Mushiku munyanguke, mukana mukanga, ne ditshibuka dikole dia tshiadi ne mpala Dilama dia njila wa luya¶

Nansha mpala wa muntu wa kuinshi mua kuikala mubuluke kunyima kua yeye mumane kuela mbila anyi kuya kutangila munganga wa menu (Acute Temporomandibular Joint [TMJ] Dislocation), anyi mpala wende wa kuinshi ne mpala wende wa pankatshi binyanguke mu njiwu ya mashinyi, mu dibunda anyi mu dikuluka (Bilateral Mandibular "Flail Jaw" Fracture ne **Fort I, II, Lolocation), the Fail #1 njiwu ya lukasa ya muoyo i dikanga dia njila wa luya lua kuulu. Bu mudi ludimi lua muntu lulamakaja buludiludi ku tshitupa tshia munda tshia mufuba wa kuinshi kua nshingu (the mandibular symphysis), ditshibuka dia ku nseke yonso ibidi ya tshiadi didi dienza bua tshitupa tshijima tshia mufuba wa kabalu ne ludimi lukuluke bululame kunyima ku nyima kua nshingu dîba didi muntu udibu bashipe mulale pa mukolo (**gloss optosis). Tshidi tshibi menemene ntshia se: mishiku ya kuulu mitshibuka (Le Fort fractures) idi itshibula matamba a mushipa wa munda wa tshiadi, ipongolola mashi, bipese bia mashi, ne menu adi mapueka mu tshiadi tshia mu tshiadi pikala mubedi musuikila pa tshilamba tshia panyima. Shi muntu udi na mputa ku mpala nansha ku tshiadi udi ne mutoyi wa mutoyi anyi udi upuyakana, mashi a bungi apatuka mukana ne mu mishiku, anyi tshiadi tshiunzulula, ubikile nimero wa lupitadi lua muaba unudi diakamue ku diambuluisha dia nomba ya tshimpitshimpi. Tangila malu adi atangila dilama dia njiwu mu malu a tshimpitshimpi a meno ne menu mapueka, mputa ku mutu ne disama dia mutshima, ne mputa ya mukolo ne dibenga kuenza mudimu.

Enza nunku mpindieu¶

1. Kuenzeji mubedi udi ne lungenyi lukole udi ne tshiadi tshia kuinshi anyi tshia munkatshi mua mpala bua kulala panshi pa mukolo (supine). Bikala mubedi udi mubike ne tshiadi tshitshibuka anyi mpala udi upatuka mashi udi uluangana bua kusomba ne kuinama kumpala, balekele basombe balulame batangile kumpala bua bukole budi bukokela ludimi luabu kumpala ne kulekela mashi, mate, ne dinu dipatuka mu tshibombi tshiabu mu tshibombi tshiabu pamutu pa kujimija mifuba yabu.
2. Bikala mubedi mujimije lungenyi anyi dijinga ne dipangisha dia mukolo, umuteke mu muaba wa diondopangana dia ku luseke (muele ku luseke luende ne dikolesha dia nshingu dia ku bianza) anyi ukoke ludimi luende ne mpala wende wa kuinshi kumpala diakamue. Kulala muntu udi kayi mumanye tshidiye ne ditshibuka dia mu tshiadi anyi ditshibuka dia tshiadi tshia Fort III ku mukolo wende ludimi ludi kaluyi lukuatshisha anyi tshiadi tshia kuulu tshitshibuka bua kukanga njila wa luya mu tusekonde tukese.
3. Bikila nimero ya tshimpitshimpi ya muaba unudi diakamue (911 mu États-Unis ne Canada, 112 mu Union européenne, 999 mu Royaume-Uni) bua disama dia mpala dikole, ditshibuka dia mpala, anyi mpala munyanguke udi kayi mua kukanga.
4. Tangila munda mua mukana diakamue ne upuekeshe mashi adi manyanguke, meno adi mapatuke, meno a tshiamu adi matshibuka, anyi nsukadi ku diambuluisha dia munu udi ne tshianza anyi tshiamu tshia kuela nabi mâyi. Meno adi mapatuke ne bitupa bia meno a tshiamu tshia acrylique matshibuka bidi mu tshina tshia mashi mukana bitu misangu ya bungi bipuekeshibua mu lupepele (tshiamu tshidi tshilonda) mupuya mukole. Lama menu a kashidi adi kaayi manyanguke mu mabele mashika anyi mu mâyi a mukele (tangila malu a tshimpitshimpi a meno).
5. Bikala mubedi udi ne mishiku mikanga (Maxillomandibular Fixation [MMF]) anyi mikanga ne tshiamu tshikole kunyima kua dipanda dia mishiku udi utuadija kuela nsukadi anyi kuela mbila:
6. Bashikame balulame ne bateke mutu wabu kumpala diakamue bua mayi a mâyi apatuke mu bitupa bidi panyima pa meno abu a nyima ne mu mishiku yabu.
7. Anu bobu kabayi mua kujikija luya luabu, balua bule, anyi bajimija lungenyi: Enza mudimu ne biamu bia kukosa nabi nshinga bia lukasa anyi bia kukosa nabi mishiku bia bungi (bidi ne bua kuikala bilamakaja ku bulalu bua mubedi mu lupitadi anyi kuikala nabi mu tshibombi tshia bilamba biabu misangu yonso) bua kukosa nsinga ya tshiamu tshia mitaku idi mimane anyi idi pankatshi pa NE mionji ya ku mutu ne ya kuinshi (kujimiji dîba nansha dikese bua kuteta bua kukosa mionji idi mitangile ku meno nkayayi to).
8. Bua "Locked-Open Jaw" udi kayi ne kanyinganyinga anyi udi usama kunyima kua kuela mbila, kuseka anyi kuela nsukadi (Acute Anterior TMJ Dislocation with zero trauma): Kuatshisha tshitupa tshia kuinshi kua tshiadi tshia kuinshi bitekete bitekete ne bianza biebe anyi ne tshilamba tshia kuowela natshi, ela tshintu tshia kapia pa mishipa ya ku matama kumpala kua matshi bua kukepesha dikokangana dia mishipa ** teta kukuma anyi kuenzeja tshibeku kuulu (tshidi tshitshibula nshingu wa condylar), ne uya ku tshibambalu tshia malu a mpukapuka bua kuenza Syringe-Roll anyi Bimanual Reduction.
9. Tangila ni mushiku wa kuinshi ne tshiadi bidi kabiyi biumvuika, ne tangila ni meno a kunyima adi apetangana bimpe. Nansha mudi pambelu pa mpala umueneka anu muwule kakese panyima pa dikuma anyi dikuluka, udi umvua ne: meno ebe kaena kabidi mu mulongo paudi ualenga pamue bitekete bitekete (malocclusion, tshimanyinu tshimuepele tshitambe buimpe tshia ditshibuka dia tshiadi anyi tshia ditshibuka dia tshiadi) (mushiku wa kuinshi udi umvua bibi ne mushiku wa kuinshi disama dia tshiadi tshia alveolar) didi dileja ne tshiadi tshidi tshitshibuka.

Mutshi wa dipangadika: Dilombola dia njila wa luya ne disungula dia dishilangana dia dinyanguka dia mpala ne ditshibuka dia mpala¶

flowchart TD
    Start["Disama dia ku tshiadi / dia ku mpala NANSHA dipanga dia tshimpitshimpi dia kukanga mukana ('Mushiku mukanga')"] --> AirwayFirst{"MUSHINDU 1: Tangila njila wa lupepele ne mushindu udiye wenza mudimu: Kudi disama dia bukole bua bungi, dipatuka dia mashi a bungi mukana/mu mishiku, dikuma dia mbila/dipuekesha dia mishiku, anyi mpala wa kuinshi udi kayi mushindame anyi?"}

    AirwayFirst -->|"EYOWA: Disama dikole dia ku mpala, dipatuka dia mashi, anyi Stridor/Gurgling"| PositionAirway["MUSHINDU WA LUPETU WA LUPETU: 1. Bikila 911 / 112 / 999 Diakamue. 2. Shi udi mubike: Somba mululame muiname kumpala bua kupatula mashi ne ikala ne ludimi kumpala. 3. Shi udi kayi mumanye tshidiye wenza: Log-roll onto SIDE (Lateral Trauma Position) na inline C-spine control + pull tongue/chin before. 4. ZERO nasal tubes."]

    PositionAirway --> FractureType{"Umanye mushindu kampanda wa ditshibuka dia mpala ne mpala udi ne njiwu mikole"}

    FractureType -->|"Mushiku wa kuinshi udi mulekelela ku nseke yonso ibidi + Ludimi ludi lupueka panyima + Bilonda panshi pa mukana"| FlailMandible["BILATERAL MANDIBULAR ('FLAIL / BUCKET-HANDLE') FRACTURE: Koka tshitupa tshia kumpala tshia tshibeku/ludimi kumpala ku bianza anyi ne tshiamu tshia kuowela natshi/tshiamu tshia kukoka natshi; kulongolola njila wa lupepele wa tshimpitshimpi anyi wa dipanda (cricothyrotomy)."]

    FractureType -->|"Mushiku wa kuulu / munkatshi mua mpala udi wendakana paudi ukoka meno a kuulu a kumpala + mashi a bungi a ku mishiku/ku nshingu"| LeFortPath["LE FORT I, II, OR III MIDFACE FRACTURE: Ikala mululame/ku luseke; dikumbaja dia tshiamu tshia ku mishiku tshia kumpala anyi tshia panyima + dipuekesha dia tshiadi tshia ku bianza pikala mashi apatuka mu mushipa wa munda wa ku mutu; Tangila ni CSF rhinorrhea."]

    AirwayFirst -->|"KAKUENA kanyinganyinga anyi bukole bukese (kuela mbila, kuseka, dikonkonona dia menu, kuela nsukadi, anyi manga a diondapa nawu lungenyi): Mukana mukanga bikole"| TMJCheck{"MUSHINDU 2: Ela meji bua 'mukana mukanga' udi kauyi ne kanyinganyinga: Nseke yonso ibidi idi mifuanangane anyi Tshianza tshidi tshishintuluke ku luseke lumue?"}

    TMJCheck -->|"Mukana mukanga bikole munkatshi (bilateral) ANYI Tshianza tshipambuke ku luseke lukuabu (Unilateral) + Tshina tshidi ne munda mutupu kumpala kua ditshi"| AnteriorTMJ["DISHINTULUKA DIA KUMPALA DIA TMJ: 1. Tangila ni udi ne disama dia Dystonia (haloperidol, metoclopramide -> ufila IV diphenhydramine / benztropine). 2. Enda ku tshibambalu tshia malu a tshimpitshimpi bua kuenza mudimu ne tshiamu tshia mitaku ('Hands-Free') anyi Bimanual Hippocratic Reduction."]

    TMJCheck -->|"Muyuki wa dikuma/dikuluka + Meno kaena mu mulongo (Malocclusion) + Mushiku wa kuinshi udi kayi umvua bimpe + Hematoma wa panshi pa mukana"| SimpleMandible["DITUPA DIA MU MUTU: 1. Kutetshi bua kukepesha TMJ kumpala kua CT/Panorex X-ray to. 2. 'Diteta dia Blade Bite' dipangile; udi ulomba CT wa tshibambalu tshia malu a mpukapuka, IV antibiotics (ditshibuka dia mu tshina tshia meno), ne dijadika dia mpala ne mpala."]

Tshilumbu 1: Dinyanguka dia tshitupa tshia mubidi tshia mu tshiadi (TMJ) (The "Locked-Open Jaw")¶

Anatomie: Mushindu kayi udi tshitupa tshia mu nshingu tshikuata kumpala kua tshitupa tshia mu nshingu¶

Tshitupa tshia temporomandibular (TMJ) ntshisangilu tshidi tshienda tshiendakana mudi mupimbu wa tshijengu udi ku mutu kua mufuba wa nshingu wa kuinshi (the mandibular condyle) musombele munda mua tshitupa tshidi katshiyi tshitamba bunene ku nshindamenu wa tshifuba kumpala kua tshina tshia matshi (the glenoid fossa). Kumpala kua tshina etshi kudi mukuna wa mifuba udibu babikila ne: the articular eminence of the temporal bone: 1. Diunzulula dia mukana dia pa tshibidilu: Paudi ukangula mukana muebe kakese, tshitupa tshia mukana tshidi tshinyunguluka bu tshintu tshidi tshinyunguluka munda mua tshibombi tshiatshi. Paudi unzulula bikole bua kuela mbila anyi kuluma sandwich munene, mushipa wa pterygoïde wa ku luseke udi ukoka condyle kumpala pa tshibandilu tshia panyima tshia articular eminence, ne udi upingana mu tshina tshiawu paudi ukanga mukana muebe. 2. Anterior TMJ Dislocation (95% of TMJ Dislocations): Padibu babulula mukana bikole, bu mudi kuela mbila bikole, kuseka bikole, kupatula meno mutantshi mule, kuela nsukadi, kusama, anyi kuenza laryngoscopie, tshitupa tshia mu tshiadi tshidi tshienda **kule menemene kumpala, tshipita pa tshibandilu tshia infratemporal emincular fossa. 3. Bua tshinyi tshiadi katshiena mua kukanga nkayatshi (Tshiamu tshia Masseter Spasm): Dîba didi tshiadi tshienda tshisesuka kumpala kua tshibandilu tshia articular eminence, misunyi idi ikanga tshiadi (masseter, temporalis, ne medial pterygoid) idi ibuela mu tshipupu tshikole tshia bukubi. Pamutu pa kukoka tshiadi tshianyima mu tshibombi tshiatshi, mishipa idi ikoka tshiadi lulame KU MUTU pa mutu pa tshibandilu tshia articular eminence, tshikanga tshiadi tshiunzulula bikole.

Dinyanguka dia TMJ dia kumpala dia ku luseke lubidi ne dia ku luseke lumue (bimanyinu bia kumona)¶

• Dinyanguka dia tshitupa tshia kumpala tshia TMJ (tshitamba kuenzeka): Bitupa bionso bibidi bia ku dia bakaji ne bia ku dia balume bitu bipatuka mu miaba yabi. Mukana mudi mukanga mu mushindu mujalame (\(3\text{ to }5\text{ centimeters}\) pankatshi pa meno a kumpala), tshiadi tshia kuinshi tshidi tshipatuka kumpala (tshimuenekelu tshia prognathic), muntu udi wela mate, wakula ne ngakuilu mupuwe, ne udi ne tshina tshidi tshimueneka kumpala kua matshi onso abidi.
• Dinyanguka dia tshitupa tshia kumpala tshia TMJ: Anu tshitupa tshimue tshia mubidi tshidi tshipatuka kumpala mu tshina tshiatshi. Mukana mudi mubulula, NE tshibeku tshidi tshimueneka tshitangile ku luseke lukuabu (luimpe).
• Dishilangana ne ditshibuka dia nshingu:
  • Unilateral TMJ Dislocation: Tshianza tshidi tshipatuka KULE ne luseke ludi lutapike (lutangile ku luseke ludi ne makanda a mubidi), ne mukana udi mukanga mubulula.
  • Unilateral Mandibular Condylar Fracture: Chin devia TOWARD the injured (broken) side padibu banzulula mukana.

Misangu yonso, ikala ulekela disama dia oromandibulaire dikole didi difumina ku manga (tshilejilu tshinene tshia TMJ)¶

Kumpala kua kuela meji ne: tshiadi tshiunzuluke anyi tshikoseka ntshienza anu ku tshiamu, webeja ne: "Mubedi mmunue manga adi ajikija disama dia mutshima, manga adi ajikija disama dia lungenyi anyi manga a mu njila mu mêba 24 anyi 72 adi mapite aa anyi?" - Maluvu adi akanda dopamine D2, nangananga metoclopramide (Reglan), prochlorperazine (Compazine), promethazine (Phenergan), haloperidol (Haldol), risperidone, olanzapine, anyi aripiprazole, adi mua kujula extrapyramidal dystonic reaction (ororomandibulardystonia. - Tshidi tshienzeka: Dikokangana dia tetanic dia ku luseke dia pterygoid, ludimi, ne nshingu didi dikoka mpala mubulula anyi ku luseke (misangu ya bungi dikoka TMJ musangu muibidi), dilondangana ne dipatuka dia ludimi anyi dienda dia mêsu mulu (oculogyric crisis). - Diondapangana dia lukasa: Difila dia Diphenhydramine (\(25\text{ to }50\text{ mg}\)) anyi Benztropine (\(1\text{ to }2\text{ mg}\) IV/IM) didi ditshibula tshitupa tshia mubidi tshia munkatshi mua minite 55 too ne ku dikumi dia mapapu a tshiadi kupingana pa muaba wende ku mpukapuka.

Mishindu ya kukepesha disama dia TMJ dia kumpala¶

(Mukenji wa diambuluisha dia kumpala: Kuena mua kukuma, kukuma, anyi kuela kumpala kua tshibeku tshidi tshinyanguke mulu, bidi mua kutshibula nshingu wa condylar. Dipuekesha didi dilomba bua kubandisha menu a panyima KUINSHI kumpala bua kumbusha tshibandilu tshia articular eminence, ne pashishe kupingana panyima).

1. Mushindu wa dienza dia syringe udi kauyi unyanguka (Kakuyi bianza" (Mushindu wa matuku etu aa udi ne lukasa ne udi kauyi ne kanyinganyinga ka bungi, 95%+ wa ditanta):
2. Kakuena diondapangana dia mu mishipa ne kakuena tshianza tshia munganga munda mua mukana tshidi tshikengela to.
3. Munganga udi uteka tshiamu tshia plastike tshia 5-mililitre anyi 10-mililitre tshia tshiamu tshia nzembu tshia buanga mu tshikoso pankatshi pa meno a mubedi a kuulu ne a kuinshi ku luseke ludi lunyanguke.
4. Mubedi udi uluma bitekete bitekete pa tshibombi tshia tshiamu tshia nzembu ne udi wela tshiamu tshia nzembu kumpala ne panyima pankatshi pa meno ende a nyima bu tshiamu tshia nzembu.
5. Mushindu udibi bienza mudimu: Kusuma pa tshibombi tshia tshiamu tshia mitaku kudi kutshienza mudimu bu Class I fulcrum bua kubandisha nyima kua mpala panshi eku wenda unyunguluka condyle upingana panyima pa tshitupa tshia articular eminence mu tshitupa tshiawu mu 60 too ne ku 120 secondes.
6. The Extraoral Technique: Ku luseke lukuabu, munganga udi ukoka tshitupa tshia coronoid panyima pa pambelu pa ditama eku wela condyle mukuabu panyima bitekete bitekete, wepuka bua kuela minu munda mua mukana.
7. Dipuekesha dia mukana dia kale (Hippocratic) (ne dipangisha dia TMJ dia lidocaine anyi diondopangana):
8. Munganga udi ufunda minu yonso ibidi mu tshilamba tshikole, ulamakaja mutu wa mubedi udi musombe bikole ku tshimanu, uteka minu yonso ibidi pa mishiku ya kuinshi kua dikasa (tshitupa tshia pambelu tshidi tshitangile), udi ukuata minu muinshi mua tshibeku, wela bikole KUINSHI ku mishiku ya panyima bua kukangula mashika adi muinshi mua dikasa eku ulengeja tshibeku ne mupuya muimpe udi ulenga mpala KUNYIMA.
9. Dilama dia panyima pa dipuekesha: Ela tshilamba tshia ku mutu tshia tshibeku, ulonde biakudia bipepele bia kubenga kutafuna munkatshi mua matuku 7 too ne ku 10, ne misangu yonso uteke tshianza muinshi mua tshibeku dîba dionso didiye utua mbila bua mukana kauyi mua kunzuluka kupita santimetre 2 to.

*(Note on Rare Superior and Posterior TMJ Dislocations: Si un high-energy blow frappe the chin, condyle can be conduced UPWARD into middle cranial fossa [Superior Dislocation] or **BACKWARD into the canal [Posterior Dislocating, causeing bleeding earth]**Teta nansha kakese bua kukepesha disama. ne mashi adi apatuka mu matshi anyi bimanyinu bia malu a mitu;

Tshilumbu 2: Ditshibuka dia tshiadi ne tshianza tshia "Flail / Bucket-Handle" tshia lufu¶

Bua tshinyi tshiadi tshidi tshitshibuka miaba ibidi musangu umua (mukenji wa "mufuba wa tshijengu")¶

Mushiku wa kuinshi (mandible) i tshitupa tshia mifuba tshikole tshidi tshienza bu U tshidi tshilamakaja ku tshifu ku nseke yonso ibidi kudi bitupa bia temporomandibular, tshienza tshijengu tshikanga: - Mukenji wa tshilamba tshia mu lupitadi: Anu bu pretzel mukole anyi tshifu tshia mifuba, kuena utshibula tshilamba tshia mifuba tshikole anu muaba umue to. Pa mutu pa 50 pa lukama ya ditshibuka dia mu tshiadi didi dia ku luseke lubidi anyi dia bungi (tshilejilu, dikuma dia ku dia balume ku tshiadi didi difikisha ku ditshibuka ku mubidi wa ku dia balume/parasymphysis buludiludi muinshi mua tshianza NE ditshibuka dibidi dia counter-coup ku tshitupa tshia dikasa dia ku dia bakaji anyi ku nshingu wa ku dia bakaji ku luseke lukuabu). - Dîba dionso didibu bapeta ditshibuka dimue mu tshiadi, baminganga badi ne bua kukeba ditshibuka dibidi ku luseke lukuabu.

Mushindu kayi udi ditshibuka dia tshiadi tshikebesha disama dia asphyxie ("The Flail Mandibula")¶

Mushipa munene wa ludimi lua muntu (mushipa wa genioglossus, udi ukoka ludimi kumpala bua kulama njila wa luya lua mu tshiadi mubulula) udi ulamakaja buludiludi ku mifuba ibidi mikese (tubercules genial) idi munda mua mufuba wa tshiadi tshia kumpala (the mandibular symphysis): - Shi dibunda, dikuma dia tshiamu tshia mashinyi, dikuma dia bingoma, anyi dikuluka ditshibula mpala wa kuinshi ku ku dia bakaji ne ku dia balume dia tshibeku (ditshibuka dia bilateral parasymphyseal anyi bilateral body "bucket-handle" fracture), tshitupa tshia tshibeba tshia munkatshi mudi ludimi lulamakaja tshidi mpindieu tshipatuka tshishiki ne tshitupa tshikuabu tshia tshifu. - Tshidi tshienzeka padi mubedi mulale panshi pa mukolo: Dîba didi baminganga anyi bantu badi pabuipi apu balala mubedi udi ne disama dia mu tshiadi panshi pa mukolo, bukole budi bukokela panshi ne dikoka dia misunya ya mylohyoid ne geniohyoid didi dikoka mufuba wa tshiadi udi mupatuke ne tshitupa tshijima tshia ludimi panyima pa tshimanu tshia panyima, ** njila wa lupepele mukanga tshishiki (glossoptose mecanique acute). - Disungila dia lukasa dia muoyo: 1. Somba mubedi udi mumanye malu mululame muinamine kumpala nunku bukole budi bukoka bintu budi bukoka tshitupa tshia tshibeku ne ludimi kumpala pambelu pa nshingu. 2. Mu mubedi udi kayi mumanye tshidiye wenza anyi udi mulale panshi: Kueyemenyi ku kueyemena mutu wa pa tshibidilu (udi kauyi wenza bualu padi tshibeku tshipatuka ku tshifu). Kuata meno a kuinshi a kumeso ne tshitupa tshia mufuba wa tshiadi buludiludi ne tshianza tshidi ne tshianza (anyi kuela gauze pa ludimi nkayalu) ne koka tshitupa tshia tshiadi tshia munkatshi tshidi tshitshibuka ne ludimi buludiludi KUMPALA (kumpala) batangile ku plafond. Mu nzubu wa dilengeja, baminganga badi bapanda bantu badi bapeta njiwu batu bapitshisha tshilamba tshia soie anyi tshilamba tshia kuowela natshi mu ludimi lua munkatshi anyi pabuipi ne tshitupa tshia mubidi bua kutshilama kumpala too ne padibu babueja njila wa luya anyi padibu benza dipanda dia cricothyrotomie.

Bimanyinu bia ku bulalu bia ditshibuka dia tshiadi (ne "Diteta dia disuma dia ludimi")¶

Tangila mubedi yonso udi ne disama dia mpala bua Bimanyinu bitanu bia kale bia ditshibuka dia tshiadi tshia kuinshi ebi: 1. Subjective Malocclusion (Most Sensitive Symptom): Ebeja mubedi ne bupole ne: "Paudi usangisha meno ebe bipepele, udi umvua bimpe anyi, anyi amue meno adi akuma kumpala kua dîba anyi?" Meno a bantu adi ne neurorecepteurs idi itaba dishintuluka dia muinshi mua 0.1 millimeters; shi mubedi unena amba disuma diandi didi diumvuika "dibi," mpala udi utshibuka too ne padi CT uleja ne ki mmuomu to. 2. Sublingual Hematoma (Pathognomonic Sign): Lomba mubedi bua kubandisha nsongo ya ludimi luende ku mutu kua mukana ne kutangila panshi pa mukana muinshi mua ludimi. Tshiamu tshia violet tshifiike anyi tshikunze tshipupu (ecchymose) anyi hematoma mubandile panshi pa mukana tshidi tshileja 100 pa lukama tshia mubidi wa tshiadi anyi tshia ditshibuka dia symphyseal. 3. Disama dia mishiku ya kuinshi ne tshia ku tshiadi (Anesthesie wa mu mishiku ya kuinshi / ya mu lungenyi): Muonji wa kuinshi wa alveole udi wenda munda mua tshina tshia mifuba tshidi ne munda mutupu tshidi tshipita munkatshi mua mufuba wa kuinshi kua tshiadi kumpala kua kupatuka ku tshiadi. Ditshibuka dia tshitupa, mubidi, anyi parasymphysis didi dikola anyi dikosa tshitupa etshi, dishiya tshitupa tshia mushiku wa kuinshi ne tshibeku tshikole. 4. Dipatuka dia meno ne dipatuka dia mashi pankatshi pa meno: Ditapuluka didi dimueneka dia tshibandilu anyi ditshibuka mu tshitupa tshia menu tshidi pankatshi pa meno abidi a kuinshi. (Mukenji wa mushinga wa disama: Bualu muaba wa tshitupa tshia dinu tshidi tshinyunguluke dinu dionso udi uyukila buludiludi ne mufuba wa nshingu udi muinshi mua dinu, Ditshibuka dionso dia dinu didi dipita mu tshitupa tshia dinu tshidi ne dinu didi dimueneka bu ditshibuka dia OPEN (COMPOUND) didi dipetangana ne bactérie ya mate, didi dilomba bua kuela mu mishipa bu mudi antibiosullin anyi ampi-bacillin clindamycin). 5. Diteta dia disuma dia ludimi (95% mushinga mubi wa dimanyisha mu malonga a luondapu): Shi mubedi udi ne disama dia mu tshiadi dikese ne meno adi amueneka bu a pa tshibidilu, munganga wa lupitadi lua lukasa udi uteka tshiamu tshia ludimi tshia mabaya pankatshi pa meno a ku dia bakaji, ulomba mubedi bua kuluma bikole, ne unyungulula dikoba dia mutshi. Shi mubedi udi mua kusuma bikole ku ku dia bakaji ne ku dia balume bua munganga kukosolola ludimi lua mutshi mu bitupa bibidi pa kulukosa, ditshibuka dia tshiadi didi ne mushinga wa bungi mu lupitadi didi dipangisha ne dishindika dia \(>95\%\).

Nsombelu 3: Le Fort I, II, ne III Midface Fractures¶

Mu dibunda dia mashinyi adi enda lubilu lukole, dikuluka dia moto, dikuluka dia mu midimu, anyi dikuluka dikole, bukole budi kabuyi bumueneka budi bukuma munkatshi mua mpala budi butshibula maxilla (mushiku wa kuulu), mifuba ya mu mishiku, orbite, ne mabeji a pterygoid a mufuba wa sphenoid bilondeshile milongo isatu ya kale idi kayiyi ne bukole idibu bumvuije kudi Forté Leont French.

Difuanyikija dia malu a luondapu dia Le Fort I, II, ne III¶

Dilombola dia tshimpitshimpi dia mashi adi apatuka mu mpala ne ku mpala ne dimanya dia dipatuka dia CSF¶

1. Bua tshinyi bitupa bia Le Fort bidi bipatuka mashi a bungi: Mubidi wa pankatshi udi ufila kudi mushipa wa munda wa tshiadi (tshitupa tshinene tshia ndekelu tshia mushipa wa pambelu udi wenda anu panyima pa mabeji a pterygoïde adi matshibuke) ne mushipa wa ethmoidal wa kumpala/wa panyima (wa mu tshiadi tshia munda). Padi ditshibuka dia Le Fort II anyi III ditshibula tshitupa tshia panyima tshia tshiadi, mashi adi apatuka musangu umue mu mishiku yonso ibidi ne apueka buludiludi kunyima kua nshingu, awuja lukasa tshifu ne njila wa luya.
2. Dilama dia mashi kumpala kua lupitadi / ER: Teka mubedi muimane muimane kumpala yeye mubike, anyi mu muaba wa kuondopibua ku luseke padiye kayi mumanye tshidiye wenza. Padi tshiamu tshia endotracheal tshia mukana anyi tshiamu tshia cricothyrotomie tshia kupanda tshilama njila wa luya, baminganga ba mu lupitadi lua lukasa badi babueja katetere ya epistaxis ya mu mishiku ya panyima anyi ya kumpala (anyi katetere ya Foley), basuikila tshitupa tshia mukana ne tshia mu tshiadi tshikole ne tshiamu tshia gaze ku dikasa dia mukana, ne kutshikuma ku tshianza tshia ku tshianza tshidi tshishindame ne ** kuulu** (kukepesha bitupa bia mifuba kudi kutekesha dinyanguka dia mishipa) eku wenza mudimu ne radiologie wa diambuluisha bua dibueja dia mashi mu mashi mu tshiamu tshia transcatheter.
3. Mushindu wa kujingulula dipatuka dia mayi a mu buongo (CSF) masangisha ne mashi a mu mishiku:
4. Mu ditshibuka dia Le Fort II anyi III, mashi a mu tshiadi adi apatuka mu tshitupa tshia muulu tshidi tshipanduluke ku mutu kua diulu adi asambakana ne mashi.
5. Bimanyinu: Mubedi udi umona mayi a tshiamu anyi a mukele adi apueka kunyima kua nshingu wende padiye musombe, anyi mâyi matoke adi apueka lukasa mu mishiku padiye muinamine kumpala. Shi ditontolola dia mayi a mu mishiku adi ne mashi dikuluka pa tshilamba tshia kulala tshitoke anyi pa tshilamba tshia gauze, CSF udi ne mâyi matoke udi uya pambelu lukasa kupita globules rouges, wenza tshijengu tshitekete tshia jaune-rose tshidi tshinyunguluke tshitupa tshia mashi tshia munkatshi (tshimanyinu tshia "Halo" anyi "Double-Ring"; tshijadikibua mu laboratware wa lupitadi ku diambuluisha dia diteta dia **Betrenferin).
6. Mukenji wa diambuluisha dia kumpala bua CSF Rhinorrhea: Kuena ne bua kukanga mishiku bikole kumbelu, kuela mu mishiku nansha kakese, ne kutetshi nansha kakese bua kukanga mishiku bua kupangisha mâyi matoke bua kupatuka to. Kupangisha dipatukila dia CSF kudi kuenzeja bactérie ya mu mishiku idi ne bukoya bua kuya muulu kupitshila ku tshitupa tshia dural tshidi tshibuela mu buongo, ne kuenza bua kapepe ka mu mishiku kadi kafua anyi katataka ka mu tshifu tshibumba (tension pneumocephalus). Kuata mayi adi apueka pa tshilamba tshia gaze tshidi katshiyi ne disama tshikuate muinshi mua diulu.

Tshilejilu tshia pa buatshi: Dilama dia lukasa dia babedi badi ne mishiku mikanga (Maxillomandibular Fixation)¶

Babedi badi buondopibua ku dipanda dia tshiadi anyi tshia Le Fort batu misangu ya bungi bapingana kumbelu munkatshi mua mbingu 2 too ne ku 6 ne tshiamu tshia arc bars tshisuika ku mishiku yabu ya kuulu ne ya kuinshi ne milamakaja pamue ku diambuluisha dia mionji ya tshiamu tshia mitaku anyi bande ya caoutchouc mikole (Maxillomandibular Fixation [MMF]).

Mukenji wa diela ne dikuma dia mishiku bua babedi badi ne mishiku¶

1. Bua tshinyi kuela manyi kakuena kulomba bua kukosa mionji nkayayi to: Malu a mayi ne aside wa mu tshifu bidi mua kupatuka mu bitupa bidi panyima pa dinu dia panyima (trigone retromolar), pankatshi pa meno, ne mu mishiku PIDI mubedi musombe diakamue mululame ne muinamine mutu wende kumpala ne pa mutu pa tshina tshia mâyi anyi tshia kuowela mâyi. Mubedi yense wa tshiadi udi ne tshia kufundila ondansetron (Zofran) wa ku mishiku anyi wa kunua kumbelu bua kuepuka disama dia tshiadi kumpala kua kutuadija.
2. Mukenji wa tshiamu tshia mitaku: Mubedi yense udi ne tshiamu tshia mitaku tshidi katshiyi tshinyanguka udi ne tshia kuikala ne tshiamu tshia kupanda natshi tshia tshiamu tshia mitaku (anyi tshiamu tshia kukosa natshi mishiku tshikole tshia kupanda nabi) pa tshilamba tshia mu nshingu, mu tshibombi, anyi tshilamakaja ku mutu kua bulalu buende mêba 24 ku dituku.
3. Muaba wa kukosa mu njiwu ya luya lua luya: Shi mubedi udi ne tshiadi tshia nshinga udi upuekesha luya lukole, kayi mua kukosa njila wende wa luya mutangile kumpala, udi wenda ulua cyanotic (bule), anyi udi ulua mujimije lungenyi:
4. Koka mishiku ya mulu ne ya kuinshi bua kuleja tshiamu tshia mitaku tshidi pa mishiku.
5. Kosa ANYI mionji mimane (anyi bande ya caoutchouc) idi yenda MU MUTU-NE-MUINSHI pankatshi pa mishiku ya kuulu ne ya kuinshi (pa tshibidilu mionji 2 anyi 3 ku dia bakaji ne mionji 2 anyi 3 ku dia balume).
6. KUTEKI bua kukosa mionji idi mitangile ku nshindamenu wa meno a muntu pa nkayende, idi kayiyi ilama mishiku mikanga to. Padibu bamane kukosa mionji idi mimane, tshiadi tshia kuinshi tshidi tshiunzuluka diakamue.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

• États-Unis ne Canada: Ela 911. Muinshi mua ACS ATLS ne AAOMS mikenji ya disama dia tshiadi, disama dia mu tshiadi ne dia mpala didi ne dinyanguka dia njila wa luya didi dienda dienda diakane/diteka kumpala (bikalaye mubike ne c-spine mulengejibue) anyi ne dikuma ne diteka dia ku luseke ku nzubu wa njiwu udi ne bintu bia video laryngoscopy ne cricothyrotomy wa dipanda.
• Bukalenge bua ditunga: Ela 999 (anyi 112). Londa mikenji ya Resuscitation Council UK, NICE Major Trauma (NG39), ne BAOMS bua kukandamena mashi adi apatuka mu mishiku ne ku mpala, kuepuka njila ya luya lua mu mishiku mu disama dia mu mutu, ne dipuekesha dia TMJ.
• Buobumue bua matunga a ku Mputu: Ela 112. Londa mikenji ya ERC ne EACMFS idi itangila njila ya luya.
• Australie ne Nouvelle-Zélande: Ela 000 mu Australie anyi 111 mu Nouvelle-Zélande. Londa mikenji ya ANZCOR ne ANZAOMS.
• India ne Asia-Pacifique: Ela 112 mu Inde, 119 mu Japon ne mu Corée du Sud, anyi 995 mu Singapour. Mu njiwu ya moto idi ne ditshibuka dia mu tshiadi ne dia Le Fort, ikala ne muntu udibu bashipe muinamine kumpala anyi ku luseke luende padibu bamuambula bua mashi a mukana apatuke pambelu.

Tangila nomba ya tshimpitshimpi bua nomba yonso ya dituma dia njiwu ya pa buloba bujima.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi tshianza tshianyi tshiakabuluka kunyima kua meme mumane kuela mbila, ne bua tshinyi tshiena mua kuela tshianza tshianyi mulu bua kutshikanga?¶

Paudi ukangula mukana muebe mu mushindu udi kauyi wa pa tshibidilu paudi utua mikemu, useka anyi wenza mudimu wa diondopangana dia meno, tshitupa tshia mubidi tshidi tshinyunguluke tshidi kunyima kua tshiadi tshiebe tshia kuinshi (**the mandibular condyle**) tshidi tshienda tshiya kumpala pa mutu pa mukuna wa mifuba kumpala kua tshitupa tshia ditshi diebe (**the articular eminence**). Diakamue, mifuba yebe ya ku ditama (**the masseters**) idi ikola ne ikoka tshitupa tshia mubidi tshidi tshitangile kuulu kumpala kua mukuna wa mifuba, itshikuata. Kuteta bua kuela tshitupa tshia kumpala tshia tshibeku tshiebe tshilulame kudi kukuata mufuba bikole ku mukuna; munganga udi ne tshia kuanji kufina **meno a kunyima panshi** (anyi kukulomba bua kuela tshibombi tshia tshiamu tshia mitaku pankatshi pa meno eba a kunyima) bua kumbusha tshibandabanda tshia mifuba kumpala kua tshiadi kupingana tshianyima mu tshina tshiatshi.

Mmunyi mudi manga a diluisha disama dia tshiadi bu mudi Reglan anyi Compazine mua kuenza bua tshiadi tshianyi tshipatuke?¶

Maluvu adi ambuluisha bua kujikija tshiji bu mudi metoclopramide (Reglan) ne prochlorperazine (Compazine), ne kabidi manga adi ambuluisha bua kujikija tshiji bu mudi haloperidol anyi risperidone, adi akanda dopamine mu tshitupa tshia kuinshi tshia buongo. Mu bantu bakuabu, nangananga bana, bansonga, ne bantu bakulumpe, bualu ebu budi bujula disama dia tshimpitshimpi dia mubidi didibu babikila ne: **acute dystonic reaction (oromandibular dystonia)**, mudi misunyi ya pterygoïde ikoka mpala bikole anyi ku luseke. Dibueja dia **diphenhydramine (Benadryl) anyi benztropine** mu mashi mu nzubu wa lupitadi didi dipingaja disama dia mubidi mu minite mikese.

Bua tshinyi kulala muntu pa mukolo pa tshibandilu kudi ne njiwu ya bungi padi mpala wende wa kuinshi mutshibuka ku nseke yonso ibidi?¶

Ludimi luebe ludi lulamakaja buludiludi ku luseke lua munda lua panyima lua mufuba wa tshiadi tshiebe tshia kumpala (**the mandibular symphysis**). Pa tshibidilu, tshitupa tshikole tshia mufuba webe wa kuinshi tshidi tshilama tshibeku tshiebe ne ludimi luebe kumpala kule ne muonji webe wa luya. Padi tshiadi tshia kuinshi tshitshibuka ku nseke yonso ibidi ya tshiadi (**ditshibuka dia "flail" anyi "bucket-handle" dia ku nseke ibidi**), tshitupa tshia tshiadi tshia kumpala tshidi tshipatuka. Kulala muntu udibu bashipe panshi pa mukolo kudi kuenza bua bukole budi bukokela bintu panshi bupueke tshitupa tshia tshiadi tshitshibuka ne ludimi luende buludiludi mu nshingu, bimushipa padiye usomba muinamine kumpala anyi muntu mukuabu ukoka tshibeku ne ludimi luabu kumpala.

Bua tshinyi ditshibuka dia mushiku mudi mishiku idi ipatuka mashi pankatshi pa meno abidi didi diangatshibua bu "ditshibuka dia tshitupa tshiunzulula"?¶

Nansha mudi dikoba dia pambelu dia ditama diebe ne dia tshiadi tshiebe kadiyi ne mputa, tshibombi tshia mionji tshidi tshinyunguluke muji wa dino dionso (**tshitupa tshia mu tshiadi**) tshidi tshilamakaja buludiludi ne mufuba wa mu tshiadi. Dîba dionso didi mulongo wa ditshibuka utshibuka pankatshi pa meno abidi ne utshibula mulongo wa mishiku munda mua mukana, mate a muntu, adi ne nkama ya miliyo ya bactérie ku millilitre, adi abuela buludiludi mu mufuba mutshibuka, wenza bua se **ditshibuka diunzuluke** didi dilomba manga a antibiotique bua kuepuka disama dia mufuba (**osteomyelitis**).

Bua tshinyi baminganga ne baminganga badi bakandike bua kuela tshiamu tshia kupuya natshi luya anyi tshia mu tshifu mu mishiku kunyima kua njiwu ya mpala (Le Fort)?¶

Ditshibuka dia mpala wa Le Fort II anyi Le Fort III, anyi disama dionso didi mua kufikisha ku mêsu mafiike ("mêsu a mbua"), disama dia kunyima kua matshi ("tshimanyinu tshia mvita"), anyi ditshibuka dia mu mishiku, misangu ya bungi didi ditshibuka tshitupa tshikese tshia **cribriform tshia mufuba wa ethmoid** tshidi tshienza tshisasa tshia tshina tshia munda ne panshi tshia buongo. Kuela tshiamu tshia mu mishiku anyi tshiamu tshia nasogastrique pa mutu pa diulu padi tshitupa tshia mufuba atshi tshipanduluke kudi mua kutuma tshiamu atshi buludiludi ku mutu kua diulu **mu bitupa bia kumpala bia buongo**; milonda yonso idi ne tshia kupita mukana pamutu pa nanku.

Padibu bapingaja tshiadi tshianyi tshidi tshinyanguke mu nzubu wa lupitadi lua lukasa, mmunyi mundi mua kupangisha bualu ebu bua kabuenzeki kabidi?¶

Misangu yonso idi tshitupa tshia temporomandibular tshipatuka, tshitupa tshia ligament tshidi tshikuata mupimbu wa tshitupa tshidi tshienda tshikola, bienza bua dipingana dia tshitupa tshia mubidi dikale dipepele mu mbingu 2 ya kumpala. Ikala anu udia biakudia bipepele bidi kabiyi bikengela kudia mu matuku 10 anyi 14, kuepuka bua kukangula mukana muebe kupita bunene bua munu umue, ne **misangu yonso ufina tshianza tshiebe bikole muinshi mua tshibeku tshiebe dîba dionso diudi umvua mupuya, utua mishiku anyi useka** bua kupangisha mushiku webe bua kukangula bikole.

Malu adi apetangana¶

• Malu a tshimpitshimpi a meno ne dilama dia meno adi manyanguke
• Diambuluisha dia kumpala dia dikuma ne dikanga dia njila wa luya
• Mputa ku mutu ne disama dia mutshima
• Disama dia mukolo ne dibenga kuenza mudimu

Miaba ne buludiki bua mbulamatadi¶

• American College of Surgeons (ACS, United States) Committee on Trauma: Advanced Trauma Life Support (ATLS) Student Course Manual (Maxillofacial trauma positioning way airway, flail mandible tongue traction, contraindication of nasopharyngeal/nasogastric tubes in cribriform plate/fad fracture and hemr or frage).
• Tshisumbu tshia bena Amerike tshia baminganga ba mukana ne ba ku mpala (AAOMS, États-Unis): Malu adibu ne bua kuenza: Mikenji ya mudimu wa dipanda dia mukana ne wa ku mpala (Dilama dia disama dia mukana ne dia mpala).
• Tshisumbu tshia bena Grande-Bretagne tshia baminganga ba mukana ne ba ku mpala (BAOMS) ne Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bantu (NICE, Royaume-Uni): Disama dinene: Dikonkonona ne diondopangana dia kumpala (NG39) ne Diondopangana dia lukasa dia mashi adi apatuka mu mpala ne dipangisha dia njila wa luya.
• European Resuscitation Council (ERC) ne European Association for Cranio-Maxillo-Facial Surgery (EACMFS): Mibelu ya dilama dia njila ya luya mu mputa ya mpala ne mpala.
• American College of Emergency Physicians (ACEP, United States): Clinical Procedures in Emergency Medicine: Reduction of Temporomandibular Joint Dislocation (Syringe-Roll, Extraoral, and Intraoral Techniques) and Tongue Blade Bite Test Validation.