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1、口腔颌面部损伤口腔颌面部损伤口腔颌面部损伤口腔颌面部损伤Dr.Dr.Dr.Dr.Steve GF Steve GF Steve GF Steve GF ShenShenShenShenOral and Maxillofacial Oral and Maxillofacial Oral and Maxillofacial Oral and Maxillofacial SurgerySurgerySurgerySurgerySchool of StomatologySchool of StomatologySchool of StomatologySchool of StomatologyShan
2、ghai Ninth Peoples HospitalShanghai Ninth Peoples HospitalShanghai Ninth Peoples HospitalShanghai Ninth Peoples HospitalShanghai Second Medical UniversityShanghai Second Medical UniversityShanghai Second Medical UniversityShanghai Second Medical UniversityOral&Maxillofacial TraumaOral&Maxillofacial
3、TraumaChapter 7Chapter 7VocabularyVocabularyabrasionabrasion擦伤擦伤擦伤擦伤adjacenttoothadjacenttooth邻牙邻牙邻牙邻牙alaralar鼻翼的鼻翼的鼻翼的鼻翼的antibioticsantibiotics抗生素抗生素抗生素抗生素anti-infectionanti-infection抗感染抗感染抗感染抗感染anuriaanuria无尿无尿无尿无尿archbararchbar牙弓夹板牙弓夹板牙弓夹板牙弓夹板arterialarterial动脉的动脉的动脉的动脉的asphyxiaasphyxia窒息窒息窒息窒息ba
4、ndagebandage绑带绑带绑带绑带bitewoundbitewound咬伤咬伤咬伤咬伤bloodsupplybloodsupply血供血供血供血供bustupbustup斗殴斗殴斗殴斗殴capillarycapillary毛细血管的毛细血管的毛细血管的毛细血管的cerebralcerebral脑的脑的脑的脑的cerebralfluidcerebralfluid脑脊液脑脊液脑脊液脑脊液cervicalcervical颈的颈的颈的颈的concussionconcussion震荡震荡震荡震荡contaminatecontaminate污染污染污染污染contusioncontusion挫伤挫伤
5、挫伤挫伤2024/6/152VocabularyVocabularycyanosiscyanosis发绀发绀发绀发绀debridementdebridement清创术清创术清创术清创术alveolarprocessalveolarprocess齿槽突齿槽突齿槽突齿槽突dentalpulpdentalpulp牙髓牙髓牙髓牙髓devitalizedevitalize失活失活失活失活dysfunctiondysfunction功能异常功能异常功能异常功能异常dysphoriadysphoria烦躁不安烦躁不安烦躁不安烦躁不安edemaedema水肿水肿水肿水肿estheticesthetic美学的美
6、学的美学的美学的exfoliateexfoliate脱落脱落脱落脱落exsanguineexsanguine失血的失血的失血的失血的extraduralextradural硬脑膜外的硬脑膜外的硬脑膜外的硬脑膜外的extrinsicforceextrinsicforce外力外力外力外力extrusionextrusion突出的突出的突出的突出的facialnervefacialnerve面神经面神经面神经面神经foreignbodyforeignbody异物异物异物异物fracturefracture骨折骨折骨折骨折gingivalgingival牙龈的牙龈的牙龈的牙龈的hematomahema
7、toma血肿血肿血肿血肿hemostasiahemostasia止血，止血法止血，止血法止血，止血法止血，止血法2024/6/153VocabularyVocabularyhemostathemostat止血钳止血钳止血钳止血钳hyponuriahyponuria少尿少尿少尿少尿hypopneahypopnea低通气低通气低通气低通气incisedwoundincisedwound切割伤切割伤切割伤切割伤inhaleinhale吸气吸气吸气吸气inspiratoryinspiratoryasphyxiaasphyxia吸入性窒息吸入性窒息吸入性窒息吸入性窒息intracranialintrac
8、ranial颅内的颅内的颅内的颅内的intubationintubation插管插管插管插管laceratelacerate撕裂撕裂撕裂撕裂lacerationlaceration撕裂撕裂撕裂撕裂ligationligation结扎结扎结扎结扎luxationluxation脱位脱位脱位脱位malocclusionmalocclusion咬合错乱咬合错乱咬合错乱咬合错乱mandiblemandible下颌骨下颌骨下颌骨下颌骨masticationmastication咀嚼咀嚼咀嚼咀嚼maxillamaxilla上颌骨上颌骨上颌骨上颌骨maxillofacialmaxillofacial颌面的颌
9、面的颌面的颌面的mouthopeningmouthopening张口度张口度张口度张口度nasalcavitynasalcavity鼻腔鼻腔鼻腔鼻腔obliviscenceobliviscence遗忘遗忘遗忘遗忘2024/6/154VocabularyVocabularyobstructiveasphyxiaobstructiveasphyxia阻塞性窒息阻塞性窒息阻塞性窒息阻塞性窒息occlusionocclusion咬合咬合咬合咬合oralcavityoralcavity口腔口腔口腔口腔oralhygieneoralhygiene口腔卫生口腔卫生口腔卫生口腔卫生orbitorbit眼眶眼眶
10、眼眶眼眶pain-killerpain-killer止痛剂止痛剂止痛剂止痛剂paralysisparalysis瘫痪瘫痪瘫痪瘫痪paranasalparanasalsinussinus副鼻窦副鼻窦副鼻窦副鼻窦parotidglandparotidgland腮腺腮腺腮腺腮腺percussionpercussion叩诊叩诊叩诊叩诊periodontal ligamentperiodontal ligament牙周韧带牙周韧带petechiapetechia瘀斑，瘀点瘀斑，瘀点pharyngeal cavitypharyngeal cavity咽腔咽腔plasmaplasma血浆血浆psycholo
11、gicalpsychological心理的心理的psychotherapypsychotherapy精神疗法精神疗法rabiesrabies狂犬病狂犬病regenerateregenerate再生再生reimplantationreimplantation再植再植rescuerescue营救，抢救营救，抢救2024/6/155VocabularyVocabularyrespiratoryrespiratory呼吸的呼吸的呼吸的呼吸的salivasaliva涎液，唾液涎液，唾液涎液，唾液涎液，唾液salivarysalivary涎液的涎液的涎液的涎液的shockshock休克休克休克休克skul
12、lbaseskullbase颅底颅底颅底颅底stomatognathicstomatognathic口颌的口颌的口颌的口颌的subdermalsubdermal皮下的皮下的皮下的皮下的swallowswallow吞咽吞咽吞咽吞咽sweatsweat出汗出汗出汗出汗tetanustetanus破伤风破伤风破伤风破伤风toothachetoothache牙疼牙疼牙疼牙疼toxicshocktoxicshock中毒性休克中毒性休克中毒性休克中毒性休克transportationtransportation运输，搬运运输，搬运运输，搬运运输，搬运traumatrauma损伤，外伤损伤，外伤损伤，外伤损
13、伤，外伤trigeminalnervetrigeminalnerve三叉神经三叉神经三叉神经三叉神经unconsciousnessunconsciousness神志不清神志不清神志不清神志不清upperairwayupperairway上呼吸道上呼吸道上呼吸道上呼吸道vaccinationvaccination接种疫苗接种疫苗接种疫苗接种疫苗venousvenous静脉的静脉的静脉的静脉的visceraviscera内脏内脏内脏内脏2024/6/156DefinitionoftraumaDefinitionoftraumatraumanounCorUtraumanounCorU1.1.seve
14、reemotionalshockandpaincausedbyansevereemotionalshockandpaincausedbyanextremelyupsettingexperience:extremelyupsettingexperience:the trauma of marriage breakdownthe trauma of marriage breakdownHe had psychotherapy to help him deal with his He had psychotherapy to help him deal with his childhood trau
15、mas.childhood traumas.2.2.SPECIALIZEDSPECIALIZEDasevereinjury,usuallycausedbyaasevereinjury,usuallycausedbyaviolentattackoranaccidentviolentattackoranaccident(fromCambridgeAdvancedLearnersDictionary)2024/6/157Section1IntroductionSection1IntroductionWarWarWarIncidenceIncidenceTrafficAccidentTrafficAc
16、cidentSportsFallingFallingBustupBustupLaborinjuryLaborinjury2024/6/158TrafficAccidentTrafficAccident2024/6/1510 Combinedinjurytootherviscera-FataltolifeCombinedinjurytootherviscera-FataltolifeCombinedinjurytootherviscera-Fataltolife DamagetomaxillofacialstructureDamagetomaxillofacialstructureDamaget
17、omaxillofacialstructure StomatognathicStomatognathicStomatognathicdysfunctiondysfunctiondysfunction FacialestheticproblemFacialestheticproblemFacialestheticproblem PsychologicaltraumaPsychologicaltraumaPsychologicaltraumaEffect of Trauma on the Effect of Trauma on the Human BodyHuman Body2024/6/1511
18、1.RichbloodsupplySection2CharacteristicsofOMFTraumaSection2CharacteristicsofOMFTrauma2024/6/1512DebridementDebridement Time:24 48 h Time:24 48 hTend to Tend to hematomahematoma,edema,edemaRespiratoryRespiratory tract tractAsphyxiaAsphyxiaAbility to anti-infection,Ability to anti-infection,regenerati
19、onregenerationWound healingWound healing1.Richbloodsupply1.Richbloodsupply2024/6/1513 Cerebral concussionCerebral concussion Cerebral contusionCerebral contusion Intracranial Intracranial hematomahematoma Skull base fracture Skull base fracture Increase infectious incidenceIncrease infectious incide
20、nce Malocclusion caused-DiagnosisMalocclusion caused-Diagnosis Occlusion regained-TreatmentOcclusion regained-Treatment2.Relationshipbtwtooth&OMFtrauma2.Relationshipbtwtooth&OMFtrauma3.3.CranioCranio-cerebraltrauma-cerebraltrauma2024/6/1514Mouth opening,Mouth opening,mastication,swallowingmasticatio
21、n,swallowing4.Cervicaltrauma4.Cervicaltrauma5.Effectonbreathing5.Effectonbreathing6.Effectofon6.EffectofondigastricdigastricsystemsystemBleedingBleedingParalysisParalysis瘫痪瘫痪Leading difficulty breathingLeading difficulty breathingdietdietworse oral hygieneworse oral hygieneAsphyxia Asphyxia 窒息窒息2024
22、/6/15157.Multi-sinus7.Multi-sinus-contamination-contamination InfectionInfectionOral cavityOral cavityNasal cavityNasal cavityPharyngeal Pharyngeal cavitycavityOrbitOrbitParanasalParanasal sinus sinusBacteriaBacteriaTempTempHumidityHumidity2024/6/15168.Damagetospecificstructure8.Damagetospecificstru
23、ctureParotid GlandParotid GlandFacial N.Facial N.Trigeminal N.Trigeminal N.Salivary fistulaSalivary fistulaFacial paralysisFacial paralysisRegional numbnessRegional numbness2024/6/15179.FacialDefect9.FacialDefect Facial contour Facial contour Psychological traumaPsychological trauma2024/6/1518Evalua
24、te trauma soonEvaluate trauma soonIdentify the key trauma,Identify the key trauma,manage the fatal firstmanage the fatal firstCareful history taking,Careful history taking,thorough physical examthorough physical examRescue in timeRescue in timeManagement in orderManagement in orderGeneral RulesGener
25、al RulesSection3RescueSection3Rescue2024/6/15191.PreventionofAsphyxia1.PreventionofAsphyxiaSection3Rescue2024/6/1520DysphoriaDysphoria,sweating,inhalingrespiration,sweating,inhalingrespirationDifficulttoinhale,Difficulttoinhale,hypopneahypopnea,nasal,nasalalaralarmovement,movement,labialcyanosislabi
26、alcyanosisThreeconcavesignsThreeconcavesigns、Rapidbreathing,weakpulse,Rapidbreathing,weakpulse,decreasedBPdecreasedBPPupilsdiluted,NoreflectiontolightPupilsdiluted,Noreflectiontolight1.1Clinicalfeaturesofasphyxia1.1ClinicalfeaturesofasphyxiaProdrome2024/6/15211.21.2 EtiologyofAsphyxiaEtiologyofAsphy
27、xia ForeignbodyobstructionForeignbodyobstructionInspiratoryInspiratoryAsphyxiaAsphyxiaLowLowAirwayAirwaySwellingSwellingForeignbodyForeignbodyBlood,salivaBlood,salivaVomitVomitUpperUpperairwayairwayTissueTissuedislocationdislocation ObstructiveAsphyxiaObstructiveAsphyxia2024/6/15221.31.3 RescueofAsp
28、hyxiaRescueofAsphyxiaClearforeignbodyinupperClearforeignbodyinupperairwayairwaySuspendmaxillaSuspendmaxillaIntubationIntubationHoldthetongueoutHoldthetongueoutObstructiveObstructiveAsphyxiaAsphyxia吸入性窒息吸入性窒息气管切开术气管切开术2024/6/1523 2.2.HemostasiaHemostasia Two stepsTwo steps：Judge bleeding situationJud
29、ge bleeding situationChoose the way to stop bleedingChoose the way to stop bleedingSection3Rescue2024/6/15242.12.1 JudgebleedingsituationJudgebleedingsituationThree categoriesArterialCapillaryVenousBased on origin2024/6/1525压迫止血压迫止血指压止血法指压止血法包扎止血法包扎止血法填塞止血法填塞止血法结扎止血法结扎止血法药物止血法药物止血法2.22.2 Methodsofhe
30、mostatMethodsofhemostat2024/6/15263.Anti-shocktreatment3.Anti-shocktreatment(2)(2)Purpose of anti-shockPurpose of anti-shock(1)(1)Definition&ClassificationDefinition&Classification Traumatic shockTraumatic shockExsanguineExsanguine shock shock 20%Body weight20%Body weightToxic shockToxic shockInfect
31、ious shockInfectious shock Restore circulationRestore circulation2024/6/1527(4)(4)Principles of TreatmentPrinciples of Treatment (3)(3)Features of ShockFeatures of ShockEarly stage:Early stage:DysphoriaDysphoria,quick&superficial breath,quick&superficial breath,sweating,palenesssweating,palenessMidd
32、le stage:Tingle to Middle stage:Tingle to supressionsupression,emotional faint,emotional faint,unconsciousness,decrease BP,labial palenessunconsciousness,decrease BP,labial palenessLate stage:weaker pulsation,Late stage:weaker pulsation,unmeasurableunmeasurable BP,BP,hyponuriahyponuria,anuriaanuria
33、30ml/h 30ml/hHemostasisHemostasis,blood transfusion,pain control,blood transfusion,pain control,fluid transfusion,sedationfluid transfusion,sedation2024/6/1528(1)(1)JudgementJudgement4.Combined4.CombinedCraniocerebralCraniocerebralInjuriesInjuriesConsciousness,pulse,BP,respiration,pupilConsciousness
34、,pulse,BP,respiration,pupil(2)Early discovery,early management(2)Early discovery,early managementRetrograde Retrograde obliviscenceobliviscenceCerebral concussionCerebral concussionIntermediate wake-upIntermediate wake-upExtraduralExtradural hematomahematomaCerebral fluid leakCerebral fluid leakSkul
35、l base fractureSkull base fracture2024/6/15292024/6/1530DebridementWound closureAntibiotics5.PreventionofInfection5.PreventionofInfection6.Bandage&Transportation6.Bandage&Transportation2024/6/1531Section4SoftTissueTrauma2024/6/1532Abrasions Abrasions 擦伤擦伤ContusionsContusions挫伤挫伤Contusions&Laceration
36、sContusions&Lacerations挫裂伤挫裂伤Incised&Puncture WoundIncised&Puncture Wound切割伤及刺伤切割伤及刺伤 Bite WoundBite Wound 咬伤咬伤 Types of injuriesTypes of injuriesSection4SoftTissueTrauma2024/6/1533Character:Character:Character:Irregularwoundedge,foreignbody,Irregularwoundedge,foreignbody,Irregularwoundedge,foreignb
37、ody,pain,oozing&yellowishplasmaoozingpain,oozing&yellowishplasmaoozingpain,oozing&yellowishplasmaoozingManagement:Management:Management:DebridementDebridementDebridement,removeforeign,removeforeign,removeforeignbody,Drywound,drainwheninfectedbody,Drywound,drainwheninfectedbody,Drywound,drainwheninfe
38、cted1.Abrasions1.AbrasionsProperty:Property:Property:roughsurfaceroughsurfaceroughsurfaceEpidermis&superficialdermisEpidermis&superficialdermisEpidermis&superficialdermis2024/6/15341.Abrasions1.Abrasions2024/6/15352.Contusions2.ContusionsCharaterCharater:petechiapetechia,swelling,pain,swelling,painM
39、anagement:Management:l lHemostasisHemostasisl lPain-killerPain-killerl lPreventionofinfectionPreventionofinfectionl lHematomaHematoma resorptionresorptionl lRe-establishmentoffunctionRe-establishmentoffunctionProperty:bluntmaterial&felltoProperty:bluntmaterial&felltohardobjecthardobjectSubdermalSubd
40、ermaltissue(noopenwound)tissue(noopenwound)2024/6/1536Property:Blunt object with high Property:Blunt object with high mechanical forcemechanical force3.Contusions&Lacerations3.Contusions&LacerationsCharacterCharacterllI Irregular wound edge,saw-toothedrregular wound edge,saw-toothedllBig lacerationB
41、ig lacerationllw/wow/wo necrotic tissue&open fractures necrotic tissue&open fracturesManagementManagementllDebridementDebridementllWound ClosureWound ClosureSoft tissueSoft tissueSoft tissue2024/6/15373.Contusions&Lacerations3.Contusions&Lacerations2024/6/1538Property:Sharp object or instrumentsProp
42、erty:Sharp object or instruments4.Incised&Puncture Wound4.Incised&Puncture WoundCharaterCharater llRegular wound edgeRegular wound edgellBleedingBleedingllSmall access,but deep woundSmall access,but deep woundManagementManagementllDebridementDebridementllWound closureWound closureSoft tissueSoft tis
43、sueSoft tissue2024/6/1539Property:Animal(Wolf,dog,Bear)or human beingsProperty:Animal(Wolf,dog,Bear)or human beingsCharacterCharacterllTooth tracedTooth tracedllHeavy contaminationHeavy contaminationllTend to infectionTend to infectionManagementManagementllThorough Thorough debridementdebridementllI
44、nfection controlInfection controlllSkin graft after granular tissue regeneratedSkin graft after granular tissue regeneratedllVaccination of Tetanus,RabiesVaccination of Tetanus,Rabies5.Bite Wound5.Bite Wound2024/6/1540DefinitionDefinitionDebridementDebridementMainEntry:MainEntry:MainEntry:debridemen
45、tdebridementdebridement Pronunciation:Pronunciation:Pronunciation:di-brEd-m&ntdi-brEd-m&ntdi-brEd-m&nt,dAdAdA-,-,-,-mntmntmnt,dA-brEd-mndA-brEd-mndA-brEd-mnFunction:Function:Function:nounnounnounEtymology:Etymology:Etymology:FrenchFrenchFrenchdbridementdbridementdbridement,fromfromfromdbriderdbrider
46、dbrider toremoveadhesions,toremoveadhesions,toremoveadhesions,literally,tounbridle,fromMiddleFrenchliterally,tounbridle,fromMiddleFrenchliterally,tounbridle,fromMiddleFrenchdesbriderdesbriderdesbrider,fromfromfromdes-des-des-de-+de-+de-+bride bride bride bridle,fromMiddleHighGermanbridle,fromMiddleH
47、ighGermanbridle,fromMiddleHighGermanbrIdelbrIdelbrIdel-moreat-moreat-moreatBRIDLEBRIDLEBRIDLE:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue:thesurgicalremovaloflacerated,devitalized,orcontaminatedtissue2024/6/1541Protoco
48、l1.wash wound1.wash wound TimeTime：6-12h6-12h Solution:soap water,saline,Solution:soap water,saline,hydrogen dioxidehydrogen dioxideDebridementDebridement3.Closure3.Closure2.Clean wound2.Clean wound Removal of foreign bodyRemoval of foreign body Trimming of necrotic tissue Trimming of necrotic tissu
49、e2024/6/15422024/6/1543Cheek injuriesCheek injuriesPalate injuriesPalate injuriesInjuries at other regionsInjuries at other regionsManagement of soft Management of soft tissuretissure injuriesinjuriesTongue injuries Tongue injuries Lengthmaintain,longitudinalclosureLengthmaintain,longitudinalclosure
50、Independentclosure,buttonguesuturedominationIndependentclosure,buttonguesuturedominationBigneedlewithbig,depthsuturingorBigneedlewithbig,depthsuturingormatricmatricsuturingsuturing2024/6/1544Management of soft Management of soft tissuretissure injuriesinjuries2024/6/15452024/6/1546Section5InjuryofTe