Asesmen Klinis Trauma Maksilofasial
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Anamnesis dan pemeriksaan fisik pada trauma wajah (trauma maksilofasial) tetap merupakan strategi utama untuk menegakkan diagnosis dan menentukan rencana tata laksana. Kurang lebih seperempat kasus cedera kepala datang dengan trauma maksilofasial, baik pada jaringan lunak maupun tulang. Keterampilan anamnesis, pemeriksaan fisik, dan pemilihan pemeriksaan penunjang menjadi penting bagi dokter yang melayani di pelayanan gawat darurat.
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Asesmen Klinis Trauma Maksilofasial
- 1. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Asesmen Klinis Trauma Maksilofasial Robertus Arian Datusanantyo (EAN) Plastic Surgeon RS St. Carolus Borromeus Kupang
- 2. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 2 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
- 3. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Penyebab Trauma Maksilofasial 3 (Barbosa et. al, 2017)
- 4. #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 4 A M P L E
- 5. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Pemeriksaan Fisik ● Inspeksi ● Palpasi ● Pemeriksaan nervus facialis ● Oftalmologi ● Pemeriksaan intraoral ● Oklusi 5
- 6. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 6 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
- 7. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Inspeksi ● Perlukaan apapun ● Darah, CSF, saliva ● Pergerakan abnormal mata dan rahang ● Edema 7 ● Distopia ● Interchantal ● Battle’s Sign ● Hematoma ● Rhinorrhea ● Otorrhea
- 9. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Palpasi 9 http://most-beautiful-woman-in-the-world.blogspot.com/
- 21. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Nervus Facialis Sensorik Sentuhan Dahi, pipi, bibir atas, bibir bawah, Gigi 21 Motorik Angkat alis Tutup mata Senyum Mecucu / bersiul
- 23. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Oftalmologi & Intraoral Oftalmologi ● Refleks pupil (direk, indirek) ● Visus ● Diplopia ● Gerak bola mata 23 Intra Oral ● Laserasi palatum, dll ● Perdarahan aktif ● Trauma dentoalveolar ● Oklusi ● MIO
- 26. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 26 Oklusi Crossbite Oklusi Open Bite
- 31. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Tujuan Pembedahan Restorasi Fungsi ● Oklusi ● Cavum Nasal ● Volume Cavum Orbita 31 Restorasi Bentuk Wajah ● Facial Height ● Facial Width ● Proyeksi
- 33. #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! 33
- 34. #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 34
- 35. #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. 35
- 36. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic dr. Robertus Arian D. (EAN), M.P.H., M.Ked.Klin., SpBP-RE Klinik Bedah Plastik RS St. Carolus Borromeus Kupang Senin, Rabu, Kamis, & Sabtu jam 17.00 – 19.00 WITA Melayani pasien BPJS Kesehatan dan Umum Rujukan dari FKTP ke Bedah Plastik tidak perlu melalui dokter spesialis lain.
- 37. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 37 Terima Kasih http://bit.ly/ean_slideshare