口腔颌面外科学（中山大学）9.创伤各论.pptVIP

* General considerations multiple fracture sites are common broad categories: Unilateral (double or multiple) Bilateral fractures with contralateral condyle Bilateral condyle with symphysis/anterior body Whenever one fracture of the mandible is identified, the surgeon must always suspect that one or more additional fractures are present. Careful clinical and x-ray examination will assist in establishing the correct diagnosis. Body fracture (left fragment outward displacement, right medial displacement, and mandible deviation * （2）Maxillary fracture site manifestation Diagnosis principle of tx * Anatomy framework pillars * Lines of fractures Le Fort I 梨状孔水平/牙槽突上方/上颌翼突缝（低位/水平骨折） (horizontal) * Lines of fractures * Le Fort II 鼻额缝/鼻梁/眶内侧壁/眶底/颧上颌缝/翼突（中位/锥形骨折） (pyramidal) * Lines of fractures Le Fort III 鼻额缝/鼻梁/眶部/颧额缝/翼突（高位/颅面分离骨折） (transverse) * LeFort classification maxilla mandible displacement malocclusion open restriction abnormal mobility numbness of lip displacement malocclusion open restriction Orbital/periorbital brain damage * Clinical manifestation * Limitation of mouth opening Possible causes? * Malocclusion posterior maxilla drop, resulted in anterior open bite and posterior premature contact Pre-operation post-operation Diagnosis A: History summary ——询问受伤原因、致伤物、致伤方式、致伤部位 以便判断骨折部位、创伤程度和伴发损伤 ——询问受伤时间、伤后症状、伤后处理 以便决定治疗计划、手术方案，并预测治疗效果 ——询问骨折是自伤或他伤 以便判断伤者治疗心理，由于他伤常涉及医疗赔付问题 某些伤者可能会扩大治疗要求 * B: Physical examination C: imaging examination plain film（全景片/华氏位/薛氏位/体层摄影） CT (esp.spiral 3-D CT) * 治疗时机 及早治疗，先救命后治伤 昏迷伤员禁止作颌间结扎固定 老年人和小儿无手术适应证时可保守治疗 精确复位、功能稳定性固定 复位标准：恢复原有咬合关系 固定方法：视情况而定 手术开放复位，坚强内固定(RIF)是主流 Principle of treatment * AO/ASIF principles 解剖复位 功能稳定性固定 无创外科手术