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Traumamaksilofasial
Dr Dewi Haryanti K, SpBP-RE
Sub bagian bedah plastik FK UNSRSUD Dr!uwardi Surakarta
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De"nisiSuatu kelainan yang ti#bul akibat trau#a dan
#enyebabkan $raktur pada #aksil%$a&ial 'Fraktur Nasal
Fraktur (yg%#a
Fraktur !andibula
Fraktur !a)illa '
*e$%rt + ' ransersal *e$%rt ++ ' Pyra#idal
*e$%rt +++ ' .rani%$a&ial dis/un&ti%n
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AnatomiMaksiloFacial
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0askularisasi #uka
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0askularisasi #uka
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$a&e
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N Fasialis
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N1 Fasialis
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N1Fasialis
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N1rige#inalis
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N1 riger#inalis
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Pe#eriksaan Klinis2na#nesis
Pe#eriksaan "sik
Pe#eriksaan F%t% R%ntgen
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Pe#eriksaan Klinis2na#nesis ' adanya riwayat trau#a #uka
Pe#eriksaan "sik '
U#u#*%kal '3e/ala yang ti#bul ' luka /e/as di #uka,ude#,
de$%r#itas, e&hy#%sis,#al%klusi,anestesiahip%estesia, pendarahan hidung atau
#ulut, dipl%pia, en%$tal#us
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Pe#eriksaan F%t%
R%ntgenF%t% kepala 2P dan *ateral
F%t% 4aters
3a#baran yang didapat 'ada perkabutan padasinus #aksilaris dan ada garis $raktur padatulang #uka
Biasanya $raktur #aksil%$a&ial disertai &edera
kepala
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F%t% 52P*at4ater6s7
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Hist%ry2lterati%n in the way the teeth #eet1
Pain site5s7, aggraating, relieing$a&t%rs,seerity1
Nu#bness %$ skin, #u&%sa and teeth1
2lterati%n in ability t% speak, swall%w,&hew%pen #%uth1
Disturban&es %$ isi%n ' blurring,d%uble isi%n1
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Redu&ed paten&y %$ %ral and nasal airway1
Hearing disturban&e1
2bn%r#al s%unds $r%# the /aw /%ints1Ne&k pr%ble#s1
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E)a#inati%nS&alp, $r%ntal b%nes and supra%rbital
ridges1
8rbits and nas%eth#%idal regi%n5trau#ati& tele&anthus and saddle n%sede$%r#ity7
E)ternal audit%ry #eati, 9yg%#ati& ar&hes
and in$ra%rbital #argins1(yg%#ati& buttreses, alar regi%ns and
upper teeth1
!:, #andible and l%wer teeth1
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2sy##etryStep de$e&tsDis&%ntinuity.repitus endernessNeur%l%gi&al de"&its 5sens%ry and #%t%ri&7
!issing and #%bile teeth1!%bility %$ the #id $a&e1
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+ndikasi 8perasiBila ter/adi gangguan $ungsi
Bila ter/adi gangguan estetik
Prinsip erapi ' indakan dilakukanse&epatnya,tetapi bila k%ndisi tidak#e#ungkinkan sebaiknya tindakan dilakukansebelu# hari ke ;< pas&a trau#a1
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8rbita0isual a&uity,dipl%pia1
E)%phthal#usEn%phthal#us 5retr%bulbarhe#at%#,bl%w %ut $ra&ture7
ele&anthus1
.%rneal abrasi%ns, &%n/ungtial tears andeyelid la&erati%n1
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Penanganan Fr 8rbita2 B .
Ekspl%rasiRep%sisi
Fiksasi dengan '4ire atau !iniplate inter $rag#en
2pabila ada dipl%pia dilakukan penangananuntuk #us&le entrap#ent
Ekspl%rasi dan pe#bebasan dapat dilakukan
=-> hari pr%ses trau#a 5saat ede#a sudahhilang7
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Nasal2sy##etryDe$%r#ity in all three di#ensi%nsBilateral %r unilateral epista)isP%ssible leak %$ &erebr%spinal ?uid 5bethadine
test7Septal hae#at%#a %r disrupti%n2n%s#ia %r paran%s#ia.repitus
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Penanganan Fr Nasal2 B .
Rep%sisi dengan $%r&eps 4alsha#, $%r&eps2s&h atau Salinger
Pasang ta#p%n &au# nasi
Pasan gips kupu-kupu
Sangat dian/urkan tindakan ini dilakukandala# nark%se u#u#
a#p%n di&abut hari @-= hari
3ips dipertahankan ;A-;= hari
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!id$a&e 59yg%#ati&%-
#a)illary7!al%&&lusi%n
!a)illa #%ing
!alar ?atteningD%wnsl%ping palpebral "ssure
+n$ra%rbital nere paresthesis
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(yg%#a2 B .
Ekspl%rasiRep%sisi
Fiksasi dengan ' #iniplate dan s&rew ataudengan wire
2prr%a&h 'Se#i %pen ' Fr 2rkus (yg%#a dgn 3illis&s
Pr%&edure
8pen ' ekstra %ral,sub&ilier,in$ra%rbita,sub&%n/ungtia,intra%ral
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!andibula!al%&&lusi%n
enderness and step-%s 5palpati%n7
Swelling and bruising*%wer lip paresthesias 5in$ra ale%lar nere7
He#at%#as in the ?%%r %$ the #%uth
8pen bite, tris#us 5#andibular &%ndyle7
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Penanganan Fr !andibula
u/uan' #enge#balikan 8klusi sepertikeadaan se#ula
2 B .
+nter Dental 4iring-+nter #a)ilary 4iring
5+D4-+4R72r&h Barr
!iniplate dan s&rew
Fiksasi dengan wire atau ar&h barrdipertahankan
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!a)illa2nteri%r %pen bite, #al%&&lusi%n!%bility %$ #a)illa5?%ating7Epista)isEl%ngati%n %$ the $a&e1*e$%rt + 'pyri$%r# ri#*e$%rt ++ ' nasal r%%t 5nas%$r%ntal suture7
*e$%rt +++ 5&rani%$a&ial disarti&ulati%n7'9yg%#at%&%$r%ntal suture
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Penanganan Fr !aksilla2 B .
*e$%rt + ' transersal*e$%rt ++ ' Pyra#idalRep%sisi dengan R%we F%rleps,Heat%n 4illia#s
Fiksasi ' +D4+!42r&h Barr suspensi 559yg%#ati&%
.ir&u#$erential wiring7
!iniplate dan s&rewFiksasi wire atau ar&bar dipertahankan sela#a =-C
#inggu
*e$%rt +++ 8pen Redu&ti%n +nternal Fi)ati%nFiksasi dengan ' #iniplate,suspensi 5$r%nt%
&ir&u#$erential wiring7
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Nas%%rbital eth#%idal
5N8E7Saddle n%se de$%r#ity
rau#ati& tele&anthus
2ulsi%n %$ #edial &anthal liga#ents
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Radi%l%gi& e)a#inati%nsSkull -rays 52P*ateral7
4ater6sreerse 4ater6s
Sub#ent%erte) iewPan%ra#i& radi%graphs 5Pan%re)7
.-S&ann
hree Di#ensi%n .-S&ann1
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!anage#entDepends %n ' %rganised,tea#w%rk1
!aintain airway se&ure &eri&al spine1
Bilateral parasy#physeal $ra&ture 5i##ediatestabili9ati%npulling the t%ngue anteri%r7
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.l%sed redu&ti%n3illies pr%&edure
!!F 5+D4-iy l%%p,ar&h bar7
.ir&u#$erential wiring1Bart%n bandages1
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8pen redu&ti%n2ppr%a&h '
bi&%r%nair1in$ra&illiar,ginggi%bu&&al1
Delayed untill patient has been stabili9ed1B%ny repair 5;A days t% weeks7
+!Fplate and s&rew with %r with%ut !!F1
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S%$t tissue abrasi%ns and
la&erati%nGHigh-pri&ed real estate
2nat%#i& land#arks 5 white skin r%ll,er#ili%n b%rder,br%w eyes7
.leanse the w%und with n%r#al saline
E)pl%re the in/ury t% its $ull depth
Beware $a&ial nere and par%tid gland and
du&t in/uryII*ayered &l%sure
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S%$t tissue as s%%n as p%ssible1
*a&ri#al du&t 'Da&ry%&yst%rhin%st%#yrepair%$ Stensen du&t1
Retr%bulbar he#at%#a' e#ergen&yea&uati%n
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Stens%n6s du&t rupture
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S&alp l%ss
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S%$t tissue la&erati%n
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4indshield in/ury
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Juesti%ns?
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Thankyou
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