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Oral Surgery 2 > Maxillofacial Trauma I > Flashcards

Maxillofacial Trauma I Flashcards

1
Q

etiology of maxillofacial trauma in pediatric population

A

falls

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2
Q

etiology of maxillofacial trauma in children and adolescents

A
  1. sports and playground

2. child abuse

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3
Q

what percent of physical trauma from abuse seen on children and adolescents occur in the head and neck?

A

50%

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4
Q

etiology of maxillofacial trauma in adult population

A
  1. interpersonal violence
  2. moter vehicle collisions
  3. sports injuries
  4. work-related injuries
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5
Q

what percent of MVC (motor vehicle collisions) survivors have facial injuries?

A

50-70%

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6
Q

when does maxillofacial examination occur?

A

after Advanced Trauma Life Support (ATLS) has been completed and the patient is stabilized

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7
Q

evaluation of maxillofacial trauma

A
  1. immediate assessment
  2. H&P
  3. radiographic exam
  4. assessment
  5. plan
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8
Q

extraoral mandibular exam includes what?

A
  1. palpation inferior border and TMJ
  2. ROM and excursive movements
  3. V3 status
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9
Q

intraoral mandibular exam includes what?

A
  1. floor of mouth hematoma
  2. malocclusion
  3. alveolus
  4. teeth
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10
Q

what is included in the radiographic exam of the mandible?

A
  1. panorex
  2. CT scan

there’s other radiographs you can take but these are the two Dr. Eman wants us to know

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11
Q

floor the the mouth hematoma is pathognomonic for what?

A

symphyseal fracture (symphysis of mandible fracture)

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12
Q

tx of intrusion

A
  1. compression fracture of alveolus to accommodate new postion
  2. metallic sound upon percussion
  3. allow passive eruption of deciduous teeth
  4. orthodontic traction
  5. stabilize 2-3 months
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13
Q

tx of extrusion and lateral displacement

A
  1. reposition tooth fully at socket

2. splint for 1-3 weeks

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14
Q

goal of tx for avulsed tooth

A

maintain periodontal attachment

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15
Q

T/F: you should scrape or sterilize the roots of an avulsed tooth

A

false

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16
Q

physiological movement of avulsed teeth allows what?

A

fibrous instead of osseous attachment of the root to the alveolar bone

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17
Q

what can you use to transport avulsed tooth?

A
  1. saliva
  2. saline
  3. milk
  4. Hank’s solution
  5. ViaSpan
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18
Q

which dentoalveolar injury has the worst prognosis? 2nd worst?

A

intrusion then lateral displacement

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19
Q

tx of avulsed tooth with OPEN apex <2 hours after the the accident

A
  1. replant immediately if possible
  2. transport in Hanks or milk (good for 30 minutes)
  3. doxycycline 1 mg/20ml for 5 minutes
  4. L.A., socket irrigation, tetanus, abx
  5. replant
  6. splint for 7-10 days
  7. apexification (CaOH)
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20
Q

tx of avulsed tooth with CLOSED apex <2 hours after the the accident

A
  1. store in Hank’s solution for about 30 minutes
  2. replant
  3. splint for 7-10 days
  4. perform endodontic cleansing and shaping of canal at time of splint removal
  5. fill canal with CaOH (6-12 mo)
  6. perform final gutta-percha obturation (~6-12 mo)
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21
Q

tx of avulsed tooth >2 hours after the the accident

A
  1. replant immediately if possible
  2. transport in Hanks or milk (30 minutes)
  3. bathe tooth in sodium hypochlorite for ~30 minutes vs manual debridement of periodontal ligament
  4. perform extra-oral RCT
  5. bathe tooth in citric acid (~3 min)
  6. bathe tooth in 1% stannous fluoride (~5 min)
  7. transfer to 1 mg/20mL doxycycline bathe for 5 min
  8. L.A., socket irrigation, tetanus, abx
  9. replant
  10. splint for 7-10 days
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22
Q

how long should you stabilize mobile teeth?

A

3-4 wks

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23
Q

how long should you stabilize displaced teeth?

A

3-4 wks

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24
Q

how long should you stabilize root fracture?

A

2-4 months

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25
how long should you stabilize reimplanted tooth (mature)?
7-10 days
26
tx of alveolar fractures
1. reduction 2. stabilization 3. RCT within 1-2 wks
27
why must patients with alveolar fractures get a RCT within 1-2 wks of accident?
prevent inflammatory root resorption and infection
28
tx of traumatic cutaneous injuries depend on what?
1. circumstances and location | 2. time
29
why does tx of traumatic cutaneous injuries depend on time?
longer the time, greater will be the bacterial inoculate
30
contusions are what type of trauma?
blunt trauma
31
contusions
subcutaneous or submucosal hemorrhage without breakage of soft tissue
32
what should you always check when you exam patients with contusions?
check underlying structures
33
tx of contusions
1. surgical exploration if aterial involvement suspected | 2. abx recommended if it's a contaminated wount
34
abrasions removes what?
epithelial layer and papillary dermis
35
abrasions leave what?
raw bleeding reticular dermis exposed
36
why are abrasions painful?
owing to exposes nerve endings
37
what is critical when tx'ing abrasions?
debridement
38
how should you debride abrasions?
1. scrub with mild soapy solution followed by copious irrigation with balanced saline solution 2. cover with thin layer abx ointment
39
laceration
tear in epithelial and subcutatneous tissue
40
goal when tx'ing patients with laceration
return tissues to proper orientation
41
tx of lacerations
1. cleaning 2. debridement 3. hemostasis 4. closure
42
T/F: when cleansing lacerations, you should make sure the soap doesn't harm the skin
true
43
why is it important to use soaps that don't harm skin when cleaning lacerations?
soaps which enter the wound may cause cellular damage and necrosis
44
what should you avoid when cleansing the laceration?
direct wound contact with 1. alcohol 2. peroxide 3. providone-iodine
45
if direct contact is made with either alcohol, peroxide, providone-iodine, what should be used around the wound?
copious irrigation with BSS (balanced salt solution)
46
how to debride lacerations
1. pulsatile > constant flow | 2. scrubbing
47
dead tissue fragments, foreign bodies, hematomas act as physical barriers to what in patients with lacerations?
fibroblast penetration
48
T/F: radical excision of tissue in facial area should always be done when tx'ing lacerations
false, usually not necessary
49
why do you remove irregular wound margins when debriding lacerations?
to improve marginal approximation at closure
50
continuous bleeding when tx'ing a laceration may lead to what?
hematoma
51
what should you do once you ID bleeding vessel?
1. clamp 2. tie 3. cauterize
52
why should you close in layers?
1. eliminate dead space, hematoma formation 2. reduces unsupported tissue during healing 3. restores anatomical orientation
53
T/F: you should approximate not strangulate closure
true
54
how should you tackle closure of laceration?
work from known to unknown: orient known landmarks first with tack suture
55
where should you start suturing a laceration?
vermillion border
56
what must be ruled out with animal bites?
facial fractures
57
puncture wounds from animal bites are more likely to become what?
infected due to inability to cleanse
58
abx prophylaxis for animal bites
augmentin p/o/ 7 days
59
bacteria found in animal bites
Pasteurella multocida (gram-negative rod)
60
T/F: chance of infection from animal bites are greater with dogs than cats
false, cats > dogs

Oral Surgery 2 (13 decks)

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