1) Ballistic maxillofacial trauma management depends on the timing of treatment, from immediate management within 1 hour to address life-threatening injuries, to early management within 28 days involving debridement and reconstruction, to long-term rehabilitation over months.
2) Immediate management prioritizes hemorrhage control and securing the airway, while damage control maxillofacial surgery within 2 hours aims to temporarily stabilize injuries before physiological recovery.
3) Early management includes aggressive debridement, closure of deep spaces, use of flaps or grafts for soft tissue defects, and temporary fixation of fractures using external devices to aid healing and prevent complications.
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
Emergency management of patients with facial traumaAhmed Adawy
Emergency management of patients with facial trauma
Dr. Ahmed M. Adawy Professor Emeritus, Dept. Oral & Maxillofacial Surg. Former Dean, Faculty of Dental Medicine
Al-Azhar University.
Maxillofacial trauma is without doubt a most challenging area within the specialty of oral and maxillofacial surgery. As with all traumas, basic Advanced Trauma Life Support principles (ATLS) should be applied to the initial assessment of the casualty. The primary survey is given by the letters ABCDE.
• Airway maintenance with cervical spine protection.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability: neurological status.
• Exposure/environmental control - undress the patient but prevent hypothermia.
Each was explored and discussed.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Emergency management of patients with facial traumaAhmed Adawy
Emergency management of patients with facial trauma
Dr. Ahmed M. Adawy Professor Emeritus, Dept. Oral & Maxillofacial Surg. Former Dean, Faculty of Dental Medicine
Al-Azhar University.
Maxillofacial trauma is without doubt a most challenging area within the specialty of oral and maxillofacial surgery. As with all traumas, basic Advanced Trauma Life Support principles (ATLS) should be applied to the initial assessment of the casualty. The primary survey is given by the letters ABCDE.
• Airway maintenance with cervical spine protection.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability: neurological status.
• Exposure/environmental control - undress the patient but prevent hypothermia.
Each was explored and discussed.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Disease of the nasal septum can cause nasal obstruction, excessive nasal discharge, epistaxis, headache and sinusitis. The diseases could be deviated nasal septum, septal haematoma, septal abscess and septal perforation. All these complaints are treatable.
Significant advances in management have resulted in an increase in survival after burn injury in regions of the world with access to current medical and surgical resources. As a consequence, burn survivors with access to up-to-date care and who tend to be young adults have long-term sequelae that impair function and limit
return to preinjury function, including work and community
reintegration. Up to 1 million burns require treatment annually in North America, and over 10 times as many burns occur worldwide. In low-income and middle-income countries, mortality is significantly greater than in high-income countries.The future
of burn care will be challenged by the expense and complexity of treatment, a predicted shortage of qualified burn care providers, and an aging population.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Contemporary management of ballastic injuries
1.
2. CONTEMPORARY MANAGEMENT OF
MAXILLOFACIAL BALLISTIC TRAUMA
British journal of Oral and Maxillofacial Surgery : 2017
Muhammad Ramzan Adeel
Resident
Oral and Maxillofacial Surgery
3. PRESENTATION LAYOUT
Introduction
Pathophysiology
Timing of treatment
• Immediate management
• Damage control Maxillofacial Surgery
• Early management
• Long term rehabilitation
5. PATHOPHYSIOLOGY
• Bullet wound from high velocity rifles
• Transfer of energy and cavitation
• Secondary formation of missiles by hard tissue
• Most commonly by IED’S
7. IED’S
PRIMARY BLAST INJURIES
• Sudden increase in air pressure
• Air sinus containing bones are primarily effected
• Isolated orbital blow out fractures
11. TIMING OF TREATMENT
• Different mechanisms of injury in civilian and military
• Different timings of treatment
• Damage control maxillofacial surgery within an hour
• Exsanguination
• Airway
12. IMMEDIATE MANAGEMENT
• 0-120 Min
• Based on ATLS principles
• Modification in military
• Hemorrhage precedes the airway
• Cervical spine injury
• Cricothyroidotomy airway of choice
13. DAMAGE CONTROL MAXILLOFACIAL SURGERY
Surgical operations are shortened to the minimum to prioritise short-
term physiological recovery over anatomical reconstruction in
seriously injured and compromised patients
14. DAMAGE CONTROL MAXILLOFACIAL SURGERY
• < 120 Minutes
• Rapid initial assessment of injuries
• Life threatening injuries prioritized
• Seriously injured patients
• By pass emergency department
• Taken directly to OT
• CT Scan if possible
15. DAMAGE CONTROL MAXILLOFACIAL SURGERY
• First facial examination
• Review of CT Scan
• Meticulous examination
• Laceration of scalp
• Nasal fractures
• Missing teeth
• Deep damage from small fragments
16. DAMAGE CONTROL MAXILLOFACIAL SURGERY
• Heamorrhage
• early and aggressive debridement
• Temporary reduction and fixation of mandibular fractures
17. HAEMORRHAGE
• Packing and Compression
• Radiological guided embolization
• Ligation of external carotids
• Blind clamping should be avoided
• Facial nerve and parotid duct damage
• Anterior and posterior nasal packing
• Rule out base of skull fracture
18. EARLY AND AGGRESSIVE DEBRIDEMENT
• To prevent infection
• Scrubbing brushes, pulsed lavage, surgical dermabrasion
• Remove ragged margins 1-2 mm
• Severed branches of facial nerve and parotid ducts tagged
• low threshold for tracheostomy
• delayed swelling of airway suspected
19. EARLY AND AGGRESSIVE DEBRIDEMENT
• Most facial wound closure within 36 hours of injury
• Delayed closure not necessary like rest of the body
• Serial debridement highly unusual
• Primary closure
• Viable tissue
• Tension free closure
• Delayed primary closure
• Tissue vitality questionable
• Iodine soaked gauze pack
20. TEMPORARY REDUCTION AND FIXATION OF
FRACTURES
• Reduce bleeding and pain
• Comminuted and open to cutaneous and mucosal surface
• Orbital compartment syndrome
• Lateral canthotomy
• Inferior cantholysis
21. TEMPORARY REDUCTION AND FIXATION OF
FRACTURES
• Mandibular fractures
• External fixators
• Generic hoffman device
• Mandible specific external fixators
• External fixators
• No compromise of airway as in IMF
• Easy debridement of tissues
• Oral hygiene maintainace
• Good nutrition
• Trismus due to fibrosis and scarring is reduced
22. TEMPORARY REDUCTION AND FIXATION OF
FRACTURES
• External fixators for midface
• Lavant frame
• Maxilla or zygoma attached to supraorbital ridges
• Better than box frame
• Mini plate fixation of smaller segments
27. EARLY MANAGEMENT
• 120 min -28 days
• Asses extent of necrosis in 36 hours
• Primary closure if possible
• Debridement and suture of deep spaces
• Surgical drains
28. EARLY MANAGEMENT
• local rotation and advancement flaps
• Preserve facial vessels for future anastomosis
• Skin grafts are best avoided for first 5-7 days
• Risk of infection
• More prone to contracture
• once a scar has contracted then it is almost impossible to rectify
later
29. EARLY MANAGEMENT
• Infection rates range from 7 – 19%
• Bullets and fragment wounds are contaminated
• Contrary to popular belief
• Patient from iraq and afganistan
• Actinobacter baumanni
• Empiral broad spectrum antibiotic for 10-14 days
• Clostridium perfringens and clostridium tetani
30. EARLY MANAGEMENT
• High energy transfer
• Thrombosis 3 cm away from macroscopic wound
• Consideration for microvascular anastomosis
• 7-10 days for repair
• Anastomosis after 2 weeks
31. EARLY MANAGEMENT
• Complex military ballistic facial trauma in UK and US
• Secure airway and reconstruct mandible in 3-5 days
• Contemporary management of mandibular fracture
• Miniplate osteosynthesis
• Serious comminution, periosteal damage, through and through
injury
• Conventional direct osteosynthesis not recommended
32. EARLY MANAGEMENT
• Open fractures
• Debrided
• Irrigated and closed temporarily
• Repair be delayed upto 2 weeks for clearance of infection
• Except
• Fracture that compromise airway
• impair hemostasis
33. EARLY MANAGEMENT
• Longer delays not recommended
• Fibrosis and collapse of fibrous tissue envelope
• Dental impression
• Splints and arch bar for mandible
• Vertical height and form of dental arch
• To prevent splay at angles
34. LONG TERM REHABLITATION
• 1-3 months
• Provision enough bone
• Implants
• bone loss replaced
• Iliac crest deep circumflex iliac artery flap
• Scapular flap
• fibular flap
In the name of ALLAH SWT THE MOST BENEFICIENT THE MOST MERCIFUL
This is the presentation layout
Ballistic maxillofacial trauma encompasses all injuries that are sustained either directly by, or secondary to, firearms and explosive devices. 79 percent maxillofacial ballistic injuries were caused by ieds to british soldier in Iraq and afganistan
Surprisingly these injuries have very low mortality rate of about 2 to 3%
Bullet wounds from high velocity rifles result in the trans-fer of considerable energy and cavitation of tissue . Those that pass through the face and jaws often strike hard tissues (the bony skeleton and teeth), which results in deposition of energy and secondary formation of missiles from the hard fragments of tissue.
Ieds cause injuries in four ways
Primary blast injuries are caused by the sudden increase in air pressure after an explosion and in the maxillofacial region affect predominantly bones that contain air
Evidence of isolated orbital blowout fractures without surrounding rim fractures has been reported
5Secondary blast injuries are caused by energised frag-ments, or soil overlying a buried IED
tertiary blast,which occurs when the casualty is thrown by the explosion and collides with nearby objects; such blunt injuries
Quaternary injuries are due to thermal effects which causes burns
Timing of treatment varies in both civilian and military ballistic trauma
But in both settings exsanguination and airway management should commence within an hour
Excessive loss of blood due to hemorrhage
How does exsanguination occur?
Exsanguination or bleeding out occurs most often after a major artery is severed and the bleeding is not stopped
Immediate management should commence from the moment trauma occurred. It is based on ATLS Protocols. However modified atls protocols are used in military setting. In which hemorrhage control is done before airway as there are less chances of airway damage in military setting than bleeding
Choice of emergency air is cricothyroidotomy.
Always suspect cervicle spine injury in a patients who are thrown away by blast
Damage control maxillofacial surgery should commence before 2 hours. rapid initial assessment is made to rule out life threatening injureis to other parts of the body
Seriously injured patient are often bypassed from emergency department and directly taken to ot. The author has suggested that if ct scan can be of great diagnostic value if it can be done before bringing patient to ot.
For MAXILLOFACIAL DAMAGE CONTROL SURGERY facial examination is done and ct scan is reviewed. Then meticulous examination is performed to check if there are
Damage control maxillofacial surgery consists of three parts
There can be profuse bleeding in Maxillofacial region after trauama but it is rarely associated with appreciable mortality.
Most of the hemorrhage in Maxillofacial region is stopped by packing and compression
Other methods to control hemorrhage are ligation of external carotids under direct visualization . Anterior and posterior nasal packing in case of nasal bleed after ruling out of base of skull fracture .
Blind clamping of vessels should be avoided as it can cause injury to facial nerve and parotid ducts
Early and aggressive debridement should be performed to prevent infection. Scrubbing brushes pulsed lavage and surgical dermabrasion can be used. If margin are ragged then remove 1-2 mm. if severed branched of facial nerve or parotid duct are found ther must be tagged with no resorbable suture for future anastomosis.
There should be a very low threshold to perform tracheostomy. Even if minor swelling of airways is suspected tracheostomy should be performed.
Most facial wounds can be closed primarily within 36 hours and delayed closure like the rest of the body is not advocated. Serial debridement is highly unusal in facial ballistic wounds. Primary closure can be done if tissues are viable and tension free primary closure is achievable. In case primary closure is not possible or tissue vitality is questionable then wound is packed with iodine soaked gauze pack.
Temporary reduction and fixation of fractures reduces bleeding and pain. Fractures due to ballsit trauma are often comminuted and are open to cutaneous and mucosal surfaces
Explosion can cause orbital blow out fractures and burns which results in orbital compartment syndrome . In this case lateral canthotomy and inferior cantholysis is necessary.
Mandibular fractures are best reduced and fixed with external fixator like Generic hoffman device and
Mandible specific external fixators. External fixatior are preferable to imf because there is no No compromise of airway as in IMF
Easy debridement of tissues can be done
Oral hygiene maintainace is easy
Good nutrition is not compromise and there is less
Trismus due to fibrosis and scarring i
External fixators for midface are lavant frame these are attached to maxilla or zygoma. These better than box frame as there is less interference when patient is lying or sleeping
Miniplates can be used to fix small fragment to make large fragrmen which then can be attached to external fixators
External fixators for midface are lavant frame these are attached to maxilla or zygoma. These better than box frame as there is less interference when patient is lying or sleeping
Miniplates can be used to fix small fragment to make large fragrmen which then can be attached to external fixators
External fixators for midface are lavant frame these are attached to maxilla or zygoma. These better than box frame as there is less interference when patient is lying or sleeping
Miniplates can be used to fix small fragment to make large fragrmen which then can be attached to external fixators
External fixators for midface are lavant frame these are attached to maxilla or zygoma. These better than box frame as there is less interference when patient is lying or sleeping
Miniplates can be used to fix small fragment to make large fragrmen which then can be attached to external fixators
External fixators for midface are lavant frame these are attached to maxilla or zygoma. These better than box frame as there is less interference when patient is lying or sleeping
Miniplates can be used to fix small fragment to make large fragrmen which then can be attached to external fixators
The early management phase last from 2 hours till 28 days. In first 36 hours assess th extent of necrosis if tension free primary closure is possible it can be performed at this stage.
Deep spaces should be further debride if it needs and sutured with resorbable suture to remove dead spaces. Surgical drains can be placed.
Local rotation and advancement flaps can be utilized if facial vessel are not ligated. Because they can be used in future for anastomosis .
Skin grafts are best avoided for first 5 to 7 days due to risk of infection and contracture.
Infection rates from ballistic trauma are poorly charachterized which range form 7 to 19 %
Bullets and fragement of ied are contaminated contrary to popular belief
Patient who returned from Iraq and afganistan were infected with Actinobacter baumanni
Limited evidence exist to guide the choice of antimicrobial. It is Generally accepted that broad spectrum antibiotics should be used for 10 to 14 days.
High energy transfer can cause thrombosis of vessels 3 cm away form macroscopic wound margin. This should be considered for microvascular anastomosis. These vessels take 7 to 10 days for repair . It is recommended that anastomosis be performed after 2 weeks
In cComplex military ballistic facial trauma , surgeons in both uk and us secure airway and reconstruct mandible in 3-5 days Contemporary management of mandibular fracture is largely dependant on Miniplate osteosynthesis. However in Serious comminution, periosteal damage, through and through injury
Conventional direct osteosynthesis not recommended
open fractures should be debrided, irrigated, and closed tem-porarily to prevent infection. With the exception of fractures that compromise the airway or impair haemostasis repair may be delayed for up to two weeks after injury to clear any infection
Longer delays increase the chance of fibrosis and collapse of the soft-tissue envelope,which makes it harder for them to assume their premorbid anatomy. Dental impressions can be taken for the manu-facture of splints and arch bars using the mandible as there ference point. This will provide a guide to vertical height and the form of the dental arch, as it is easy to splay the angles, which results in excess facial width.
The longer-term rehabilitation of those patients with gross maxillofacial bony injuries revolves around provision of enough bone to enable placement of dental implants
Bone loss may be replaced by either free or vascularised bone grafts, with the latter generally taken from the iliac crest deep cir-cumflex iliac artery flap, scapular flap, or fibular flap.
. In later reconstruction distraction osteogenesis can pro-vide additional bone, with the advantages of no donor site morbidity and slow growth that enable the overlying soft tissues to adapt to the new bony shape. alloplastic methods using prostheses still have a role in those tissues that are cur-rently challenging to reconstruct aesthetically, such as the ears, nose, and orbit.
. In later reconstruction distraction osteogenesis can pro-vide additional bone, with the advantages of no donor site morbidity and slow growth that enable the overlying soft tissues to adapt to the new bony shape. alloplastic methods using prostheses still have a role in those tissues that are cur-rently challenging to reconstruct aesthetically, such as the ears, nose, and orbit.