Dawolo wulilen, da wulilen datugulen, ani ɲɛda karilen jugumanba fiɲɛbɔyɔrɔw ladonni¶

Ni mɔgɔ dɔ ka duguma dawolo bɛ da wuli kosɛbɛ sɔgɔsɔgɔninjɛba kɔfɛ walima ɲinw lajɛ kɔfɛ (Acute Temporomandibular Joint [TMJ] Dislocation), walima a duguma dawolo ni a cɛmancɛ ɲɛda karilen don mobili tiɲɛni na, binkanni na, walima binkanni na (Bilateral Mandibular "Flail Jaw" Fracture ani Le Fort I, II, walima III Maxillofacial Fractures), o #1 teliya la farati min bɛ ɲɛnamaya la , o ye fiɲɛbɔyɔrɔ sanfɛla balili jugumanba ye . Ikomi hadamaden kan bɛ siri k’a ɲɛsin a dawolo duguma kolo ɲɛfɛla kɔnɔna na (symphysis mandibular), ni a dawolo fan fila bɛɛ karilen don, o bɛ a to kolo sofaw bɛɛ ka bin ka segin kɔfɛ ka ɲɛsin a dawolo kɔ ma waati min na a tigi dalen bɛ u kɔ kan (glossoptosis). Min ka jugu ni o bɛɛ ye, o ye ko sanfɛla dawolo karilenw (Le Fort karilenw) bɛ ɲɛdawolo kɔnɔna bolow tigɛ, ka joli bɔn, joli kurulenw, ani ɲinw gosilenw ka jigin fiɲɛbɔlan kɔnɔ ni banabagatɔ sirilen don a da la kɔfɛla la. Ni mɔgɔ o mɔgɔ ɲɛda walima a dawolo jogin na, ni ninakili bɛ mankan bɔ walima ni a bɛ sɔgɔsɔgɔ, ni joli gɛlɛn bɛ bɔ a da ni a nu na, walima ni a dawolo datugulen don, aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele o yɔrɔnin bɛɛ fɛ kɔrɔtɔko nimɔrɔw. Seginkanni min bɛ tali kɛ joginda ladonni na in ɲinw kɔrɔtɔko ni ɲinw gosilenw, . kunkolo joginw ni kirinni, ani kɔkolo joginw ani a lamagacogo.

Aw bɛ o kɛ sisan¶

1. AW KAN’a wajibiya abada banabagatɔ hakili la, ni a ɲɛda duguma walima a cɛmancɛ karilen don kosɛbɛ, a ka da a kɔ kan (a dawolo karilen don). Ni banabagatɔ kununna, a dawolo karilen don walima a ɲɛda joli bɛ bɔ, o bɛ kɛlɛ kɛ walasa ka sigi ka wuli ka a biri ɲɛfɛ, a ka sigi ka jɔ ka a biri ɲɛfɛ o la, girinya ka u nɛnkun sama ka taa ɲɛfɛ, ka joli, nɔgɔ ani ɲinw karilenw bɔ u da la ka taa a basikɛti sanni u ka u fogonfogonw su ji la.
2. Ni banabagatɔ hakili tɛ a la walima ni a mago bɛ kɔkolo jɔli la, aw bɛ u bila Lateral Trauma Recovery Position (log-rolled onto their side with inline manual neck stabilization) walima ka a kan ni a duguma dawolo sama ka taa ɲɛfɛ o yɔrɔnin bɛɛ. Ni banabagatɔ hakili tɛ a la, ni a kɔkolo karilen don a fan fila fɛ walima ni a ɲɛda cɛmancɛ karilen don Le Fort III la, o bɛ kɛ sababu ye ka dɛmɛ tɛ min na kan walima sanfɛla dawolo karilen walasa ka fiɲɛbɔyɔrɔ datugu segin kɔnɔ.
3. Aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele joona (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri) ni ɲɛda joginni fanga ka bon, dawolo karilen, walima dawolo wulilen, n’o tɛ se ka datugu.
4. Aw bɛ da kɔnɔna lajɛ joona ka joli kurukuruw labɔ, ɲinw gosilenw, ɲinw karilenw, walima fɔɔnɔ ni bolokɔni gansan ye walima ni fiyɛli ye. Ɲɛw gosilenw ni ɲinw tigɛlenw akiriliki karilenw minnu sigilen bɛ joli jidagayɔrɔ la da kɔnɔ, olu bɛ to ka fiyɛ fiɲɛbɔlan kɔnɔ (tracheobronchial aspiration) juguman nata la ninakili. Aw bɛ ɲinw banbali gosilenw mara nɔnɔ nɛnɛman walima kɔgɔ la (aw ye sɛbɛn ɲɛ ɲinw furakɛli kɔrɔtɔko).
5. Ni banabagatɔ min dawolo datugulen don ni nɛgɛ ye (Maxillomandibular Fixation [MMF]) walima ni a sirilen don ni elastiki sirilenw ye dawolo opereli kɔfɛ, o bɛ fɔɔnɔ walima ka sɔgɔsɔgɔ daminɛ:
6. Aw bɛ u jɔ ka u kunkolo kɔrɔta ka taa ɲɛfɛ o yɔrɔnin bɛɛ walasa fɔɔnɔ jilama ka se ka bɔ u kɔfɛla ɲinw kɔfɛ yɔrɔw la ani u nugu fɛ.
7. Ni u tɛ se ka u fiɲɛbɔyɔrɔ jɛya dɔrɔn, ni u bɛ ka kɛ bulu ye, walima ni u hakili tɛ bɔ dɔrɔn: Aw bɛ kɔrɔtɔko nɛgɛ tigɛlanw walima joginda girinmanw tigɛlanw (minnu ka kan ka to banabagatɔ ka dɔgɔtɔrɔso dilan na walima ka u ta a ka kamisɔn bɔrɛ kɔnɔ tuma bɛɛ) walasa ka sanfɛla cɛsira jɔlenw walima lastikuw tigɛ minnu bɛ boli UP-AND-DOWN ni ɲɔgɔn cɛ ani duguma jirisunw (aw kana waati tiɲɛ abada k’a ɲini ka nɛgɛ tilennenw tigɛ minnu sirilen bɛ ɲinw yɛrɛ la).
8. Ni "Locked-Open Jaw" dimi tɛ min na walima min bɛ dimi, sɔgɔsɔgɔninjɛ, ŋɛɲɛ walima fɔɔnɔ kɔfɛ (Acute Anterior TMJ Dislocation with zero trauma): Aw bɛ duguma dawolo duguma dɛmɛ nɔgɔya la ni aw bolow ye walima ni finimugu nɔgɔlen ye, aw bɛ degun sumalen kɛ ɲɛda fasaw kan tulo ɲɛfɛ walasa ka masseter muscle spasm dɔgɔya, aw bɛ o kɛ aw kana a ɲini ka dawolo sɔgɔ walima ka a wajibiya ka taa sanfɛ (o bɛ kondili kɔ kari), ani ka taa Kɔrɔtɔko ɲɛmɔgɔso la walasa ka Syringe-Roll walima Bimanual Reduction kɛ ni dususuma ye.
9. Aw bɛ a lajɛ ni dawolo duguma ni dawolo bɛ sɔgɔsɔgɔ, ani ka a lajɛ ni kɔ ɲinw bɛ ɲɔgɔn sɔrɔ cogo bɛnnen na. Hali ni ɲɛda kɛnɛma bɛ i n’a fɔ a fununna dɔɔni dɔɔni dɔrɔn punch walima bin kɔfɛ, aw bɛ a ye ko aw ɲinw tɛ layini kɛ tuguni ni aw magara u la nɔgɔya la (malocclusion, o ye dawolo kari taamasiɲɛ kelen ye min ka gɛlɛn kosɛbɛ) walima ka a ye ko aw dawolo duguma ni aw dawolo bɛ sɔgɔsɔgɔ (inferior alveolar nerve injury) bɛ a jira ko ɲɛgɛnɛsira karilen don.

Desizɔn jiri : Fiɲɛbɔyɔrɔw ɲɛnabɔli ani diferential triage of jaw dislocation vs. facial fractures¶

flowchart TD
    Start["Jaw / Facial Trauma Acute OR Sebaliya barikama ka da datugu (‘Locked-Open Jaw’) ."] --> AirwayFirst{"ƝƐNABƆLI 1: Aw ye fiɲɛbɔyɔrɔw dabɔli ni a kɛcogo lajɛ: Yala fanga caman bɛ joginni na, da/nu joli bɔli gɛlɛn, sɔgɔsɔgɔninjɛ/sɔgɔsɔgɔninjɛ, walima duguma dawolo sabatibali bɛ yen wa?"}

    AirwayFirst -->|"ƆWƆ: Ɲɛda jogin juguman, joli bɔli, walima Stridor/Gurgling"| PositionAirway["FIƝƐLA YƆRƆLI KƆLƆSI: 1. Aw bɛ telefɔni 911 / 112 / 999 wele o yɔrɔnin bɛɛ. 2. Ni aw kununna: Aw bɛ aw sigi ka wuli ka aw biri ɲɛfɛ walasa ka joli bɔ & ka kan to ɲɛfɛ. 3. Ni aw hakili tɛ: Aw bɛ log-roll kɛ SIDE (Lateral Trauma Position) kan ni inline C-spine control ye + aw bɛ kan/dan sama ka taa ɲɛfɛ. 4. ZERO nugulatumuw."]

    PositionAirway --> FractureType{"Aw bɛ ɲɛda karicogo kɛrɛnkɛrɛnnen dɔn min farati ka bon"}

    FractureType -->|"Jiginni Jaw Arch Lajɔlen don a fan fila bɛɛ la + Kan bɛ bin kɔ fɛ + Dawolo duguma-bɔgɔbɔgɔli"| FlailMandible["BILATERAL MANDIBULAR (‘FLAIL / BUCKET-HANDLE’) FRACTURE: Aw bɛ dawolo ɲɛfɛla yɔrɔ/kan sama ka taa ɲɛfɛ ni bolo ye walima ni finimugu sirilan/traction suture ye; aw bɛ fiɲɛbɔyɔrɔ labɛn kɔrɔtɔlen kununni walima opereli (cricothyrotomy)."]

    FractureType -->|"Sanfɛla dawolo / Midface Mobile Ni aw bɛ Sanfɛ ɲɛfɛ ɲinw sama + Nu/Glo joli caman bɔli"| LeFortPath["LE FORT I, II, OR III MIDFACE FRACTURE: Aw bɛ to ka jɔ/kɛrɛfɛ; nugu ɲɛfɛla/kɔfɛ balon pake + bololabaarakɛlaw ka dawolo dɔgɔyali ni joli bɛ bɔ ɲɛdawolo la; aw bɛ a lajɛ ni CSF sɔgɔsɔgɔninjɛ tɛ."]

    AirwayFirst -->|"No Trauma or Minimal Force (Aw bɛ sɔgɔsɔgɔ, ka ŋɛɲɛ, ɲinw sɛgɛsɛgɛli, fɔɔnɔ, walima hakiliɲagami fura): Da bɛ da wuli"| TMJCheck{"SEN 2: Aw ye ‘Da da wulilen’ min tɛ bɔnɛ ye, aw ka jateminɛ kɛ: Yala fan fila bɛɛ bɛ ɲɔgɔn ta wa walima a dawolo bɛ wuli ka taa fan kelen fɛ wa?"}

    TMJCheck -->|"Da datugulen Dabɔlen don cɛmancɛ la (Bilateral) OR Dawolo bɛ bɔ a fan dɔ fɛ (kɛrɛ kelen fɛ) + Dingɛ kɔnɔna bɛ tulo ɲɛfɛ"| AnteriorTMJ["TMJ ƝƐNABƆLI ƝƐNABƆLI ƝƐNABƆLI: 1. Aw bɛ a lajɛ ni furaw bɛ sɔrɔ distoniya jugumanba fɛ (haloperidol, metoclopramide -> aw bɛ difenhidramini / bɛnzitropini di IV la). 2. Aw bɛ taa Kɔrɔtɔko ɲɛmɔgɔso la min bɛ pikirijikɛlan-roli (‘Bolo tɛ min na’) walima bolo fila la Hippocratic Reduction."]

    TMJCheck -->|"Punch/Fall tariku + Denw tɛ ɲɔgɔn sɔrɔ (Malocclusion) + Dawolo duguma dawolo sɔgɔsɔgɔninjɛ + Dawolo duguma joli-sira-funu"| SimpleMandible["MANDIBULAR OR CONDYLAR FRACTURE: 1. Aw kana a ɲini ka TMJ dɔgɔya sani aw ka CT/Panorex X-ray kɛ. 2. ‘Blade Bite Test’ min ma ɲɛ; a mago bɛ Kɔrɔtɔko ɲɛmɔgɔso CT la, banakisɛfagalanw IV la (kari dafalen ɲin sosɛti fɛ), & ɲɛda ɲɛfɛla sirili."]

Ɲɛnamaya 1 : Joli temporomandibular (TMJ) bɔli jugumanba ("Jaw da wulilen min datugulen don") .¶

Anatomie: Cogo min na mandibular condyle bɛ siri articular eminence ɲɛfɛ¶

Temporomandibular joint (TMJ) ye hinge-and-glide joint ye, bololanɛgɛ bulama min bɛ duguma dawolo sanfɛla kɔkanna na (mandibular condyle) bɛ sigi socket dɔ kɔnɔ min man dun kungolo da la tulo ɲɛfɛla la (the glenoid fossa). O sosɛti ɲɛfɛ yɛrɛ, koloma kulu nɔgɔlen dɔ sigilen bɛ yen min bɛ wele ko the articular eminence of the temporal bone: 1. Da da wulicogo nɔgɔman: Ni aw ye aw da wuli dɔɔni, kondili bɛ wuli i n’a fɔ charnière a socket kɔnɔ. Ni aw bɛ da wuli ka sanwiyemugu dɔ sɔgɔ walima ka a kin, lateral pterygoid muscle bɛ kondili sama ka taa ɲɛfɛ ka taa ɲɛfɛla la ka taa ɲɛfɛla kɔkanna na, wa a bɛ segin ka wuli ka don a sosɛti kɔnɔ ni aw ye aw da datugu. 2. TMJ ɲɛfɛla bɔli (TMJ Dislocations 95%): Ni da wulilen don kosɛbɛ, i n’a fɔ sɔgɔsɔgɔninjɛ jugumanba, ŋɛɲɛba, ɲinw bɔli ka mɛn, fɔɔnɔ, kirinni, walima laryngoscopie, ɲɛgɛnɛsira bɛ sɔgɔsɔgɔ ka taa ɲɛfɛ kojugu, ka pan pewu ka tɛmɛ articular eminence kuncɛ kan ka don infratemporal fossa kɔnɔ. 3. Mun na dawolo tɛ se ka datugu a yɛrɛ ma (The Masseter Spasm Trap): Ni kondili bɛ sɛgɛn ka taa ɲɛdawolo sanfɛla kuncɛ ɲɛfɛ, dawolo datugulanw (masseter, temporalis, ani medial pterygoid) bɛ taa dimi lakanani sɔgɔsɔgɔninjɛ la. Sani u ka dawolo sama ka segin a sosɛti kɔnɔ, o farikolo yɔrɔ minnu bɛ sɔgɔsɔgɔ, olu bɛ kondili sama ka tilennen SANFƐ ka tɛmɛ articular eminence kuncɛ sanfɛ, ka dawolo datugu ni masin ye.

ATM ɲɛfɛla jiginni ni fan fila ni fan kelen ye (Clues visuelles) .¶

• Bilateral Anterior TMJ Dislocation (Most Common): Numanbolo ni numanbolo fila bɛɛ bɛ pan ka taa ɲɛfɛ ka bɔ u sosɛtiw la. Da bɛ datugu cogo simetri la (\(3\text{ ka se }5\text{ santimɛtɛrɛ}\) ɲɛfɛ ɲinw cɛ), duguma dawolo bɛ bɔ ɲɛfɛ (prognathic appearance), a tigi bɛ daji bɔ, a bɛ kuma ni kuma mugu ye, wa a bɛ ni palpable hollow pit directly in front of both ear tragi.
• TMJ ɲɛfɛla kelen bɔli: Kondili KELEN dɔrɔn de bɛ pan ka taa ɲɛfɛ ka bɔ a sosɛti la. Da bɛ siri ka da wuli, ANI dawolo bɛ ye ka wuli ka taa fan KƆLƆSI (kɛnɛya) fan fɛ.
• A ni Condylar Neck Fracture bɛ danfara don:
  • TMJ fan kelen bɔli: Dawolo bɛ bɔ ** YƆRƆ yɔrɔ joginlen na** (ka taa fan kɛnɛman fan fɛ), ani da bɛ datugu da wuli.
  • Unilateral Mandibular Condylar Fracture: Dawolo bɛ bɔ Fɛn joginlen (karilen) fan fɛ ni a bɛ da wuli.

Aw bɛ a bali tuma bɛɛ ka Dystonia acute oromandibulaire (TMJ mimic belebele) min bɛ sɔrɔ dɔrɔgu fɛ .¶

Sani aw k’a miiri ko dawolo da wulilen walima min tigɛlen don, o ye masin dɔrɔn ye, aw bɛ ɲininkali kɛ: "Yala banabagatɔ ye kɔnɔboli fura ta, hakiliɲagamifura, walima nbɛda fura ta sanga 24 fo lɛri 72 tɛmɛnen kɔnɔ wa?" - Fura minnu bɛ dopamine D2 sɔrɔyɔrɔw bali, kɛrɛnkɛrɛnnenya la metoclopramide (Reglan), prochlorpérazine (Compazine), promethazine (Phenergan), haloperidol (Haldol), risperidone, olanzapine, walima aripiprazole, olu bɛ se ka acute extrapyramidal dystonic reaction (oromandibular dystonia) bila mɔgɔ la. - Min bɛ kɛ: Kɛrɛfɛla pterygoïde, kan ani kɔ fasaw ka tetaniki sɔgɔsɔgɔli a yɛrɛ sago la, o bɛ dawolo sama ka da wuli walima ka taa kɛrɛ fɛ (a ka ca a la a bɛ TMJ bɔ a la filanan na), o bɛ taa ni kan bɔli ye walima ɲɛw wulicogo sanfɛ (oculogyric crisis). - Fura kɔrɔtɔlen: Ni aw ye Diphenhydramine (\(25\text{ ka se }50\text{ mg}\)) walima Benztropine (\(1\text{ ka se }2\text{ mg}\) IV/IM) tali jolisira fɛ walima farikolo la, o bɛ cɛmancɛ farikolojidɛsɛ tiɲɛ miniti 5 fo miniti 15 kɔnɔ, tuma caman na, o bɛ a to dawolo ka segin a nɔ na a yɛrɛma.

Dɔgɔtɔrɔso dɔgɔyali fɛɛrɛw ka ɲɛsin TMJ ɲɛfɛla bɔli ma¶

(Dɛmɛ fɔlɔ sariya: Aw kana dawolo wulilen ɲɛfɛla gosi, ka a sɔgɔ, walima ka a gɛrɛntɛ abada sanfɛ, o bɛ se ka kɔndili kɔ kari. Dɔgɔyali bɛ a ɲini ka kɔfɛla ɲinw lamaga Jiginni fɔlɔ walasa ka articular eminence kuncɛ saniya, ka sɔrɔ ka sɛgɛn ka segin kɔfɛ).

1. A tɛ don mɔgɔ la "Bolo tɛ" pikirijikɛlan-roli fɛɛrɛ (Fastest & Least Painful Modern Method, 95%+ Success Rate):
2. Lafiyafura tɛ jolisira fɛ ani dɔgɔtɔrɔ bolokɔnincininw tɛ kɛ da kɔnɔ.
3. Dɔgɔtɔrɔ bɛ furakɛli pikirijikɛlan plastiki mililitiri 5 walima mililitiri 10 bila ka kɛɲɛ ni banabagatɔ kɔ sanfɛla ni duguma dawolo ɲinw cɛ fan min bɔra.
4. Banabagatɔ bɛ pikirijikɛlan barajuru kin nɔgɔya la ka pikirijikɛlan wuli ka taa ɲɛfɛ ani kɔfɛ u kɔ ɲinw cɛ i n’a fɔ wulilan.
5. A bɛ baara kɛ cogo min na: Ka kinni kɛ pikirijikɛlan bara la, o bɛ baara kɛ n’a ye i n’a fɔ Class I fulcrum walasa ka dawolo kɔkanna lever ka jigin ka sɔrɔ ka girin ka kɔndili kɛ kɔfɛ ka tɛmɛ articular eminence kan ka don a socket kɔnɔ sekɔndi 60 fo 120 kɔnɔ.
6. Dɔgɔ kɔkanna fɛɛrɛ: Faan kelen fɛ, dɔgɔtɔrɔ bɛ koronawirisi taabolo sama ka segin kɔfɛ ɲɛda kɛnɛma la ka a sɔrɔ a bɛ kɔndili kɛrɛfɛla gɛrɛ nɔgɔya la ka segin kɔ, a kana bolokɔnincininw don da kɔnɔ.
7. Classic Intraoral Bimanual (Hippocratic) Reduction (Ni sigida la TMJ Lidocaine Block walima Sedation ye):
8. Dɔgɔtɔrɔ bɛ a bolokɔni fila bɛɛ siri gazemugu la, ka banabagatɔ sigilen kunkolo siri kosɛbɛ kogo la, ka a bolokɔni fila bɛɛ bila kɔ duguma dawolo la (kɛnɛma sɔgɔsɔgɔninjɛ), ka bolokɔnincininw siri a dawolo kɔrɔ, ka firmly DOWNWARD GƆDƆN kɔ dawolo la walasa ka kondili da wuli eminence duguma ka a sɔrɔ a bɛ dawolo kɔrɔta dɔɔni dɔɔni san fɛ, ka sɔgɔsɔgɔ KƆNƆ.
9. Ladonni kɔfɛ: Aw bɛ dawolo-kunkolo datugulan nɔgɔlen dɔ kɛ, ka tugu dumuni nɔgɔlen na min tɛ ɲimi fo tile 7 fo tile 10, ani aw bɛ bolokɔni dɔ da dawolo kɔrɔ tuma bɛɛ ni aw bɛ sɔgɔsɔgɔ walasa da kana da ka tɛmɛ santimɛtɛrɛ 2 kan.

(Kɔlɔsili TMJ sanfɛla ni kɔfɛla jiginni minnu man teli ka kɛ: Ni fanga caman bɛ gosi ka dawolo gosi, kɔndili bɛ se ka bila SAN fɛ ka don cɛmancɛ kunsɛmɛ na [Superior Dislocation] walima KƆLƆSI ka don tulo la [Kɔfɛla bɔli, min bɛ kɛ sababu ye ka tulo joli bɔ]. Aw kana a ɲini abada ka dɔgɔyali datugulen kɛ ni bɔnɛ ye tulo bɔli ni tulo joli bɛ bɔ walima ni hakiliɲagami taamasiɲɛw bɛ a la, aw bɛ CT scan kɛ joona).

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Jamana 2nan : Mandibular Fractures ani "Flail / Bucket-Handle" Jaw min bɛ mɔgɔ faga¶

Mun na Mandible bɛ kari yɔrɔ fila la siɲɛ kelen (The "Ring Bone" Rule)¶

Jiginni dawolo (mandibule) ye kolotuguda gɛlɛn ye min bɛ i n’a fɔ U, nɔrɔlen bɛ kungolo la a dakun fila bɛɛ la ni temporomandibular jogindaw ye, ka kɛ biyomekaniki bololanɛgɛ dagalen ye: - Kɛnɛyaso bololanɛgɛ sariya: I n’a fɔ pretzel gɛlɛn walima kolotuguda, a bɛ se ka fɔ ko i tɛ kolotuguda gɛlɛn kari yɔrɔ kelen dɔrɔn na abada. Kɛmɛsarada la 50 ni kɔ bɛ kɛ ɲɛda fila walima fan caman fɛ (misali la, ni i ye kininbolo gosi dawolo la, o bɛ kɛ sababu ye ka kari kɛ kɔnɔna kiniyanfan farikolo/parasimphyse la k’a ɲɛsin bolokɔni jukɔrɔ ANI ka kari filanan kɛ min bɛ kɛ ni counter-coup ye kɔrɔnfɛla numanbolo fan fɛ walima numanbolo subcondylar neck fan dɔ fɛ). - Tuma o tuma ni kari kelen sɔrɔla ɲɛdawolo la, dɔgɔtɔrɔw ka kan ka kari filanan ɲini a fan dɔ fɛ.

Cogo min na ɲɛda fila kari bɛ kɛ sababu ye ka sɔgɔsɔgɔninjɛ ("The Flail Mandible") .¶

Adamaden kan farikolo belebeleba (genoglossus muscle, min bɛ kan sama ka taa ɲɛfɛ walasa ka fiɲɛbɔyɔrɔ da wuli) bɛ nɔrɔ kolotuguda misɛnnin fila la (genial tubercles) ɲɛfɛla kɔkolo kɔnɔna na (the mandibular symphyse): - Ni binkanni, bolifɛn bolicogo dɔ gosi, marifa cilen, walima binna ka duguma dawolo kari damanbolo kininbolo ni numanbolo fila bɛɛ la (parasimphyseal bilateral walima bilateral body "bucket-handle" fracture), kan bɛ nɔrɔ yɔrɔ min na cɛmancɛ dawolo yɔrɔ, o bɛ tigɛ pewu sisan ni kungolo tɔ ye. - Min bɛ kɛ ni banabagatɔ dalen bɛ a kɔ la ka kɛ fla ye: Waati min na dɔgɔtɔrɔw walima kɛrɛfɛlaw bɛ banabagatɔ dɔ da ni a kɔkolo fila karilen don a kɔ la, girinya ni milohiyoyi ni geniohyoid farikolow samali ka jigin ka o sama min ye cɛmancɛ dawolo kolo ni kan basigilen bɛɛ tigɛ ka segin kɔfɛ ka ɲɛsin kɔfɛla kogo ma, ka a siri fiɲɛbɔyɔrɔ bɛ datugu pewu (glossoptose mécanique acute). - Kisili teliya la min bɛ mɔgɔ kisi: 1. Aw bɛ banabagatɔ hakili sigilen sigi ka jɔ ka a biri ɲɛfɛ walasa girinya ka flail dawolo yɔrɔ ni a kan sama ka taa ɲɛfɛ ka bɔ a dawolo la. 2. Banabagatɔ min hakili tɛ a la walima min bɛ a da la: Aw kana aw kana aw jigi da kunkolo kɔrɔtacogo nɔgɔman kan (o tɛ foyi kɛ ni dawolo tigɛra ni kungolo ye). Aw bɛ ɲɛfɛ duguma ɲinw ni dawolo kolo yɔrɔ minɛ k’a ɲɛsin a ma ni bolokɔni ye (walima aw bɛ gaze siri kan yɛrɛ la) ani ka aw bɛ cɛmancɛ dawolo yɔrɔ karilen ni kan sama ka ɲɛ ka taa ɲɛfɛ (kɔrɔn fɛ) ka taa sanfɛla la. Lakununni yɔrɔ la, joginda operelikɛlaw bɛ siliki sɔgɔlen walima finimugu sirilen dɔ tɛmɛ cɛmancɛ kan fɛ walima ka simfasi lamini walasa k’a minɛ ka taa ɲɛfɛ fo fiɲɛbɔyɔrɔ ka don walima ka opereli kɛ ka kirikotirotomi kɛ.

Dilan kɛrɛfɛ taamasiɲɛw minnu bɛ a jira ko mandibula karilen don (Ani "Tongue Blade Bite Test") .¶

Aw bɛ banabagatɔ bɛɛ lajɛ ni ɲɛda joginnen bɛ a la ni nin Taamaʃyɛn duuru klasiki minnu bɛ a dawolo karilen na: 1. Subjective Malocclusion (Most Sensitive Symptom): Aw bɛ banabagatɔ ɲininka nɔgɔya la: "Ni aw ye aw ɲinw lajɛ ɲɔgɔn fɛ dɔɔni dɔɔni, yala aw ka kinni bɛ kɛ cogo la, walima ni ɲin dɔw bɛ gosi joona kojugu wa?" Hadamadenw ɲinw bɛ ni neurorecepteurs ye minnu bɛ se ka wuli ni fɛn caman tigɛli ye minnu tɛ milimɛtɛrɛ 0,1 bɔ ni banabagatɔ ko u ka kinni bɛ i ko "off", a dawolo bɛ kari fo ka se a jirali ma ko o tɛ CT fɛ. 2. Subblingual Hematoma (Pathognomonic Sign): Aw bɛ a ɲini banabagatɔ fɛ a ka a nɛnkun kun kɔrɔta ka taa a da sanfɛla la ka da duguma kan lajɛ. Dugukolonɔn dibiman walima bilenman boli (ecchymose) walima joli wulilen da duguma o bɛ se ka kɛ kɛmɛsarada la 100 ye, min bɛ se ka kɛ sababu ye ka ɲɛdawolo farikolo jukɔrɔla walima simfasi kari. 3. Dawkun duguma ni dawolo sɔgɔsɔgɔninjɛ (Inferior Alveolar / Mental Nerve Anesthesia): Dawolo duguma nɛrɛ bɛ boli kolotuguda dɔ kɔnɔ min kɔnɔna na ka tɛmɛ duguma dawolo cɛmancɛ fɛ sani a ka bɔ dawolo la. Ni kari kɛra kɛrɛ, farikolo walima parasymphyse fɛ, o bɛ o nɛrɛmuguma in lamaga walima k’a tigɛ, ka dawolo duguma ni dawolo tilancɛ to u ka sɔgɔsɔgɔ. 4. Gingival Step-Off ani Joli bɔli ɲinw ni ɲɔgɔn cɛ: Eskala-senw cɛla walima a tigɛcogo yelen ye ɲinw dawolo la duguma ɲin fila ni ɲɔgɔn cɛ. (Bankɔni sariya nafama : Ikomi ɲin kelen-kelen bɛɛ lamini na, ɲinw dawolo yɔrɔ bɛ kumaɲɔgɔnya kɛ ni dawolo jukɔrɔla kolo ye, Kɔnɔbara karilen BƐƐ min bɛ tɛmɛ ɲin bɛ yɔrɔ min na, o ye kɛnɛyako siratigɛ la, OPEN (COMPOUND) FRACTURE ye min bɛ sɔrɔ sɔgɔsɔgɔninjɛ banakisɛw fɛ, o bɛ banakisɛfagalanw de wajibiya joli la i n’a fɔ ampicillin-sulbactam walima klindamisini). 5. The Tongue Blade Bite Test (95% Negative Predictive Value in Clinical Studies): Ni banabagatɔ dɔ ka dawolo dimi dɔɔni ani a ɲinw bɛ i n’a fɔ a bɛ cogo la, dɔgɔtɔrɔso kɔrɔtɔlen dɔ bɛ jiri kan degunfura bila a kininbolo dawolo cɛ, ka a ɲini banabagatɔ fɛ a ka kinni kɛ ka jigin kosɛbɛ, ka jiribolo firifiri. Ni banabagatɔ bɛ se ka kinni kɛ kosɛbɛ numanbolo ni numanbolo fila bɛɛ la fo dɔgɔtɔrɔ bɛ se ka jiri kan da tigɛ tilayɔrɔ fila la ni a y’a tigɛli kɛ, o la, a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ.

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Jamana 3nan : Le Fort I, II ani III cɛmancɛ ɲɛda karilenw¶

Mobili teliyaba ka ɲɔgɔn gosi la, motow tiɲɛni na, iziniw ka bɔnɛw la, walima ni binkanni juguw kɛra, fanga min bɛ ɲɛda cɛmancɛ gosi, o bɛ maxilla (sanfɛla dawolo), nugu kolo, orbits, ani pterygoïde plates de la sphenoïde kolo kari ka kɛɲɛ ni klasiki jɔcogo barikamaw ye minnu ɲɛfɔra Faransi operelikɛla René Le Fort fɛ.

Le Fort I, II ani III karilenw sumacogo ɲuman kɛnɛyaso la¶

Ɲɛda joli bɔli kɔrɔtɔlen ani CSF bɔli dɔnni¶

1. Mun na Le Fort karilenw bɛ joli bɔ ka caya: Cɛmancɛ ɲɛda bɛ sɔrɔ kɔnɔna ɲɛgɛnɛsira fɛ (kɛnɛma karotidi bolofara belebele dɔ min bɛ boli pterygoid plates karilenw kɔfɛ yɛrɛ) ani anterior/posterior ethmoidal arteries (ka bɔ carotid kɔnɔna na). Ni Le Fort II walima III kari ye kɔfɛla sɔgɔsɔgɔninjɛ tiɲɛ, joli bɛ bɔ nugu fila bɛɛ la waati kelen na ka taa ɲɛfɛ ka jigin galaka kɔfɛ, ka kɔnɔbara ni fiɲɛbɔyɔrɔ fa joona.
2. Pre-Hospital / ER Hemorrhage Control: Aw bɛ banabagatɔ sigi ka jɔ ka a biri ɲɛfɛ ni a kununna, walima ka a kɛ a kɔkanna kɛnɛya cogo la ni a tɛ a yɛrɛ dɔn. Ni da kɔnɔnatumu walima kirikotirotomi opereli ye fiɲɛbɔyɔrɔ siri ka ban, kɔrɔtɔko dɔgɔtɔrɔw bɛ nu kɔkanna/nu ɲɛfɛla epistaxis catheters dual-ballon (walima Foley catheters) don a kɔnɔ, ka da kɔnɔbara ni dawolo dawolo pake ka ɲɛ ni gazi ye ka ɲɛsin mandible sabatilen ma, ka sɔrɔ ka maxilla min gosilen don, o sama ni bolo ye ka taa ɲɛfɛ ani sanfɛ** (ka kolotugudaw dɔgɔya, o bɛ joli siraw tigɛcogo sumaya) ka sɔrɔ ka radiyodisiyɔn interventionnel (radiologie interventionnelle) baara transcatheter arterial embolization kama.
3. Kɔnɔbaralabana (CSF) bɔli dɔncogo min ɲagaminen don nugula joli la:
4. Le Fort II walima III karilen na, ji jɛlen sɔgɔsɔgɔninjɛ ji min bɛ bɔ dural membrane tigɛlen dɔ la nugu sanfɛla la, o bɛ ɲagami joli la.
5. Taamasiɲɛw: Banabagatɔ bɛ a kɔlɔsi ko nɛgɛ walima kɔgɔji dɔ bɛ bɔ a dawolo kɔfɛ min bɛ boli ka jigin u da kɔfɛ ni a sigilen don san fɛ, walima ji jɛlen bɛ jigin joona ka bɔ nugu la ni a bɛ a biri ɲɛfɛ. Ni nugulaji jolilen dɔ binna barajuru finman walima gaze kan, CSF jilama jɛlen bɛ taa kɛnɛma joona ka tɛmɛ joli kuru bilenmanw kan, ka kɛ bolokɔni jɛman-pinki fitini ye ka joli cɛmancɛ lamini ("Halo" walima "Double-Ring" Taamaʃyɛn; o sɛgɛsɛgɛra dɔgɔtɔrɔso laboratuwari la Beta-2 Transferrin sɛgɛsɛgɛli fɛ).
6. Dɛmɛ fɔlɔ sariya CSF sɔgɔsɔgɔninjɛ la: Aw kana nugu siri ka ɲɛ abada so kɔnɔ, aw kana nugu fiyɛ abada, wa aw kana a ɲini abada ka nugu da tugu walasa ji jɛlen kana bɔ ka bɔ. Ni aw ye CSF bɔli bali, o bɛ nugulatumu nɔgɔlenw wajibiya ka taa sanfɛ ka tɛmɛ dural tear fɛ ka don kunsɛmɛ na, o bɛ kɛ sababu ye ka banakisɛw ka meningitis faga, walima ka fiɲɛ bila kunsɛmɛ na (sɔgɔsɔgɔninjɛ min bɛ kɛ ni tansiyɔn ye). Aw bɛ ji jigintɔ minɛ ka ɲɛ gaze sterili kan min sirilen bɛ nugu kɔrɔ.

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Kɛrɛnkɛrɛnnenya la: Banabagatɔw ladonni kɔrɔtɔlen minnu ka dawolo bɛ ni nɛgɛ ye (Maxillomandibular Fixation) .¶

Banabagatɔ minnu bɛ kɛnɛya ka bɔ ɲɛdawolo walima Le Fort kari opereli la, olu ka teli ka segin so dɔgɔkun 2 fo dɔgɔkun 6 ni nɛgɛ arch bars ye minnu sirilen don u sanfɛla ni duguma dawolo la ani ka u siri ɲɔgɔn na ni nɛgɛ jɔlenw ye walima ni ɲinw labɛncogo girinmanw ye (Maxillomandibular Fixation [MMF]).

Fɔɔnɔ ni sɔgɔsɔgɔninjɛ furakɛli fɛɛrɛ min bɛ kɛ banabagatɔw ye minnu bɛ wele ko Wired-Jaw¶

1. Mun na a ka ca a la fɔɔnɔ tɛ wajibiya ka nɛgɛw tigɛ a yɛrɛma: Fɔɔnɔ jilama ni kɔnɔbara asidi bɛ se ka tɛmɛ kɔkanna dawolo kɔfɛ yɔrɔw fɛ (retromolar trigone), ɲinw ni ɲɔgɔn cɛ, ani nuguw fɛ N’A sɔrɔla banabagatɔ bɛ sigi o yɔrɔnin bɛɛ ka jɔ ka a kunkolo ni a farikolo biri ɲɛfɛ jisigiyɔrɔ walima jisigiyɔrɔ kan. Banabagatɔ kelen-kelen bɛɛ ka kan ka ondansetron (Zofran) min bɛ da kɔnɔ walima min bɛ se ka wuli, o sɛbɛn so kɔnɔ walasa ka kɔnɔboli bali sani a ka daminɛ.
2. Nɛgɛ tigɛcogo wajibiyalen: Banabagatɔ o banabagatɔ bɛ ni nɛgɛ tigɛlan ye ni nɛgɛ ye min tɛ sɔgɔsɔgɔ, o ka kan ka opereli nɛgɛ tigɛlanw (walima sɔgɔsɔgɔninjɛ gɛlɛnw tigɛlanw ta minnu bɛ kɛ ni fɛnɲɛnamafagalanw ye) ka kɛ juru ye u kɔ la, u ka bɔrɛ kɔnɔ, walima ka u siri u ka dilan kun na cogo yelen na sanga 24 kɔnɔ.
3. Tigɛyɔrɔ min na fiɲɛbɔyɔrɔ kɔrɔtɔlen na min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la: Ni banabagatɔ min bɛ ni nɛgɛ ye, o bɛ fɔɔnɔ gɛlɛn fiyɛ, ni a tɛ se k’a ka fiɲɛbɔyɔrɔ jɛya ka a biri ɲɛfɛ, ni a bɛ ka kɛ siyanotiki ye (bulu), walima ni a tɛ a yɛrɛ dɔn:
4. Aw bɛ sanfɛla ni duguma dawolo sama ka bɔ ɲɔgɔn na walasa ka nɛgɛberew bɔ kɛnɛ kan ɲinw kan.
5. Aw bɛ nɛgɛ jɔlenw (walima lastikuw) DƆRƆN tigɛ minnu bɛ boli san fɛ ni duguma dawolo cɛ (a ka c’a la, nɛgɛbere 2 fo 3 bɛ numanbolo fɛ ani nɛgɛbere 2 fo 3 kinin fɛ).
6. Aw kana a ɲini ka nɛgɛw tigɛ minnu sirilen bɛ ɲin kelen-kelen bɛɛ da la, minnu tɛ dawolo minɛ ka u datugu. Ni jiribolo jɔlenw tigɛra ka ban, duguma dawolo bɛ da o yɔrɔnin bɛɛ.

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

• Amerika ni Kanada: Aw bɛ 911 wele. ACS ATLS ni AAOMS joginda sariyaw kɔnɔ, ɲɛdawoloci ni fiɲɛbɔyɔrɔw bɛ tiɲɛ, o bɛ taa ni a jɔlen ye/ni a birilen don ɲɛfɛ (ni a kununna ani ni c-spine saniyalen don) walima ni sumaya ni a bilali kɛrɛfɛ ka taa Trauma Center la min labɛnna videyo laryngoscopie ni opereli cricothyrotomy kama.
• Royaume-Uni: Aw bɛ 999 (walima 112) digi. Aw bɛ Resuscitation Council UK, NICE Major Trauma (NG39), ani BAOMS ka laadilikanw labato ɲɛda joli bɔli kunbɛnni na, nugu fiɲɛbɔyɔrɔw kɔlɔsili kungolo basigilen joginni na, ani TMJ dɔgɔyali.
• Erɔpu jamanaw ka tɔnba: Aw bɛ 112 wele. Aw bɛ ERC ni EACMFS joginda fiɲɛbɔyɔrɔw laadilikanw labato.
• Ɔsitarali ani Zelande kura: Aw bɛ 000 wele Ɔsitarali walima 111 Nuwɛlika. Aw bɛ ANZCOR ani ANZAOMS sariyaw labato.
• Endi ni Azi Pasifiki: Aw bɛ 112 wele Ɛndujamana na, 119 Zapɔn ni Kore Dugu, walima 995 Singapuri. Motokari ni kɔkolo ni Le Fort karilenw faralen don ɲɔgɔn kan, aw bɛ to ka a tigi biri ɲɛfɛ walima a kɛrɛ fɛ a ta waati la walasa da kɔnɔ joli ka bɔ kɛnɛma.

Aw ye a lajɛ kɔrɔtɔko nimɔrɔw ka ɲɛsin diɲɛ kɔnɔ kɔrɔtɔko cikanw nimɔrɔw bɛɛ ma.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Mun na ne dawolo da wulila kosɛbɛ sɔgɔsɔgɔba kɔfɛ, ani mun na ne tɛ se ka ne dawolo gɛlɛya dɔrɔn ka taa san fɛ walasa k’a datugu?¶

Ni aw bɛ aw da wuli ka caya cogo la min tɛ deli ka kɛ, sɔgɔsɔgɔninjɛ, ŋɛɲɛ walima ɲinw furakɛli senfɛ, kolotuguda bololanɛgɛ bulama min bɛ aw duguma dawolo kɔfɛ (**mandibular condyle**) bɛ wuli ka taa ɲɛfɛ ka tɛmɛ kolotuguda kulu dɔ kuncɛ kan yɛrɛ i tulo dawolo ɲɛfɛ (**the articular eminence**). O yɔrɔnin bɛɛ, aw ɲɛda fasaw (**maseters**) bɛ sɔgɔsɔgɔ ka kɔndili sama ka taa san fɛ o koloma kulu ɲɛfɛ, k’a minɛ. Ni aw b’a ɲini ka aw dawolo ɲɛfɛla gɛrɛntɛ ka ɲɛ, o bɛ kolo siri ka gɛlɛya kulu la; dɔgɔtɔrɔ ka kan ka fɔlɔ ka **kɔfɛla ɲinw digi ka jigin** (walima aw ka pikirijikɛlan dɔ wuli aw kɔ dawolo cɛ) walasa ka kolotuguda kulu jɛya sani dawolo ka se ka segin kɔfɛ ka don a sosɛti kɔnɔ.

Kɔnɔnatumu fura i n’a fɔ Reglan walima Compazine bɛ se ka ne dawolo wuli cogo di?¶

Kɔnɔboli furaw i n’a fɔ metoclopramide (Reglan) ani prochlorpérazine (Compazine), ani hakiliɲagamifura minnu bɛ i n’a fɔ haloperidol walima risperidone, olu bɛ dopamine sɔrɔyɔrɔw bali kunsɛmɛ basigilenw na. Mɔgɔ dɔw la, kɛrɛnkɛrɛnnenya la denmisɛnw, funankɛninw ani baliku fitiniw, o bɛ farikolojidɛsɛ barikama dɔ bila mɔgɔ la min tɛ a yɛrɛ sago ye, o bɛ wele ko **distonie réaction acute (dystonie oromandibulaire)**, o yɔrɔ la, pterygoïde farikolow bɛ dawolo sama ni fanga ye ka da wuli walima ka taa kɛrɛ fɛ. Ni aw ye **difenhydramine (Benadryl) walima benztropine** pikiri kɛ jolisira fɛ kɛnɛyaso la, o bɛ farikolojidɛsɛ kɔsegin miniti damadɔ kɔnɔ.

Mun na ka mɔgɔ da a kɔ kan ka a da sɔgɔlan kan, o farati ka bon kosɛbɛ ni a duguma dawolo karilen don a fan fila bɛɛ la?¶

Aw kan bɛ siri ka ɲɛsin aw ɲɛfɛla kolotuguda kɔkanna kɔnɔna na (**mandibular symphyse**). A ka ca a la, i dawolo duguma kolotuguda gɛlɛn bɛ i dawolo ni i nɛnkun minɛ ka taa ɲɛfɛ ka bɔ i fiɲɛbɔlan na. Ni duguma dawolo karilen don dawolo fan fila bɛɛ la (**a bilateral "flail" walima "bucket-handle" fracture**), ɲɛfɛla dawolo yɔrɔ bɛ tigɛ. Ni aw ye a tigi da u kɔ kan, o bɛ kɛ sababu ye ka girinya ka dawolo karilen ni nɛnkun fili ka segin a dawolo la, ka u dawolo fo n’u sigilen bɛ ka u biri ɲɛfɛ walima ni mɔgɔ dɔ y’u dawolo ni u nɛnkun sama ka taa ɲɛfɛ.

Mun na dawolo karilen o dawolo karilen don, ɲinw bɛ joli bɔ yɔrɔ min na ɲin fila ni ɲɔgɔn cɛ, o bɛ furakɛ i n’a fɔ "open compound fracture"?¶

Hali ni i ɲɛda ni i dawolo kɛnɛma fari tɛ sɔgɔsɔgɔ, sɔgɔsɔgɔninjɛ mikroskɔpiki bɔrɔ min bɛ ɲin kelen-kelen bɛɛ ju lamini (**denso dawolo la**) o bɛ jɛ ka ɲɛsin dawolo kolotuguda ma. Tuma o tuma ni kari sira dɔ karilen don ɲin fila ni ɲɔgɔn cɛ ka ɲinw tigɛ da kɔnɔ, hadamadenw ka daji, banakisɛ miliyɔn kɛmɛ caman bɛ min na mililitiri kelen kɔnɔ, o bɛ woyo ka taa kolo karilen kɛnɛ la, o bɛ kɛ **kari dafalen ye** min bɛ banakisɛfagalanw de wajibiya minnu bɛ sɔrɔ dɔgɔtɔrɔso la walasa ka kolotugudaw bali (**kololabanaw**).

Mun na dɔgɔtɔrɔw ni kɛnɛyabaarakɛlaw dagalen don kosɛbɛ ka ninakiliminɛn walima kɔnɔbara basigilen don nugu fɛ ɲɛda cɛmancɛ (Le Fort) binkanni kɔfɛ?¶

Le Fort II walima Le Fort III cɛmancɛ ɲɛda kari, walima joginda fɛn o fɛn bɛ kɛ sababu ye ka ɲɛ nɛrɛma fila-fila ("raccoon eyes"), ka tulo kɔfɛ kurukuru ("Kɛlɛ taamasiɲɛ"), walima nugulamugu sɔgɔlen, o bɛ to ka ethmoid kolo** ka papiye finman **cribriform plate kari, min bɛ kɛ nugula so sanfɛla ye ani kunsɛmɛnasumaya duguma. Ni aw ye nugu fiɲɛbɔyɔrɔ walima nugulatumu dɔ gɛrɛntɛ ka wuli nugu la ni o kolotuguda karilen don, o bɛ se ka tubabufura ci ka tɛmɛ nugu sanfɛla fɛ **ka don kunsɛmɛ ɲɛfɛla yɔrɔw la** tubabufura bɛɛ ka kan ka tɛmɛ da kɔnɔ o nɔ na.

Ni ne dawolo wulilen donna ka segin a nɔ na kɛnɛyaso kɔnɔ, ne bɛ se k’a bali cogo di a kana kɛ tuguni?¶

Tuma o tuma ni temporomandibular joli bɛ bɔ, ligament capsule min bɛ kolotugudaw bolo minɛ, o bɛ wuli, o bɛ segin-ka-bɔnye nɔgɔya dɔgɔkun 2 fɔlɔ kɔnɔ. Aw bɛ aw nɔrɔ kosɛbɛ dumuni nɔgɔlenw na minnu bɛ kɛ ni zeru janya kinni ye tile 10 fo tile 14, aw kana aw da wuli ka tɛmɛ aw bolokɔni kelen bonya kan, ani **aw bɛ aw bolokɔni digi kosɛbɛ aw dawolo kɔrɔ tuma bɛɛ ni aw ye sɔgɔsɔgɔ, sɔgɔsɔgɔ, walima ŋɛɲɛ daminɛna tuma o tuma** walasa ka aw dawolo bali ka da wuli ka bonya.

Gafe minnu bɛ tali kɛ o ko la¶

• Denw ka kɔrɔtɔko ni ɲinw ladonni minnu bɛ kɛ ka u gosi
• Dɛmɛ fɔlɔ minnu bɛ mɔgɔ sɔgɔsɔgɔ ani ka fiɲɛbɔyɔrɔw datugu
• Kungolo joginw ni kirinni
• Kɔkolo joginw ni a lamagacogo

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Amerika ka operelikɛlaw ka kolɛji (ACS, Etazuni) ka jɛkulu min ɲɛsinnen bɛ joginda ma: Advanced Trauma Life Support (ATLS) Student Course Manual (Maxillofacial trauma fiɲɛbɔyɔrɔw sigicogo, flail mandible tongue traction, nasopharyngeal/nasogastric tubes tali kɛlɛli cribriform plate/midface fractures kɔnɔ, ani joli bɔli kunbɛnni).
• Amerika ka da ni ɲɛda operelikɛlaw ka tɔn (AAOMS, Etazuni): Ladoncogo misaliw: Da ni ɲɛda opereli furakɛlicogo kɛnɛyaso la (Trauma and Temporomandibular Joint Dislocation Management).
• British Association of Oral and Facial Surgeons (BAOMS) ani National Institute for Health and Care Excellence (NICE, Angletɛri): Bɔɲɔba: Jateminɛ ni a furakɛcogo fɔlɔ (NG39) ani Fɛnɲɛnɛma joli ni fiɲɛbɔyɔrɔw kunbɛnni kɔrɔtɔlen.
• Erɔpu lakununni tɔnba (ERC) ani Erɔpu tɔnba min bɛ ɲɛda ni ɲɛda opereli ɲɛnabɔ (EACMFS): Ladilikanw fiɲɛbɔyɔrɔw ɲɛnabɔli kan ɲɛda joginw na minnu bɛ mɔgɔ tɔɔrɔ.
• Amerika ka dɔgɔtɔrɔso kɔrɔtɔlenw ka kolɛji (ACEP, Etazuni): Kɔrɔtɔko furakɛli la: Kɔrɔtɔko furakɛli la: Temporomandibular Joint Dislocation (Syringe-Roll, Extraoral, and Intraoral Techniques) ani Kanbara kinni sɛgɛsɛgɛli tiɲɛni.