Dr. Dewi Haryanti K, SpBP-RE

Sub Bagian Bedah PlastikRSUD dr. Moewardi/ FK UNS SkaIntroduction

ISTILAH PLASTIK

PLASTICOS

TO MOLD TO FORM (MENGOLAH) (MEMBENTUK)

BEDAH PLASTIK : Alternatif memberi nilai tambah pada tubuh yang dianggap KURANG

REKONSTRUKSIBEDAH PLASTIKestetikESTETIKCACATNORMALSUPERNORMAL

OPERASI BEDAH REKONSTRUKSI : memperbaiki kelainan baik fungsi ataupun penampilan yang tidak normal menjadi mendekati atau normal kembali

OPERASI BEDAH ESTETIK : memperbaiki keadaan yg normal sesuai dengan kondisi lingkungan setempat menjadi lebih dari normal (supernormal)

TRAUMA MAXILLOFACIAL

Dr. Dewi Haryanti Kurniasih, SpBPSub divisi Bedah PlastikSMF Bedah RSUD dr. Moewardi/FK UNS2012

PENDAHULUANInsiden >>Bisa disertai keluhan : neurologis, ophthalmologis, aerodigestive, skeletal, soft tissue, atau otologisMultiple organ system

INITIAL MANAGEMENTPRIMARY SURVEYAirway & control of Cx spine : Open & secure, Jaw thrust & chin lift, remove foreign bodies, cricothyrotomy if necessaryBreathing : Ass of adequacy of ventilationCirculation : Control of bleeding, IV fluid rescuscitationDisability : Level of consciousness & pupillary evaluationExposure : Complete expose of the px

SECONDARY SURVEYComplete AnamneseComplete head to toe examinationHead, maxilofacial and neck ThoraxAbdomen, perineum and genitalMusculoskeletalNeurological Examination

Maxillofacial TraumaLife-threatening Emergency Treatment :Maintenance of the airwayPrevention of the hemorrhageIdentification & prevention of aspirationIdentification of other (occult) injuries, such as eye, brain and cervical spine

Maxillofacial Trauma :

Soft tissue injury Fractures of frontal sinus Fractures of the zygoma Fractures of the nose Fractures of the orbit & nasoethmoid Fractures of the maxilla Fractures of the mandible

Scalp loss

Soft tissue laceration

Windshield injury

Fractures of The Zygoma Most common injury after Nasal Fracture Prominent position Susceptible to traumatic injury Changes in facial appearance & function Associated with ocular & periocular injury

Signs & SymptomsSymptoms :Anesthesia/ hypesthesiaDiplopiaLimitation of mouth opening

Signs :Depression of cheek convexityEdemaSubconjuctival & periorbital ecchymosisLimitation of mandibular movementDeformity & tenderness along the orbital rimUnilateral epistaxis

Roentgenographic views :

Plain photo Waters ViewSubmentovertex ViewCaldwell view

CT :Axial & Coronal projections

Foto (AP/Lat/Waters)

Treatment Reduction/ reposition closed ( Gillies Approach ) openFixation (interfragmented wiring/ IFW, plating)Immobilitation (MMF)Rehabilitation

Fractures of the Nose* The most frequent fracture of facial bone* The most personal & identifiable feature of human face*Dx , Tx, & follow-up care important to reduce incidence of unfavourable sequele

DiagnosisHistory of MFTSymptoms : deformity, tenderness & bleedingRoentgenography are limited valueThe decision to operate depends on physical findings

TreatmentReduction : Simple & straightforward procedureReduce by close techniqueTiming : Not a surgical emergency, except immediately come after injuryThe usual timing : 3-5 days after injuryAnaesthesia : GA in children, LA in adults

Fractures of The MaxillaCLASSIFICATIONS

Simple & isolated fracturesComplex & associated fractures : Le Fort I,II,III (Renee Classification)

Le Fort I Fracture : Horizontal fractures above the apices of the teeth or Transverse fracture separating alveolus from upper midface

LeFort II Fracture:

Pyramidal fracture,extends from the pterygoid plates under zygoma through the inferior & medial orbital walls across the nasal bones

Le Fort III Fracture:Complete craniofacial separation, extends from zygomatic arches, lateral orbital wall, orbital floor & medial wall across the nasal bones

Clinical FindingsPeriorbital hematomasProfuse nasopharyngeal bleedingPain MalocclusionIntraoral lacerationsSymptoms of zygomatic, orbital, or nasoethmoidal fractures Facial elongation & retrusion Cerebrospinal fluid rhinorrhea (LF II & III)

Clinical FindingsStep-off on palpationSplit palate : in 10% of cases Mobility of maxillary dental arch (floating maxilla)

RoentgenographicPlain Photo : Skull PA / Lateral & Waters CT Scan

TreatmentMaxillo-mandibular fixation (MMF) : Arch BarFracture reduction : Interosseus wiresPlate & screw stabilizationPrimary bone grafting

Maxillo-Mandibular Fixation (archbar-rubber)

FRACTURES OF THE MANDIBLEProminent position succeptible to traumaCaused by traffic or sport accidents and pathologic fractures

Classification

Alveolar bone alone or involve basal boneSingle, bilateral & multiple fracturesAccording to the region of mandibleClose or open

Signs & SymptomsTenderness, limitation of mouth openingDeformity, deviation of midlineOpen bite malocclussionPalpable step defect of the jawPathologic / unnatural mobility of the mandibleSublingual hematome

Malocclusion

Roentgenography

Plain photo : Skull PA / Lateral obliquePlain photo : Townes viewPanoramic viewCT Scan

Principles of TreatmentReduced & fixed earlier, the better is the outcomeAntibiotics should be administeredFractured & caries teeth must be extractedThe first measure : Restoring & securing occlussion

TreatmentCircumdental wiring : Stability of mobile fracturesInterdental wiring : Fixation of whole mandible to the maxillaIntermaxillary fixation : Arch BarBone wiring : Transosseus wiringBone plate

CONCLUSIONSInitial management of MFT is very importantInitial rescuscitation to secure airway, ventilation & stabilized circulationSuccessful management is by complete examination ,failure often from the inability to recognised extent of an injury,then from the inability to treat the recognized an injury

Thank You

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