Download surgical dentistry 3

1.A bitten wound. Characteristic. Features of treatment.
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There are two different types:
Occlusion bites: when the teeth sink into the skin with enough force to break through the
surface of the skin.
Clenched or closed fist bites: when someone’s fist makes contact with another person’s
teeth, This can lead to infections in the finger’s joints, tendons and/or bones, along with
tendinitis and joint stiffness.
*charactaristics:
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Intense pain and swelling.
Pus around the wound.
If the wound feels warm to touch (if it’s hot, the wound is likely infected).
Reddening of the skin (erythema) in the wounded area.
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A fever, chills or generally feeling unwell.
If you’ve been bitten on your finger and lose feeling in your fingertips or have trouble
bending or fully straightening your finger, it’s likely a sign that you’ve damaged some
tendons and/or nerves.
*features of treatment :
Exam: we will ask you about your medical history, including your history of
immunizations, allergies and, if any, your medications.
Cleaning: we will clean out and disinfect the wound again, before assessing it for any
potential nerve, ligament, tendon and/or bone damage.
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Testing: we may take tissue cultures from the site of the wound to analyze for infectious
organisms. If we find symptoms of joint or tendon damage, or if the wound appears to be
infected, we may order a blood test or imaging tests, such as X-rays.
Treatment plan: we will determine which, if any, medications are best for your particular
situation. And we should close up the wound with non-absorbable stitches. In more severe cases,
we may remove all dead tissue (debridement), followed by a skin graft to close the wound.
Sometimes surgery is needed if there’s a fracture, joint/tendon damage or a severe infection.
medication treatment :
Antibiotics for soft-tissue infections (7 to 10 days), severe infections (10 to 14 days) and severe
bone/joint infections (4 to 6 weeks).
Amoxicillin (Augmentin®) is one type of antibiotic that can be used, though not for those who
are allergic to penicillin. If you’re allergic to penicillin, you will likely be prescribed
clindamycin, trimethoprim/sulfamethotrexateor ciprofloxacin
Trimethoprim/sulfamethotrexate is most commonly used with children.
2.Principles of treatment of mandibular fractures.
first there are some techniques that we should asses in order to correctly diagnose the case , such
as
Examination of the mouth with a good light, paying attention to the junction of the hard and soft,
dental arches and the sulci, is important. Patients with fractures of the mandible between the
mental foramen and the mandibular foramen often have reduced levels of sensation in the
distribution of the inferior alveolar or lingual nerves and patients with zygomatic fractures often
have areas of reduced sensation in the distribution of the infraorbital and anterior superior
alveolar nerves.
*Sublingual haematomas and tears at the gingival margin can be diagnostic of mandibular
fractures.
we also should examine the function of the jaw , for example an open bite can
be a feature of a fractures in which the middle third of the facial skeleton moves backwards and
downwards on the cranial base or of bilateral fractures of the mandibular condyles in which the
pterygomasseteric sling shortens the ascending rami.
and finally a radiograph examination will be necessary not only to reach a diagnosis but also to
inform treatment decisions, for example, about where bone plates should be applied.
*treatment :
-non-surgical : such as
haematomas, clean abrasions, small lacerations, undisplaced stable fractures and some displaced
fractures, such as those of the mandibular condyle where the occlusion is not deranged or where
the occlusion settles spontaneously
-surgical : we use plates
the principles of treatment are:
● reduction—repositioning fragments of bone
to their anatomical positions
● fixation—making sure fragments remain in
position until fractures have healed
● immobilization—preventing the broken bone
from moving during the healing period
● rehabilitation—returning the patient to normal function after the fracture has healed.
3. Stages of care for the wounded in the maxillofacial area
there are three stages
.stage I is early recovery and takes place in the postanesthesia care unit (PACU).
The following parameters must be monitored continuously:
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Oxygen Saturation: Hypoxia can occur in the postoperative period and the patient must be kept
on oxygen for 1–2 h (2–6 L/min) to prevent this. Oxygen may be delivered using a face mask or
through nasal prongs.

Pulse, blood pressure: Increase in these parameters may indicate pain. Serious complications
(Infarction, Malignant hyperthermia) may produce a drastic change in these parameters and must
be recognized.
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ECG waveform: To monitor cardiac status.
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Postanesthesia tremors/shivering: This can occur on the table during recovery from anesthesia.
It can occur if the patient is hypothermic, and is commonly associated with the use of
halogenated anesthetics. Management consists of rewarming the patient. Tramadol and
meperidine may be used to stop uncontrollable shivering [4].
.stage II is intermediate recovery, and takes place in the ward.
It is essential to infuse intravenous fluids during this period to maintain the ongoing fluid
requirements, till the patient resumes oral intake of fluids. Maintenance fluids are essential to
maintain proper pH and electrolyte balance and for adequate organ perfusion.
.stage III is late recovery that occurs after discharge.
in this stage anibiotics treatment is required to prevent any kind of enfection reaccurence such as
Amoxicillin and metronidazole are used.
4. A stab wound. Characteristic. Features of treatment.
Characteristic :
Stab wound Stab wound is caused by sharp pointed object and has the large depth and small area
of the injured skin and mucosa.
*The pain syndrome is slight,
*hiatus is absent,
*the external bleeding is absent,
* hematoma can develop.
features of treatment :
Treatment must be of a multi-disciplinary nature: it begins at the trauma unit to provide airway
maintenance, hemodynamic stabilization, and if necessary, neurological ophthalmological and
vascular evaluation
since stab wounds ar rare , one case was registered where a penetration occurred.
Penetrating lesions on the middle facial third, where intracranial extension is suspected, must be
assessed and treated following multi-disciplinary criteria. Therefore, the following is
recommended:
, so we start by cleaning the stab wound with antiseptic for example chlorhixidine, and we take
out the dameged soft tissue and we check where the pentration reached if it reached sinsitive
parts or not , and after we make sure the the area of damage is clear and that the bleeding has
stopped we can make a flap surgery to cover the area of the wound and we make sutures and we
make dressing using untibacreial creams and the patient should be addresed an antibiotic therapy
for example metronidazole and amoxicilin till the would is fully recoverd .
5.the structure of the lower jaw :
6.Traumatic disease. Clinic. Principles of treatment.
Traumatic disease - a symptom complex of traumatized patients with severe, multiple injuries; it
is a pathological process caused by severe shock-related mechanical trauma, in which the
sequential change in the key factors of pathogenesis determines the regular sequence of periods
of clinical course.
Clinic:
In the clinical course of traumatic disease, there are periods:
-Shock period - a period of acute functional and systemic disorders that are caused by severe
trauma, lasting 12-48 hours. : haracterized by a sharp pain syndrome, the patient sharply paler,
sweaty, dynamic (possible arousal), blood pressure drops dramatically, accelerates and weakens
the pulse, heart tones are deaf, shortness of breath, oliguria
-The early post-shock period - the period of threat of organ and multiple organ failure - lasts 3-7
days after injury. : characterized by the development of multiple organ failure and development
of (DIC) syndrome; fat embolism; renal-hepatic failure; heart failure with central hemodynamic
disorder; consequences of early post-traumatic endotoxicosis.
-Period of infectious complications or high risk of their development (period of secondary
immunodeficiency) - duration of 1 week - up to 1 month. : characterized by Purulent-septic
complications
-The convalescence period is a duration of several weeks to several months
treatment :
There are basic principles of treatment of victims: - the earliest start of infusion therapy that
prevents the deepening of shock, hypoxia and acidosis. In order to restore microcirculatory tissue
perfusion and elimination of hemostatic disorders use rheologically active media: saline
solutions, reopolignokin, reognoman. Colloidal and crystalloid plasma substitutes contribute to
the restoration of circulating blood volume and the restoration of microcirculatory perfusion.
Whenever possible, start restoring blood volume and plasma loss (erythrocyte mass, fresh blood,
fresh native plasma, etc.); - rapid evacuation of the wounded to the specialized medical
institutions of the surgical profile (front hospital base); - performing emergency surgery in a
single set of countermeasures. In general,
surgical treatment of polytrauma consists of: emergency operations aimed at addressing the
direct threat of life (mechanical asphyxia, bleeding and etc.), which are performed against the
background of intensive antitussive and resuscitation measures; early delayed operations aimed
at eliminating the causes of life-threatening complications (after removing the patient from
traumatic shock for 2-3 days after the post-shock period); delayed second-line operations.
All surgeries aimed at eliminating the syndrome of mutual aggravation of the lesions should be
completed within the first 2-3 days; - performing early delayed operations immediately after
removal of the wounded from the shock of the emergence of relative stabilization of
hemodynamics. The purpose of this stage is to eliminate the syndrome of mutual aggravation of
lesions; - consolidation of the process of long-term compensation. Extremely energyintensive
mechanisms of immediate compensation in the development of traumatic disease are depleted by
the end of 2-3 days, and the stored bioenergy potential is gradually switched to long-term
(sustainable) compensation; - prescribing preventive multicomponent antibacterial therapy in the
early post-shock period; - prognosis and prophylactic treatment of complications on the basis of
key pathogenetic mechanisms of each period of traumatic disease.
7.Chopped wound. Characteristic. Features of treatment.
another name of it is open wound : An open wound is an injury involving an external or internal
break in body tissue, usually involving the skin
and there are four types :
1.abrasion :when your skin rubs or scrapes against a rough or hard surface
2.laceration: is a deep cut or tearing of your skin.
3.puncture: is a small hole caused by a long, pointy object, such as a nail or needle. Sometimes, a
bullet can cause a puncture wound.
4.avulsion: is a partial or complete tearing away of skin and the tissue beneath.
treatment : Depending on the location of your wound and the potential for infection, we may not
close the wound and let it heal naturally. This is known as healing by secondary intention,
meaning from the base of the wound to the superficial epidermis.. Although the healing may not
look pretty, it prevents infection and the formation of abscesses.
Another treatment for an open wound includes pain medication. Your doctor may also prescribe
penicillin or another antibiotic if there’s an infection or high risk for developing an infection. In
some cases, you may need surgery.
if a surgery is needed we start with cleaning and possibly numbing the area, your and thin we
close the wound using skin glue, sutures, or stitches.
8. Temporary immobilization in fractures of the mandible.

Any movement in the fracture line after reduction may disturb or tear the granulations or osteoid
tissue. It may also cause the bone to heal with a deformity.
Immobilisation should therefore be complete, and continued until union has taken place, which
in the mandible is about 4 – 6 weeks, and it is achieved with maxillomandibular fixation (MMF).
maxillomandibular fixation (MMF):
components :
screws are inserted into the bony base of both jaws in the process of fracture realignment and
immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands
connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar
techniques provide the anchorage by attached cleats, hooks, or eyelets
techniques:
1. It is important to consider the patient specific anatomy via radiographic imaging for the best
treatment strategy.
2. Identify the vertical location of locking screw placement at the mucogingival junction to
minimize potential soft tissue overgrowth. Upon eventual fixation of the entire system, the lugs
of the arch bars should be aligned with the clinical crown of the tooth
3. Select the desirerable horizontal locations of screws in between tooth roots to avoid dental
injury It has been shown that manual insertion of MMF screws in contact with tooth roots does
not create permanent damage to the root or dental complications (However, care should be taken,
via pre-operative radiographic imaging and tactile feel intraoperatively, to avoid direct screw
insertion through critical structures.
4. Removal of the unused screw arms can assist the patient with hygiene and limit the areas of
potential soft tissue overgrowth. Also, manipulation of the frenum and soft tissue may further
reduce irritation and/or overgrowth due to contact with the implant.
9. Traumatic shock. Clinic. Principles of treatment.
Traumatic shock is a traumatic condition, which is accompanied by major impaired function of
the vital organs, first of all blood circulation and breathing.
clinics :
depends on the phase and it has 2 phases , erectile and torpid.
1. Erectile phase :lasts for 15-20 minutes. It is characterized by: excitement, screams, increased
physical activity of the victim, efforts to do something, the functions of the victim are intense.
This phase is a sign of the compensatory capacity of the organism injured
2.torpid phase : The body begins to store the remnants of its energy and other capabilities to
ensure the activity of only vital organs and systems. The patients are slowed down, do not move
or shout, but quietly fade away, and in this phase patients will experience hypoxia, Hypovolemia,
decrease in AT, tachycardia, decreased urination, subsequent skin fading, cyanosis and decrease
in BP.
Treatment :
Treatment. Immediate action in the treatment of traumatic shock is aimed at eliminating
circulatory and respiratory disorders, as well as related disorders.
1. Stop bleeding with a harness, bandage, artery by hand, clamp, perform skull trepanation,
laparotomy, thoracotomy to permanently stop bleeding and eliminate other life-threatening
disorders. In the maxillofacial region, the most dangerous are the carotid artery and its branches.
2. Restore impaired hemodynamics in BCC by carrying out intensive infusion transfusion
therapy, the volume of which should exceed blood loss (to compensate for the loss of tissue
fluid), transfusion of blood components, antitussive fluids, plasma substitutes (saline, electrolytic
solutions) (2-4 liters per 1 hour, only up to 0.5-3 liters). For increase of oncotic pressure and
prevention of edema of a brain and lungs polyglucine, gelatinol, protein preparations are used.
Continued infusion to stabilize systolic pressure by 90, venous - 50 mm RT. st., urinary recovery
to 20 ml in 1 hour. The volume of transfused blood should not exceed 2 liters.
3. To reduce the impulse from the lesion site make anesthetic local and central blockages,
introduce painkillers and sedatives. It is important to take into account the possibility of allergy
to the anesthetic and not to overdose it (morphine is not shown in patients with trauma to the
skull and respiratory failure).
4. Hypoxia is eliminated by restoration of airway patency by available methods - cleansing of the
mouth and nose of the pharynx, incubation of the trachea, tracheotomy, artificial ventilation of
the lungs, inhalation of moist oxygen and air, introduction of respiratory analeptics (lobelin),
bronchial drainage.
5. To prevent: a) brain swelling, which is dangerous in the first days after a traumatic brain
injury, prescribe mannitol, lasix, steroid hormones (12-48 mg of dexamethasone); b) brain
hypoxia - intravenously inject 20% sodium oxybutyrate solution with 5% glucose solution (75100 mg / kg).
6. To maintain the hormonal system, appoint ACTH (15-20 units), hydrocortisone 100-200-300
units. Norepinephrine, mesotone are used to increase AT (especially in traumatic brain injury). 7.
Correct the condition of coagulation and blood coagulation systems. To increase blood
coagulation, a 10% solution of calcium chloride, medical gelatin, aminocaproic acid and other
drugs are administered. At signs of development of thrombosis, thrombophlebitis,
thromboembolism of cerebral vessels, heparin, fibrolizin etc. are administered intravenously.
8. Neuroleptics (aminazine, propazine) are prescribed only for psychomotor excitation and
arterial hypertension.
9. Disorders of the acid-base state are corrected: with acidosis enter intravenously 200-400 ml of
4% sodium hydrocarbonate solution (soda), alkalosis - 5% solution of ascorbic acid in 40%
glucose solution, 10% solution of potassium chloride, plasma, vitamins.
10. According to the testimony perform surgical interventions (group 1 - operations on lifegiving; group 2 - operate after removing from shock (repon, fix and immobilize 75 fragments in
fast, simple and reliable ways); group 3 - surgery not shown; group 4 - hopeless (receive
symptomatic treatment).
11. To prevent septic complications use massive doses of antibiotics: penicillin, zeporin,
monomycin on the background of forced diuresis (lasix, hemodesis, glucose).
10.Crushed wound. Characteristic. Features of treatment.
Crushed wound The mechanism of this damage is equal to contused and lacerated wounds, but
the degree of injury is maximal. Crushed wounds can be infected heal worse.
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characteristics :
Bleeding
Bruising
Compartment syndrome (increased pressure in an arm or leg that causes serious muscle, nerve,
blood vessel, and tissue damage)
Fracture (broken bone)
Laceration (open wound)
Nerve injury
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Infection (caused by bacteria that enter the body through the wound)
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treatment:
Stop bleeding by applying direct pressure. Cover the area with a wet cloth or bandage. Then,
raise the area above the level of the heart, if possible. If there is suspicion of a head, neck, or
spinal injury, immobilize those areas if possible and then limit movement to only the crushed
area
11.Clinical picture of mandibular fractures.
Fracture classification. There are unilateral, bilateral, single, double, multiple fractures of the
mandible.
fractures, patients' complaints may be varied depending on the location of the fracture and its
nature. Patients are always disturbed by pain in a particular area of the mandible, which is
exacerbated during its movement. Eating and chewing food, especially solid foods, is painfully
painful, sometimes impossible.
Some patients note the numbness of the skin of the chin and lower lip (more often with nerve
rupture), incorrect closing of the teeth. There may be dizziness, headache, nausea.
12.Torn wound. Characteristic. Features of treatment.
another name of it is open wound : An open wound is an injury involving an external or internal
break in body tissue, usually involving the skin
and there are four types :
1.abrasion :when your skin rubs or scrapes against a rough or hard surface
2.laceration: is a deep cut or tearing of your skin.
3.puncture: is a small hole caused by a long, pointy object, such as a nail or needle. Sometimes, a
bullet can cause a puncture wound.
4.avulsion: is a partial or complete tearing away of skin and the tissue beneath.
treatment : Depending on the location of your wound and the potential for infection, we may not
close the wound and let it heal naturally. This is known as healing by secondary intention,
meaning from the base of the wound to the superficial epidermis.. Although the healing may not
look pretty, it prevents infection and the formation of abscesses.
Another treatment for an open wound includes pain medication. Your doctor may also prescribe
penicillin or another antibiotic if there’s an infection or high risk for developing an infection. In
some cases, you may need surgery.
if a surgery is needed we start with cleaning and possibly numbing the area, your and thin we
close the wound using skin glue, sutures, or stitches.
13.Types and classification of dental braces.
there are two classification :
1. Mobile braces: there is only one type which is invisalagin and clear aligners.
it is transparent and removable .
2. Fixed braces it has many types like :
a. lingual braces
b.self ligating braces.
c.cearmic braces.
d.metal braces
14.Asphyxia. Types, causes, treatment.
Asphyxia - an acute or subacute pathological condition that results from oxygen starvation with
carbon dioxide accumulation in the body; characterized by severe respiratory, circulatory and
nervous system disorders
types and causes.
1) aspiration - when it enters the respiratory tract mucus, blood, vomiting.
2) dislocation - at a fall of a tongue, for example as a result of trauma of the lower jaw (double
mental break, separation of the chin);
3) valve - due to the formation of a valve from the flaps of the soft palate and other tissues of the
oropharynx;
4) obstructive - as a result of airway obstruction by foreign objects;
5) stenotic - due to contraction or narrowing of the respiratory tube with inflammatory or allergic
edema, hematoma, etc.
Treatment:
Depending on the mechanism of occurrence of asphyxia treatment is to eliminate its cause.
With aspiration asphyxia - the suction of fluid from the respiratory tract, and when bleeding - its
stop. With dislocation asphyxia - displacement of the tongue in front (stitching at a distance of 1
cm from the edge of the tongue and to the side of the line or puncture with a pin) and fixation in
the elongated position; repositioning and immobilization of jaw bone fragments.
With valve asphyxia - soft tissue flaps are stitched or cut off.
At stenotic asphyxia - dissection of the centers of edema, elimination by hematoma.
With the slow development of asphyxia, the use of diuretics is effective.
With obstructive asphyxia - remove foreign bodies with tools (tweezers, clamp) or flip the victim
upside down and in the presence of a cough reflex, the foreign body may fall out
4
15.Fractures of the alveolar process.
classification:
• partial - the fracture line passes through the outer compact plate and sponge;
• complete - the fracture line passes through the entire thickness of the alveolar process; •
separation of the alveolar process;
• fracture of the alveolar process, which is combined with dislocation or fracture of the teeth;
• Fracture fracture.
Fractures of the alveolar process can occur both on the upper and lower jaw. Most often the
frontal alveolar process of the upper jaw breaks. The fragment of the alveolar process of the jaw
in the frontal area is shifted back (towards the sky or tongue), and in the lateral section - inside.
On the upper jaw broken the fragment may shift outwards if the direction of the traumatic force
is affected through the teeth of the mandible.
TREATMENTS:
are carried out under local anesthesia (more often to the conductor, rarely - infiltration). Finger
alignment of the broken fragment of the alveolar process is performed. With a sufficient number
of persistent teeth on the damaged and undamaged area of the jaw, it is necessary to impose a
smooth tireclamp. The number of teeth included in the tire on the intact section of the alveolar
process should not be less than that of the broken fragment. In other cases, it may be made of
high-speed plastic tire-kappa.
16. Traumatic damage to teeth.
all tooth injuries are divided into the following groups:
1. Incomplete fractures of teeth (without opening of pulp): there will be,
• cracks of enamel and dentin; marginal fracture of the crown and tear enamel;
• crown fracture, enamel and dentin detachment.
2. Complete fractures of the teeth (with the opening of the pulp):
• open (in the mouth) - fractures with partial defect of the crown; - fragmentation or defect of the
crown; - fragmentation or defect of crown and root;
• closed (while maintaining the integrity of the crown) - fracture of the root.
3. Dislocations of teeth:
• incomplete (partial) dislocation of tooth;
• dislocation of the tooth (separation) and separation of the edge of the alveolar process.
4. Pinching of teeth. When a tooth is struck, hemorrhage into the pulp can occur and may result
in necrosis (Necrosis), which leads to the development of inflammatory processes in the
periapical region. the jaw, which is accompanied by a rupture of the tissues of the surrounding
tooth.
It is necessary to distinguish incomplete, full and killed dislocations of a tooth. Most often there
are dislocations of the front teeth on the upper and lower jaws, which occur during mechanical
influences (falling, impact). But it can also occur with the improper use of the elevator or tongs
when removing teeth, as well as with increased stresses on the tooth when biting or chewing on
solid foods.
dislocation is accompanied by damage (rupture) of the periodontal tissues and the neurovascular
bundle. With incomplete dislocation there is a displacement of the tooth in the lingual (palatine)
or buccal side, but the tooth has not lost its connection with the hole. Part of the periodontal
fibres is torn and the rest is stretched. The neurovascular bundle may rupture, but its integrity
may be undisturbed (especially when the tooth is rotated about the axis).
With a full dislocation, the tooth completely ejects from the hole and loses its connection with it,
but it can be retained only due to the adhesive properties of the two wet (Blood-soaked) surfaces.
There is a rupture of all fibres of the periodontal and neurovascular bundle. Maybe accompanied
by a fracture of the alveoli and tooth loss from the hole.
17.Primary bleeding. Causes, methods of temporary and permanent stop.
Primary bleeding Primary haemorrhage occurs immediately following an injury.
the cause of it is an injury.
First aid for primary bleeding is to apply a pressure bandage to a bleeding wound. In case of
profuse bleeding, use a finger pinch of the vessel that supplies the blood to the anatomical site.
The common carotid artery is pressed with fingers to the transverse process of VI of the cervical
vertebra.
. At this point, the thumb presses the artery to the spine, with the other fingers located on the
back of the neck. The facial artery is pressed slightly forward of the intersection of the anterior
margin of the actual chewing muscle with the inferior edge of the mandible, the superficial
temporal - 1 cm, stepping forward and upwards from the goat ear. In order to impose pressure on
the common carotid artery, it is necessary to raise the patient's arm from the intact side and bend
it in the elbow. On the neck in the projection of the common carotid artery on the injured side
impose a dense roll of gauze or cotton wool and firmly bandaged circular rounds of bandage,
which pass through the arm, protecting the larynx, trachea and common carotid artery on the
intact side from compression.
You can also stop the bleeding by bandaging the wound in a wound or by applying a clamp to it.
18.Innervation of the mandible, anatomy.
anatomy :
the mandibular nerve has two divisions: anterior and posterior,
-Anterior division
.Nerve to medial pterygoid muscle
.Nerve to tensor veli palatini
.Nerve to tensor tympani
.Masseteric nerve
.Deep temporal nerves
.Nerve to lateral pterygoid muscle
.Buccal nerve
-Posterior division
.Auriculotemporal nerve
.Lingual nerve
.Inferior alveolar nerve
Innervation ;
.Sensory: Skin of the buccal region, sensory supply to the tongue (anterior ⅔), temporal region;
.Motor: Masticatory muscles, mylohyoid muscle, anterior belly of digastric muscle, tensor veli
palatini muscle, tensor tympani muscle.
19.The early secondary bleeding. Causes, methods of temporary and permanent stop.
Early secondary bleeding occurs when the thrombus is severed during the transport of the victim
or due to the rupture of the vessels in the absence of reliable transport immobilization of the jaw
fragments, can occur in the first 24-48 hours after the injury.
- the imposition of a pressure bandage; - the elevated position of the limb; - digital pressure of
the artery throughout; - maximum limb flexion in the joint; - stop bleeding with a tourniquet; stop bleeding with a tourniquet; - stop bleeding from the carotid artery according to the method
of Mikulich.
20.Classification of mandibular fractures (by timing, location, nature, direction of the fracture
line).
Fracture classification. There are unilateral, bilateral, single, double, multiple fractures of the
mandible. Among the single fractures there are fractures of the branch of the mandible (articular,
coronary processes, the branch itself) and its body (within the dentition).
Depending on the direction, the slit fractures may be transverse, longitudinal, oblique, zigzag
The fracture of the mandible may be complete, passing through the entire thickness of the bone
tissue, and incomplete (fracture), when the integrity of the compact plate of any bone section is
not broken.
21.Late secondary bleeding. Causes, methods of temporary and permanent stop.
Late secondary bleeding may occur as a result of purulent melting of the blood clot or the wall of
the partially damaged vessel after 7-14 days or as a result of erosion of the vessel 3-4 weeks or
later.
. Late secondary bleeding can be reliably stopped only by ligation of the main vessel throughout,
rarely by the ligation of the bleeding vessel in the wound with two ligatures and fixation to the
soft tissues. After stopping bleeding, patients are prescribed a strict bed rest for 7-10 days,
establish an individual post
22.Surgical treatment of wounds.
we start by achieveing hemostasis when stabilizing and evaluating the patient who has sustained
trauma. Most bleeding will respond to application of apressure dressing. Occasionally surgical
exploration and packing of the wound under general anesthesia may be indicated.
and if there any kind of Lacerations we apply clamping, ligation, or electrocautery and then we
give the patient anti-titanus to prevent any king of complication ,
In patients with large avulsion of tissue, definitive early reconstruction of the tissue loss with
regional or microvascular flaps may be required. After adequate anesthesia has been obtained,
the wound is thoroughly debrided. Nonvital tissue is conservatively excised in an attempt to
salvage most ofthe tissue. Devitalized tissue potentiates infection, which inhibits phagocytosis.
Repair of facial soft tissue injuries can be performed under local anesthetic with dosage 0.5 to
2%. It is usually administered with epinephrine 1:100,000. Lidocaine has a rapid onset of action,
a wide margin of safety, and a low incidence of allergic sensitivity. One should avoid injecting
directly into the wound when important landmarks could be dislocated and distorted.
and we start closing the wound , Common methods for closing wounds include suturing,
applying adhesives, and stapling. It is preferable to suture complex facial lacerations secondary
to esthetic considerations. A layered closure is almost always necessary and eliminates dead
space beneath the wound.
23.Chewing muscles, anatomy.
The muscles of mastication are muscles that attach to the mandible and thereby produce
movements of the lower jaw.
they are innervated by manibular nerve and supplied by maxillary artery .
and they are :
Temporalis,: The temporalis muscle functions mainly as an elevator of the mandible
masseter, : The major function of the masseter muscle is to elevate the mandible, with a minor
contribution to protrusion of the mandible.
medial pterygoid : The major functions of this muscle are elevation of the mandible and side-toside movements when grinding and chewing. The medial pterygoid is also involved in protrusion
of the mandible.
lateral pterygoid : The function of the lateral pterygoid depends on the degree of its contraction.
Bilateral contraction of the lateral pterygoid muscles protrudes and depresses the mandible. A
unilateral contraction on a particular side, in conjunction with the ipsilateral medial pterygoid
muscle, moves the mandible to the opposite side. This allows for alternating side-to-side
movements during chewing.