Maxillofacial trauma can result from injuries like motor vehicle accidents, falls, or animal bites. It includes soft tissue wounds, bone fractures, or a combination. Diagnosis involves clinical examination looking for signs of injury, and radiographic evaluation using techniques like plain X-rays, panoramic views, and advanced imaging to identify fractures. Treatment depends on the specific injuries but the priorities are always managing the airway, breathing, and circulation during the emergency period.
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
Management of soft tissue injuries in facial traumaAhmed Adawy
Management of soft tissue injuries in facial trauma
Dr. Ahmed M. Adawy.
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine, Al-Azhar University.
Soft-tissue injuries are the most common presentation following maxillofacial trauma. In general, injuries can initially be classified as open or closed wounds. A closed wound is one that damages underlying tissue and/or structures without breaking the skin. Examples of closed wounds include hematomas, contusions, and crush injuries. In contrast, open wounds involve a break in the skin, which exposes the underlying structures to the external environment. Open wounds include simple and complex lacerations, avulsions, punctures, abrasions, accidental tattooing, and retained foreign body. Detailed description of management is presented. The principles of repair is discussed.
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
Brief notes on the inflammation of Alveolar bone that surrounds a tooth that has recently been extracted. It occurs as a complication of tooth extraction.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
Management of soft tissue injuries in facial traumaAhmed Adawy
Management of soft tissue injuries in facial trauma
Dr. Ahmed M. Adawy.
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine, Al-Azhar University.
Soft-tissue injuries are the most common presentation following maxillofacial trauma. In general, injuries can initially be classified as open or closed wounds. A closed wound is one that damages underlying tissue and/or structures without breaking the skin. Examples of closed wounds include hematomas, contusions, and crush injuries. In contrast, open wounds involve a break in the skin, which exposes the underlying structures to the external environment. Open wounds include simple and complex lacerations, avulsions, punctures, abrasions, accidental tattooing, and retained foreign body. Detailed description of management is presented. The principles of repair is discussed.
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
Brief notes on the inflammation of Alveolar bone that surrounds a tooth that has recently been extracted. It occurs as a complication of tooth extraction.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
This contains wound and wound dressing,classification of wound,
signs and symptoms of wound
Diagnostic evaluation od wound
Wound healing process,
Factors affecting wound healing
Complication of wound
Wound Dressing
Types of dressing
Articles need in wound dreassing
Ridge preparation for implant placement - part 1Hesham El-Hawary
- criteria of ideal ridge
- implants timing protocol
- implants planning and case selection
- clinical types of bone
- preventive methods to preserve the alveolar ridge
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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
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.
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
4. Maxillofacial Trauma El-Hawary
Trauma
Serious injury or shock to the body as form of
violence or accident
Bone fracture
A medical condition in which there is a break in
the continuty of bone
7. Maxillofacial Trauma El-Hawary
WOUNDS
• Type of injury in which skin is torn, cut or
punctured (an open wound), or where blunt
force trauma causes a contusion (a closed
wound)
• In pathology: it specifically refers to a sharp
injury which damages the dermis of the skin
10. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
11. Maxillofacial Trauma El-Hawary
Classification according to object causing wound
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
12. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
13. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
14. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
16. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
http://woundbegone.blogdrive.com/
17. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury http://en.wikipedia.org/wiki/File:Knee_puncture.JPG
18. Maxillofacial Trauma El-Hawary
Classification according to object causing wound
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
http://journal.nzma.org.nz/journal/120-1267/2867/
19. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush injury http://www.podiatrytoday.com/article/6303
20. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
21. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
http://en.wikipedia.org/wiki/File:Bruises.jpg
22. Maxillofacial Trauma El-Hawary
Classification according to the exposure to the outer
environment
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury
http://www.buzzle.com/articles/hematoma-treatment.html
23. Maxillofacial Trauma El-Hawary
Classification according to object causing wound
wound
Open
Incision
Laceration
Abrasion
Puncture
Penetration
Gunshot
Closed
Contusion
Hematoma
Crush
injury http://www.smrteam.com/na1_crushinjury.htm
26. Maxillofacial Trauma El-Hawary
Classification According to level of risk of sepsis
wound
Clean wound
Clean
contaminated
wounds
Contaminated
wounds
Dirty wounds
• No viscus entered
• No septic area
• No break in aseptic technique
• Such wounds should never become
infected; infection rates less than 3%
27. Maxillofacial Trauma El-Hawary
Classification According to level of risk of sepsis
wound
Clean wound
Clean
contaminated
wounds
Contaminated
wounds
Dirty wounds
• Operation enters a non-infected area but
may encounter bacteria
• Careful control of the area should result in
minimal spillage of organisms
• Examples of this include surgery on the
upper gastrointestinal tract, biliary tree or
respiratory tract
• Infection rates for this type of surgery should
be less than 10%
28. Maxillofacial Trauma El-Hawary
Classification According to level of risk of sepsis
wound
Clean wound
Clean
contaminated
wounds
Contaminated
wounds
Dirty wounds
• Gross spillage of organisms, where there is
infection already present but without pus
formation
• There is a major break in aseptic technique
• There is an open wound that has been
exposed for less than 4 h (e.g. following
major trauma)
• In this type of wound, sepsis frequently
exceeds 30%
29. Maxillofacial Trauma El-Hawary
Classification According to level of risk of sepsis
wound
Clean wound
Clean
contaminated
wounds
Contaminated
wounds
Dirty wounds
• This is an operation through an infected area
(e.g. perforated viscus, abscess or traumatic
wound) that has been exposed for over 4 h
30. Maxillofacial Trauma El-Hawary
Classification of wound healing
• Primary Intention
• Occurs when:
– The edges are clean and held
together with ligatures
– There is little gap to bridge Healing
• Healing properties (When
uncomplicated)
– Occurs quickly
– Rapid ingrowth of wound healing
cells (macrophages, fibroblasts, etc.)
– Restoration of the gap by a small
amount of scar tissue.
• soundly united within 2 weeks
• Dense scar tissue is laid down
within 1 month
31. Maxillofacial Trauma El-Hawary
Classification of wound healing
• Secondary Intention
• Occurs when:
– The edges are separated
– The gap can not be directly bridged
– Extensive epithelial loss
– Severe contamination
– Significant subepithelial tissue damage
• Healing properties
– Occurs slowly
– Granulation; healing from the bottom
towards the surface
– Restoration of the gap by a small
amount of scar tissue.
• Scaring
• Wound contracture
32. Maxillofacial Trauma El-Hawary
Classification of wound healing
• Secondary Intention
• Occurs when:
– The edges are separated
– The gap can not be directly bridged
– Extensive epithelial loss
– Severe contamination
– Significant subepithelial tissue damage
• Healing properties
– Occurs slowly
– Granulation; healing from the bottom
towards the surface
– Restoration of the gap by a small
amount of scar tissue.
• Scaring
• Wound contracture
33. Maxillofacial Trauma El-Hawary
Differences between primary and secondary
healing
Feature Primary healing Secondary healing
Cleanness Clean Unclean
Infection Generally uninfected May be infected
Margins Surgically clean Irregular
Healing Scanty granulation tissue Granulation tissue fill the gap
Healing period Short long
Healing direction Direct healing From the bottom to the edge
Outcome Neat linear scar Contracted irregular wound
45. Maxillofacial Trauma El-Hawary
Complications of wound healing
complications
Infection
Dehiscence
Incisional
Hernia
Hypertrophic
scaring
Keloid
scarring
Contractures
• Definition: Breakdown of the deeper layers of a wound in
which the skin layer remains intact with protrusion of
underlying structures through the deeper defect
http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional_her
nia/info-incisional-hernia-gen-1.htm
46. Maxillofacial Trauma El-Hawary
Complications of wound healing
complications
Infection
Dehiscence
Incisional
Hernia
Hypertrophic
scaring
Keloid
scarring
Contractures
• Treatment:
• Difficult
• Further surgery should not be attempted for at least
6 months
• Excision of the scar and re-suturing often has
disappointing results, resulting in the same over
healing
• Radiotherapy used to be used but has now been
abandoned
• Some improvement can be achieved with local
injection of corticosteroids directly into the scar, a
process that might need repeating several times
http://www.ehow.com/about_5422431
_natural-herbs-hypertrophic-scars.html
47. Maxillofacial Trauma El-Hawary
Complications of wound healing
complications
Infection
Dehiscence
Incisional
Hernia
Hypertrophic
scaring
Keloid
scarring
Contractures
• Treatment:
• Excision generally results in a larger recurrence
• Although excision followed by compression
bandaging can have slightly better results
• Corticosteroid injections give some improvement
48. Maxillofacial Trauma El-Hawary
Complications of wound healing
complications
Infection
Dehiscence
Incisional
Hernia
Hypertrophic
scaring
Keloid
scarring
Contractures
• Wound Contractures can occur with any wounds
• More commonly with delayed healing wounds
• Contracture of a scar across a joint can result in marked
limitation of movement
• Surgical treatment include
• Skin grafting
• local flaps
• wound Z-plasty
http://www.patient.co.uk/health/D
upuytren%27s-Contracture.htm
87. Maxillofacial Trauma El-Hawary
Dentoalveolar Fractures
1. Periodontal Injuries:
i. Concussion
ii. Displacement (Luxation)
a. Subluxation
b. Intrusive luxation
c. Extrusive luxation
d. Lateral luxation
e. Avulsion
2. Fx of the Alveolar Process
89. Maxillofacial Trauma El-Hawary
Mandibular Fractures
• Classification:
I. According to Site:
a. Symphyseal
b. Parasymphyseal
c. Body
d. Angle
e. Ramus
f. Condyle
g. Coronoid
90. Maxillofacial Trauma El-Hawary
Mandibular Fractures
• Classification:
I. According to Site:
a. Symphyseal
b. Parasymphyseal
c. Body
d. Angle
e. Ramus
f. Condyle
g. Coronoid
92. Maxillofacial Trauma El-Hawary
Mandibular Fractures
• Classification:
II. According to Side:
a. Unilateral
b. Bilateral
III. According to number of lines:
a. Single
b. Multiple
95. Maxillofacial Trauma El-Hawary
Factors affecting the displacement of
fracture
• Direction of the fracture line (favorable/unfavorable)
• Direction of muscle pull (elevators/depressors)
• Presence/absence of teeth
• Direction and magnitude of the traumatizing force
100. Maxillofacial Trauma El-Hawary
Classification of the TMJ region injury
1. Contusion :
- Damage to the capsular ligaments
- May be accompanied by :
Synovial effusion. (Rowe & Kelly,2nd ed,1970)
Haemarthrosis. (Bosanquet et al., 1990, Jones et al., 1991)
Tearing of the meniscus &/or displacement of the articular
disk. (Faustia et al., 1990)
2. Dislocation : (Sullivan et al., 1995)
- Irreducible displacement of the condoyle from the glenoid fossa.
- Direction of displacement:
Anterior, medial (usually).
Lateral, posterior or central (rare).
3. Fracture:
- Any fracture above the level of the segmoid notch.
- It may be:
intracapsular i.e. within the capsule involving the condylar head or
neck.
extracapsular i.e. outside the capsule in the subcondylar region.
101. Maxillofacial Trauma El-Hawary
Classification of Condylar fracture
(Lindahl, 1977)
A. Classification according to the fracture
level:
1. Condylar head (Intracapsular).
2. Condylar Neck.
3. Subcondylar (high or low).
B. Classification according to the relation of
condyle to Mandible:
1. Non displaced.
2. Deviated or angulated.
3. Displaced ( M or L/A or P overlap).
4. No bony contact.
C. Classification according to the relation of
condyle to the Glenoid Fossa:
1. Non Displaced.
2. Displaced-still related to fossa.
3. Dislocation-completely out of fossa.
102. Maxillofacial Trauma El-Hawary
Mechanism of injury
Provide clues about the
magnitude and direction of
force delivered to the patient.
The more force delivered, the
more severe the fracture.
The direction of force
influence the fracture
pattern. (Spina
& Marciani, 2000)
Forces resulting in Trauma to the
TMJ:
1. Moving object striking a static
individual.
2. Moving individual striking a
static object.
3. Combination of forces.
110. Maxillofacial Trauma El-Hawary
• The aim of mandibular fracture treatment is
– Reduction
• Restoration of anatomical form
• Restoration of function
• Establish proper occlusion
– Fixation Immobilization
– Stabilization
– Prevention of infection
127. Maxillofacial Trauma El-Hawary
Advantages of Rigid Fixation
1. Pts with poor or inadequate dentition
2. Avoidance of debilitating weight loss
3. No interference with speech
4. Suitable for pts with seizures or alcoholism
5. Immediate return to work and normal life
style
6. Risk of infection reduced
128. Maxillofacial Trauma El-Hawary
Advantages of Rigid Fixation
7. Avoidance of TMJ disturbance especially in cases
with condylar fracture
8. Fewer complications as non- or malunion (1ry
rather than 2ry bone healing)
9. Safer airway and decreased risk of aspiration
10. Allows for proper oral hygiene
11. Ability to obtain and maintain precise anatomic
reduction of fractured segments
130. Maxillofacial Trauma El-Hawary
Factors affecting the selection of the Surgical
approaches for open reduction
1. The level of the fracture.
2. The degree of displacement or dislocation.
3. The planned method of the fixation.
4. Langer’s lines
133. Maxillofacial Trauma El-Hawary
Factors affecting the selection of the line of
treatment
1. Factors related to the patient
– Age of the patient.
– Well
– Systemic condition
2. Factors related to the fracture
– Site, type and level of fracture.
– Degree of displacement.
– Condition of the post injury occlusion.
3. Factors related to the operator
1. Conditions
2. Skill
3. Armamentarium
146. Maxillofacial Trauma El-Hawary
Fixation of Mandibular Fractures
II. Open Reduction Techniques (direct fixation
techniques) ORIF:
1. Non-rigid: (needs supplementary fixation, IMF)
a. Transosseous (intraosseous) wiring
147. Maxillofacial Trauma El-Hawary
Fixation of Mandibular Fractures
II. Open Reduction Techniques (direct fixation
techniques) ORIF:
2. Rigid: (sole fixation methods)
a. Intramedullary Pinning: Kirchner wires, Steinmann
pins.
b. Metal Mesh plates: Titanium mesh
c. Bone plates and screws: mono- or bicortical
d. Lag Screws
e. Biodegradable (resorbable) bone screws
f. Bone Clamps
166. Maxillofacial Trauma El-Hawary
Condylar Fx Treatment modalities
Treatment modalities
Conservative treatment Open reduction
Close Observation Closed reduction
167. Maxillofacial Trauma El-Hawary
Observation
Indications:
- Well aligned segments (no displacement).
- Repeatable occlusion without pain.
- Children under 12 years of age, with minimal
fracture displacement and normal occlusion.
Technique:
- Clinical observation.
- Soft diet.
- Active function.
- Physiotherapy.
168. Maxillofacial Trauma El-Hawary
Closed reduction
Indications:
- Correctable Malocclusion.
- Deviation of the mandible with function.
- Pain.
Technique:
- Immobilization (7-21 days) in the form of arch bars, Ivy
loops or individual wiring followed by active
mobilization and physiotherapy.
- Period of immobilization depend on:
Age of the patient.
Level of fracture.
Degree of displacement.
169. Maxillofacial Trauma El-Hawary
Indications for open reduction
(Zide & Kent, 1983)
Absolute indications Relative indications
1. Bilateral condylar fracture with
concomitant comminuted
midfacial fracture.
2. Bilateral condylar fracture in an
edentulous patient when splints
are unavilable or imposible
because of sever ridge atrophy.
3. Displaced condyle in an
medically compromised patient
where MMF is contraindicated.
1. Inability to obtain adequate
occlusion with closed reduction.
2. Displacement of the condyle
into the middle cranial fossa.
3. Lateral extracapsular
displacement.
4. Foreign body in the joint
capsule.
171. Maxillofacial Trauma El-Hawary
Management of condylar fractures in children
According to the degree of displacement:
Undisplaced / minimally displaced
condylar fractures:
Conservative non immobilization with
active function.
Severly displaced with malocclusion:
7:10 days immobilization followed up by
acyive function and physiotherapy.
172. Maxillofacial Trauma El-Hawary
Postoperative instructions /medications
• Good oral hygiene
– Teeth brushing
– Rinse utilizing warm saline and mouth wash
• Semi-solid feeding was ordered for the patients on
the second postoperative day and until the end of
MMF period.
• Prophylactic Antibiotics-one week postoperatively
• Anti-edemic
• Analgesics