatri: hemangioma, nevus, kelainan kongenital lain 7
- 8. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 8 Currently no national integrative data of head and facial trauma. Head trauma: leading cause of mortality + affects productivity 23.3% head trauma related to facial trauma Road traffic accident; risky behavior; motorcycle accident
- 9. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Penyebab Trauma Maksilofasial 9 (Barbosa et. al, 2017)
- 10. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Trauma Maksilofasial 10 Fraktur Tulang Maksilofasial Trauma Jaringan Lunak
- 14. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Anatomi 14 Ehrenfeld, Manson, & Prein (2012)
- 26. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Anamnesis ● Sumber: pasien, saksi mata, keluarga (riwayat, pengobatan) ● Mekanisme perlukaan ● Area yang kemungkinan terkena perlukaan ● Rentetan kejadian seputar trauma termasuk amnesia ● Alkohol: saat perlukaan dan kebiasaan ● Penggunaan helm, kaca mata, alat pelindung lain 26 A M P L E
- 27. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Pemeriksaan Fisik ● Inspeksi ● Palpasi ● Pemeriksaan nervus facialis ● Oftalmologi ● Pemeriksaan intraoral ● Oklusi 27
- 28. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 28 forehead brow / alis palpebra superior palpebra inferior canthus lateralis dorsum nasi nasal tip ala nasi columella vermillion white skin roll nasal floor nares philtrum ridge philtral column cupid’s bow helix antihelix tragus antitragus lobulus canthus medialis concha commisure
- 29. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Inspeksi ● Perlukaan apapun ● Darah, CSF, saliva ● Pergerakan abnormal mata dan rahang ● Edema 29 ● Distopia ● Interchantal ● Battle’s Sign ● Hematoma ● Rhinorrhea ● Otorrhea
- 31. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Palpasi 31 http://most-beautiful-woman-in-the-world.blogspot.com/
- 43. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Nervus Facialis Sensorik Sentuhan Dahi, pipi, bibir atas, bibir bawah, Gigi 43 Motorik Angkat alis Tutup mata Senyum Mecucu / bersiul
- 45. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Oftalmologi & Intraoral Oftalmologi ● Refleks pupil (direk, indirek) ● Visus ● Diplopia ● Gerak bola mata 45 Intra Oral ● Laserasi palatum, dll ● Perdarahan aktif ● Trauma dentoalveolar ● Oklusi ● MIO
- 48. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 48 Oklusi Crossbite Oklusi Open Bite
- 53. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Tujuan Pembedahan Restorasi Fungsi ● Oklusi ● Cavum Nasal ● Volume Cavum Orbita 53 Restorasi Bentuk Wajah ● Facial Height ● Facial Width ● Proyeksi
- 55. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Take Home Messages ● Perlu dasar pengetahuan anatomi dan fisiologi kepala – leher untuk mengelola trauma maksilofasial. ● Perlu langkah sistematis untuk mengelola trauma maksilofasial. ● Anamnesis + pemeriksaan fisik menentukan pemeriksaan penunjang. Not the other way around! ● Practice makes perfect! 55
- 56. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Bacaan Lanjutan (1) Arifin MZ, Sendjaja AN, Faried A. Application of the surgical Apgar score (SAS) to predict postoperative complication(s) in the patients with traumatic brain injury: Study of single center in Indonesia. Open Access Maced J Med Sci [Internet]. 2021 Apr 20;9(B):225–9. Barbosa KGN, de Macedo Bernardino Í, d’Avila S, Ferreira EF e., Ferreira RC. Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents. Oral Maxillofac Surg. 2017;21(2):131–45. Burkadze E, Axobadze K, Chkhaberidze N, Chikhladze N, Coman MA, Dulf D, et al. Epidemiology of traumatic brain injury in georgia: A prospective hospital-based study. Risk Manag Healthc Policy. 2021;14:1041–51. Cooter, R. D. (1990). Craniofacial Fracture Patterns. The University of Adelaide. David & Simpson (Eds), 1995, Craniomaxillofacial Trauma: A System of Multidisciplinary Management by Members of the Australian Craniofacial Unit, Churchill Livingstone, Edinburgh 56
- 57. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Bacaan Lanjutan (2) Ehrenfeld et. al., 2012, Principles of Internal Fixation of the Craniomaxillofacial Skeleton Trauma and Orthognathic Surgery, AO Foundation, Davos Raithel J. Risky Road Behavior of Adolescent Motorcyclists. Int J Adolesc Youth [Internet]. 2001 Jan;9(2–3):127–45. Tana L, Delima D, Kusumawardani N, Indrawati L. Helmet use behavior and its relation to head injury of road traffic accident in Indonesia (Basic Health Research, 2018). Heal Sci J Indones. 2021;12(1):56–65. Thorne et. al. (Eds.), 2014, Grabb and Smith’s Plastic Surgery 7th Edition, Lippincott Williams & Wilkins, Philadelphia Zandi M, Seyed Hoseini SR. The relationship between head injury and facial trauma: A case-control study. Oral Maxillofac Surg. 2013;17(3):201–7. Reis C, Wang Y, Akyol O, Ho W, II R, Stier G, et al. What’s New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci [Internet]. 2015 May 26;16(12):11903–65. 57
- 58. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic dr. Robertus Arian D. (EAN), M.P.H.,M.Ked.Klin.,Sp.B.P.R.E. Dokter Spesialis Bedah Plastik Rekonstruksi & Estetik RSUD Prof. Dr. W. Z. Johannes; RS St. Carolus Borromeus; RS Leona WA: +62 818 04 245 382; Instagram: @eanplastic; E-mail: arian9677@gmail.com; #bedahplastikntt; Presentations: http://bit.ly/ean_slideshare 58