Repair fracture of mandible and maxilla bone Definition Fracture face (FTM) is a disorder resulting from trauma and lead to fracture of the bones of the face such as the mandible, maxilla, nasal and zygoma. FTM is most often found as a prominent facial structure and not protected. The first treatment in FTM trauma is crucial, because the defect or defects that arise in the future will be more difficult to handle. Complete procedures A. Clinical Examination a. History: A history of trauma to the face b. Physical examination General: Includes airway, breathing, circulation (ABC) Local: The lesion on the face, pain / tenderness, edema deformity, echimosis, malocclusion, anesthesia / hypoesthesia, bleeding nose or mouth, diplopia, enoftalmus. c. X-ray examination: Standard position radiographs in maxillofacial trauma includes - Postero - anterior - Lateral: brow up / lateral standard - Caldwell - Submento-vertical - Water's Fracture of the maxilla Fractures according to Le Fort maxilla consists of A. Le Fort I (transverse) showed a fracture below the horizontal septum nasi with an unstable segment of the palate, alveolar processus maxillaris sinus part, the bottom of the pterygoid sphenoidalis os. 2. Le Fort II (Pyramidal) shows the fracture pyramid shape. Transverse fracture line at the base of the nose to the latero distal past sutura zygomaticomaxillaris. 3. Le Fort III (craniofacial dysjunction) fracture line parallel to the base of the skull so that the bones of the face regardless of the base of the skull past sutura zygomatico-frontal, maxillary-frontal suture, sutura naso-frontal, and orbital base. Diagnosis: a. Clinical: periorbita hematoma, active bleeding nasopharynx, pain, intra-oral lacerations, malocclusion, the mobility of the maxillary arch dentalis (floating maxilla). b. Inspection: X-ray skull AP / Lateral, Water's, and CT-Scan. Penatalaksaan: a. Le Fort I: Repositioning and maxillary arch bar hung with Stringed wire on the bottom edge of the orbit or the IMW. b. Le Fort II: Repositioning Forceps with Rowe • Fixation: IDW IMW + / arch + bar suspense • Miniplate Wire fixation / arch bar was maintained for 5-6 weeks. c. Le Fort III: Open reduction internal fixation Fixation with miniplate and wire The mandible fracture Fracture of the mandible is divided by: A. Location 2. Type of Fracture ♦ Simple / simple: • linear • not accompanied by extensive soft tissue damage ♦ Kominutif: • Multiple, in pieces • accompanied by loss of tissue / bone ♦ Pathological: • neoplasms, osteomyelitis, bone hemangioma, cyst 3. Weighing Fractures ♦ Simple fracture • no contact with the outside world • discontinuities surrounding soft tissue ♦ Compound fracture • damage to the skin, mucosa and tissues surrounding open 4. Presence of the existence of Dentistry • Class I: there are teeth on both sides of the fracture • Class II: there are teeth on only one side of the fracture • Class III: no teeth on both sides of the fracture 5. Favorableness • Unfavorable Fractures: angled upward, and the anterior • Fracture favorable: angled upward, posterior and outer Diagnosis: a. Clinical: The existence of pain, swelling, intra oral mucosal tears, crepitus, malocclusion, bleeding, open bite, trismus b. Inspection: X-ray skull AP / Lateral, panoramic and CT-Scan. Management The objective of the return of such a state before the traumatic occlusion. Actions taken may include: ♦ IDW - IMW ♦ Arch Bar ♦ Miniplate and screw Post-treatment measures A. Oral Hygiene 2. Food 3. Photos radiological control Complication ♦ Complications soon • Risk of aspiration • Loss of reduction ♦ Complications of advanced • Stiffness of joints • Malunion • Delayed union / nonunion Follow Up ♥ In a normal healthy person à mobilized for 5 weeks. ♥ fractures in children can be united in 3-4 weeks ♥ A fracture that has become infected and the parents must remain immobilized for 6 weeks.
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