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

1. Maxillofacial Trauma and Its
Emergency Management
Presented by-
Dr.Sabrina Farida Chowdhury
Dr.Nusrat jahan Mou
Dr.Jarin tasnim Disha
Dr.Nahidara parveen
Dr.Shanjida wasima

2. Maxillofacial Trauma and Its Emergency
Management

3. Maxillofacial Trauma:
Definition:
Any injury (such as wound) to a living tissue cause by an
extrinsic agent

4. When do we call Trauma an
Maxillofacial Emergency??

5. Maxillofacial Emergency:
Situation that requires early management and
may complicate affected patient’s life by
affecting his face,brain,cervical spine and
airway.

6. TRAUMA/INJURY:
Facial Trauma is one of the main reason of
maxillofacial emergencies.
Proportionally male are more prone to
trauma than the female(2:1).
Facial trauma may be associated with
traumatic brain injury in 15-48%.

7. Facial Trauma :
It may result from
1. Interpersonal Violence 52%
2. RTA 16%
3. Sport injury 19%
4. Fall 11%
5. Industrial accident 2%

8. Injury:
Maxillifacial injuries are of two types:
1. Hard Tissue Injury
2. Soft Tissue Injury

9. Hard Tissue injury
1.Fractures
● Upper Third Fractuer
● Midface fracture
● Lower third fracture/Mandibukar Fracture
2.Displacement
3.Dislocations
4.Dento-Alveolar Injury(Tooth Fracture,Tooth Avulsion)

10. Fracture
● Definition: Complte/incomplete break in continuty of
bone resulting from execessive application of force

11. FRACTURES OF FACIAL SKELETAL

12. Fracture of the upper third of the face:

13. Fractures of Upper Third of the face

14. Fractures Of the Middle Third Of the Face: Lefort I ,II
, III

15. Lowerthird – Mandible Fracture

17. Soft Tissue injuries
1. Abrasion
2.Laceration
3.Cntusion
4.Hematona
5.Incised wound
6.Penetrated wound
7. Crush and gunshot injuries

18. ABRASION
Abrasions Abrasion caused by the frictional
violence, due to friction between an object
amd surface of the soft tissue. It is
presented as raw bleeding areas. The
wound is superficial and it denudes the
epidermis, occasionally involves the deeper
layers. Abrasion involves the terminal nerve
endings of many nerve fibres and it can be
quite painful. Abrasions may be
contaminated depending on the
surroundings.

19. ABRASION(TREATMENT)
● 1. Through cleaning with profuse saline irrigation
● 2. Removal of the foreign material
● 3. Gentle scrubbing with the soft brush to remove sticky
material to prevent tattooing
● 4. Use of surgical soap is required to be done prior to dressing
● 5. Topical application of antibiotic ointment with
compression dressing promotes good healing.
● 6. Superficial abrasions can be covered with topical antibiotic
application and left open. Slowly the crust of dried blood and
serum will form a scab and it will fall off as the healing takes
place.

20. CONTUSION
Contusion is caused by a blow or fall
against a hard or blunt object. Blood
extravasates in the subcutaneous or sub
mucous tissue leading to bluish area or
bruise. Subcutaneous bleeding is self
limiting. This is without break into the
soft tissue surface. Discoloration of the
skin or mucosa causes ecchymosis.
Important for diagnosis and search for an
osseous trauma is mandatory.

21. CONTUSION(TREATMENT)
● 1. Application of ice pack will help to stop further
extravasation of blood.
● 2.An elastic bandage may be wrapped around a
bruised muscle to support the area and decrease
swelling

22. HEMATOMAS
Hematomas are localized collection of blood
in the subcutaneous or intramuscular or
submucosal space. It may be deeply seated or
superficial. It can be associated with a fracture
or rupture of a vessel or vessels. Careful
examination may be repeated and X-ray
examination is essential for proper diagnosis
and treatment .

23. HEMATOMA(TREATMENT)
● 1. Most hematomas are reabsorbed
● 2. Persistent hematoma may require incision and
drainage. It can not be aspirated as blood is partially
clotted
● 3. Antibiotic cover should be given to prevent
hematoma from getting infection.

24. LACERATED WOUND
Lacerated wounds are most frequent
type of soft tissue injuries. Here the
tearing of mucosal tissue or skin is seen
due to vehicular accidents, low velocity
missiles (pistols) or bomb splinters. The
margins are contused and lacerated in
deep wounds, the muscles are also
lacerated and devitalized. There may
be associated injury to the underlying
vessels, nerves and bone. These
wounds are usually highly
contaminated with dust, mud, greasy
material, bone splinters etc.

25. LACERATED WOUND(TREATMENT)
● 1. Through cleaning, minimum debridement, removal
of foreign bodies and proper suturing as early as
possible should be done
● 2. Closure should be done in multiple layers (muscle,
dermis, epidermis, submucosa and mucosal closure).

26. INCISED WOUNDS
Incised wound Incised wounds
are caused by a sharp cutting
objects such as knife
,dagger,glass piece, tin etc.

27. INCISED WOUND (TREATMENT)
1.cleaning,exploring,and the bleeding should be
stopped. 2.wound closed by primary intension

28. PENETRATING WOUNDS AND PUNCTURED
WOUNDS
Punctured wounds are caused by pointed
onjects like knife,bullet,bomb
splinter.careful clinical examination and
other investigations are required.

29. CRUSH INJURIES
Crush injuries Crush injuries is caused by road accidents
and machinary accidents.it damages to the skin ,nerve
,blood vessels,muscle bone is also seen

30. CRUSH INJURIES(TREATMENT)
● Tetanus shot will be neccessary as well antibiotics
● Immediiate medical attention is required.
● In serious crush injuries injuries,in which compartment
syndrome has already set in or is
inevitable.immediate surgery will be required to
eliminate the pressure on the muscles and nerves

31. GUNSHOT INJURIES
It is in reality penetrating wounds but
are classified separately because of
their extensiveness of the wound
and special problem arise during
their management. They are
subclassified as a
1.penetrating wounds
2.perforating wounds
3.avulsion

33. Emergency Management of a Trauma patient:
Advanced trauma life support(commonly
abbreviated ATLS) is a training program for medical
providers in the management of acute trauma cases,
developed by the American College of Surgeons.

34. ATLS Overview
● Triage
● Primary Survey
● Resuscitation
● Adjunct to primary
survey
● Secondary Survey
● Adjuct to secondary
survey
● Definitive Care

35. Triage:
The process of categorizing victims or mass casualties
based on their need for treatment and resource available.
Goal:
-prevent avoidable death
-To provide initial treatment in a minimal time

36. Primary Survey:
It is the first and important key part of ATLS.
It includes~~ABCDE
● A-Airway Maintainance and Spine Protection
● B-Breathing and Ventillation
● C-Circulation and Heamorrhage Control
● D-Disability
● E-Exposure

37. Airway Maintainance and Spine
Protection

38. Factors That May Compromise the Airway:
According to Hutchison et al., there are six specific situations
associated with maxillofacial trauma, which can adversely
affect the airway.

39. NO.1
Posterior inferior displacement of a fractured maxilla parallel
to the inclined plane of the base of the skull may block the
nasopharyngeal airway

40. NO.2
A bilateral fracture of the anterior
mandible may cause the fractured
symphysis and the tongue to slide
posteriorly and block the oropharynx in
the supine patient.

41. NO.3
Fractured or exfoliated teeth, bone fragments, vomitus,
blood, and secretions as well as foreign bodies, such as
dentures, debris, and shrapnel, may block the airway
anywhere along the oropharynx and larynx.

42. NO.4
Hemorrhage from distinct vessels
in open wounds or severe nasal
bleeding from complex blood
supply of the nose may also
contribute to airway obstruction.

43. NO.5
Soft tissue swelling and edema
because of trauma to the head
and neck may cause delayed
airway compromise.

44. NO.6
Trauma of the larynx and trachea may cause swelling
and displacement of structures, such as the epiglottis,
arytenoid cartilages, and vocal cords, thereby
increasing the risk of cervical airway obstruction.

45. Airway Maintainance:
● Head Tilt-Chin-Lift Maneuver

46. Airway Maintainance
● Oropharyngeal Toileting:By digital exploration or using
cotton swabs
● Suction Nasal Cavity,Oral Cavity and Throat
● Control the tongue by Tongue suturing
● Temporary stabilization of fracture
● Mouth to mouth breathing
● Endotracheal intubation

47. Airway Maintainance
● Jaw Thrust
● Surgical:
Tracheostomy
Cricothyroidotomy

48. Spine Protection

49. Breathing and Ventillation

50. Breathing and Ventillation
Aim:
-is to identify and manage six
life-threatening thoracic
conditions as
Airway Obstruction,
Tension Pneumothorax
Massive Haemothorax
Open Pneumothorax
Flail chest segment
with Pulmonary Contusion
and Cardiac Tamponade.

51. Circulation and Heamorrhage Control

52. Circulation and Heamorrhage Control
● If evacuation time is <1 hr,surgical intervention should be done after
establishing airway and breathing.
● If evacuation time is > 1hr,a Fluid line to be established first
● Usually Crystalloid solution are preferrable
● Blood is drawn and sent for grouping and crossmatching
● As soon as possible blood trasfusion is started
● Vital parameters are monitored
● Antibiotics and Analgesics
● Anti tetanous protection

53. For speedy Recovery:
● High calorie,High protein diet
● Nasogastric feeding in severe case
● Vitamin supplement

54. Secondary Survey

55. -Definitive Care

56. Thank YOU