Chibwano Choduka, Pakamwa Lotseguka, ndi Chithandizo Chachikulu cha Maxillofacial Fracture Airway Care¶

Kaya nsagwada za m'munsi mwa munthu zimakhala zotseguka kwambiri pambuyo pa kuyasamula kwakukulu kapena ulendo wa mano (Acute Temporomandibular Joint [TMJ] Dislocation), kapena nsagwada zawo zam'munsi ndi pakati zimasweka chifukwa cha ngozi ya galimoto, kumenyedwa, kapena kugwa (Bilateral Mandibular "Flail Jaw" Fracture, kapena # Le Fort1) Chiwopsezo chanthawi yomweyo kumoyo ndi **kutsekeka kwapanjira yam'mwamba yam'mwamba . Chifukwa lilime laumunthu limakhazikika kutsogolo kutsogolo kwa nsagwada za m'munsi ( mandibular symphysis ), kupasuka kumbali zonse za chibwano kumapangitsa kuti fupa lonse la kavalo ndi lilime ligwe molunjika kumbuyo kwa mmero pamene wovulalayo akugona kumbuyo kwake ( glossoptosis **). Choipa kwambiri, nsagwada zam'mwamba zosweka (Le Fort fractures) zimang'amba nthambi za mtsempha wamkati wamkati, kuthira magazi, kutsekeka kwa magazi, ndi mano ogwetsera mu trachea ngati wodwalayo wamangidwa cham'mwamba pamsana. Ngati wina wavulala kumaso kapena nsagwada ali ndi phokoso kapena kupuma mokokomeza, kutuluka magazi kwambiri m'kamwa ndi m'mphuno, kapena nsagwada zili zotseguka, imbani foni nambala yanu yazadzidzi nthawi yomweyo. manambala angozi. Onaninso chisamaliro chokhudzana ndi zoopsa mu matenda adzidzidzi ndi mano ong'ambika, kuvulala m'mutu ndi kugwedezeka,ndi kuvulala kwa msana ndi immobilization.

Chitani izi tsopano¶

1. Musakakamize wodwala wachibwano chakumunsi kwambiri kapena wothyoka pakati kuti agone chagada chagada (chapamwamba). Ngati wodwala maso wosweka nsagwada kapena nkhope yotuluka magazi akumenyera kukhala tsonga ndi kutsamira kutsogolo, asiyeni akhale molunjika atatsamira kutsogolo kotero mphamvu yokoka imakokera lilime lawo kutsogolo ndikulola magazi, malovu, ndi kutuluka m'kamwa m'kamwa mwake.
2. Ngati wodwalayo sakudziwa kapena akufunika kugwedezeka kwa msana, ikani mu Lateral Trauma Recovery Position (yopindika pambali pawo ndi kukhazikika kwa khosi) kapena kukokera lilime lawo ndi nsagwada zapansi nthawi yomweyo. Kuyika munthu wosazindikira ndi kusweka kwa mandibular kapena Le Fort III pakati pa nkhope yophwanyika mkati mwa lirime lakumbuyo kumapangitsa kuti lirime losasunthika likhale lopanda kuthandizira. masekondi.
3. Imbani foni nambala yanu yazadzidzi nthawi yomweyo (911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom) chifukwa cha kuvulala kulikonse kwamphamvu kumaso, kuthyoka kwa nsagwada, kapena kusweka nsagwada zomwe sizingatseke.
4. Yang'anani m'kamwa nthawi yomweyo ndikusesa magazi omwe akutuluka magazi otuluka, mano oduka, mano osweka, kapena masanzi pogwiritsa ntchito chala chopukutidwa kapena kuyamwa. Mano ogogoda ndi zidutswa za mano osweka a acrylic zomwe zimakhala m'madzi ambiri m'kamwa zimakokera m'mphuno (tracheobronchial aspiration yotsatira). Sungani mano osatha ochotsedwa mu mkaka wozizira kapena saline (onani zadzidzidzi zamano).
5. Ngati wodwala amene nsagwada zake zatsekedwa ndi zingwe (Maxillomandibular Fixation [MMF]) kapena zomangika zolimba pambuyo pa opaleshoni ya nsagwada wayamba kusanza kapena kutsamwitsidwa:
6. Akhazikitseni mowongoka ndikuweramitsa mutu wawo patsogolo nthawi yomweyo kuti masanzi amadzimadzi azitha kutuluka pamipata yakuseri kwa mano awo akumbuyo komanso m'mphuno.
7. Pokhapokha ngati sangathe kukonza njira yawo yolowera mpweya, akusanduka buluu, kapena akukomoka: Gwiritsani ntchito zodulira mawaya adzidzidzi kapena masing'anga ovulala kwambiri (omwe amayenera kulumikizidwa ku bedi lachipatala la wodwalayo kapena kunyamulidwa m'thumba la malaya awo nthawi zonse) kuti mudutse mawaya* opindika opingasa kapena mawaya apakati kapena mphira-NDI-ZONKHULA pakati pa mipiringidzo ya m'mwamba ndi m'munsi (osataya nthawi kuyesa kudula mawaya opingasa atakulungidwa pamano okha).
8. Kwa "nsagwada Yotsekedwa Yotsekedwa" yopanda ululu kapena yopweteka mutatha kuyasamula, kuseka, kapena kusanza (Acute Anterior TMJ Dislocation with zero trauma): Thandizani pansi pa nsagwada zapansi pang'onopang'ono ndi manja anu kapena chopukutira chofewa, gwiritsani ntchito compress yotentha pamasaya kutsogolo kwa makutu kuti muchepetse kugwedeza kwa masseter** yesetsani kuti muchepetse kugwedeza kwa minofu * amathyola khosi la condylar), ndikupita ku Dipatimenti Yadzidzidzi kuti muchepetse ** Syringe-Roll kapena Bimanual Reduction **.
9. Yang'anirani dzanzi la mlomo wam'munsi ndi chibwano, ndipo muwone ngati mano akumbuyo akumana bwino. Ngakhale kunja kwa nkhope kumawoneka ngati kutupa pang'onopang'ono pambuyo pa nkhonya kapena kugwa, kumverera kuti mano anu salinso pamzere pamene mukuwakhudza pang'onopang'ono (**malocclusion *, chizindikiro chimodzi chodziwika kwambiri cha kuthyoka kwa nsagwada) kapena kumva dzanzi m'munsi mwa mphuno * ya m'munsi zimatsimikizira kuti mandible yasweka.

Mtengo wachigamulo: Kuwongolera ndege ndi kuyesedwa kosiyana kwa kusuntha kwa nsagwada motsutsana ndi fractures ya nkhope¶

flowchart TD
    Start["Chisawawa Chachikulu / Kuvulala Kwankhope KAPENA Kulephera Kutseka Pakamwa Mwadzidzidzi ('Chibwano Chotsekeka')"] --> AirwayFirst{"CHOCHITA 1: Yang'anani Patency ya Airway & Mechanism: Kodi pali kupwetekedwa kwamphamvu kwamphamvu, kutuluka magazi m'kamwa / m'mphuno, kugwedeza / kugwedeza, kapena nsagwada zosakhazikika?"}

    AirwayFirst -->|"INDE: Kuvulala Kwambiri Kwankhope, Kutuluka magazi, kapena Stridor / Gurgling"| PositionAirway["POSITIONAL AIRWAY POSITIONAL RESCUE: 1. Itanani 911 / 112 / 999 Nthawi yomweyo. 2. Ngati Mdzuka: Khalani IMODZI motsamira kukhetsa magazi & sungani lilime patsogolo. 3. Ngati Wopanda Chidziwitso: Lowani pa SIDE (Lateral Trauma Position) yokhala ndi mzere wa C-msana + kukoka lilime/chibwano patsogolo. 4. ZERO machubu amphuno."]

    PositionAirway --> FractureType{"Dziwani Zambiri Zachiwopsezo Chachiwopsezo cha Maxillofacial Fracture Pattern"}

    FractureType -->|"Chibwano Cham'munsi Chomasuka M'mbali Zonse ziwiri + Lilime Lobwerera Mmbuyo + Pansi Pakamwa Pakamwa"| FlailMandible["BILATERAL MANDIBULAR ('FLAIL / BUCKET-HANDLE') KUPWUKA: Kokani gawo lakunja la chibwano/lilime patsogolo pamanja kapena ndi chodulira chopukutira/chokokera; konzekerani njira yodzidzimutsa yodzidzimutsa kapena opaleshoni yapanjira (cricothyrotomy)."]

    FractureType -->|"Chibwano Cham'mwamba / Pakati Pam'manja Mukakoka Mano Pamwamba Pamwamba + Mphuno Yambiri/Kutuluka Kutuluka Kutuluka Pakhosi"| LeFortPath["LE FORT I, II, OR III MIDFACE FRACTURE: Khalani mowongoka/mombali; anterior/posterior mphuno baluni kulongedza + Buku kuchepetsa palatal ngati mkati maxillary mtsempha wamagazi kukha mwazi; fufuzani CSF rhinorrhea."]

    AirwayFirst -->|"PALIBE Zopweteka kapena Mphamvu Zochepa (Kuyasamula, Kuseka, Mayeso a Mano, Kusanza, kapena Mankhwala Oletsa Kusokoneza Maganizo): Pakamwa Pakamwa Pang'onopang'ono"| TMJCheck{"CHOCHITA CHACHIWIRI: Unikani 'Pakamwa Lotseguka' Osavulaza: Kodi Mambali Onse Awiri Amakhala Ofanana Kapena Chin Chasunthidwa Kumbali Imodzi?"}

    TMJCheck -->|"Mouth Locked Wide Open Centered (Bilateral) OR Chin Chapatukira Mbali Yotsutsana (Unilateral) + Dzenje Lopanda Kutsogolo kwa Khutu"| AnteriorTMJ["KUSINTHA KWA ACUTE ANTERIOR TMJ: 1. Yang'anirani Dystonia Yopweteka Kwambiri Yotchedwa Drug-Induced Acute Dystonia (haloperidol, metoclopramide -> perekani IV diphenhydramine / benztropine). 2. Pitani ku dipatimenti ya Emergency Department for Syringe-Roll ('Hands-Free') kapena Bimanual Hippocratic Reduction."]

    TMJCheck -->|"Mbiri Yankhonya / Kugwa + Mano Osadulira (Malocclusion) + Nambala Yam'munsi Milomo + Pansi-pa Mlomo Hematoma"| SimpleMandible["MANDIBULAR OR CONDYLAR FRACTURE: 1. Musayese kuchepetsa TMJ pamaso pa CT / Panorex X-ray. 2. Yalephera 'Blade Bite Test'; imafuna Emergency Department CT, maantibayotiki a IV (kuthyoka kotsegula kudzera pazitsulo za dzino), & kukonza kwa maxillofacial."]

Condition 1: Acute Temporomandibular Joint (TMJ) Dislocation (The "Locked-Open Jaw")¶

Anatomy: Momwe mandibular condyle imatsekeredwa kutsogolo kwa kutchuka¶

The ** temporomandibular joint (TMJ)** ndi cholumikizira cha hinge-ndi-glide pomwe mpira wozungulira kumbuyo kwa nsagwada zam'munsi (** mandibular condyle **) umakhala mkati mwa socket yozama m'munsi mwa chigaza kutsogolo kwa ngalande ya khutu (**the glenoid fossa **). Kutsogolo kwa soketiyo pamakhala phiri losalala la fupa lotchedwa ** kukongola kwa fupa lanthawi yayitali **: 1. Kutsegula Pakamwa Kwachizolowezi: Mukatsegula pakamwa panu pang'ono, kondomuyo imazungulira ngati hinji mkati mwa soketi yake. Mukatsegula kwambiri kuti muyasamule kapena kuluma sangweji wandiweyani, minofu ya lateral pterygoid imakokera kondomu kutsogolo kumtunda wakumbuyo kwa articular eminence, ndipo imabwereranso muzitsulo zake mukatseka pakamwa panu. 2. Anterior TMJ Dislocation (95% of TMJ Dislocations): Panthawi yotsegula kwambiri pakamwa, monga kuyasamula kwambiri, kuseka mokweza, kuchotsa mano kwa nthawi yayitali, kusanza, kugwidwa, kapena laryngoscopy, mandibular condyle slides kutsogolo kwambiri, kulumphira pamwamba pa nsonga yam'mwamba. 3. **Chifukwa Chakehibwano Sichingathe Kutseka Pachokha (Msampha wa Masseter Spasm): Nthawi yomwe condyle imatsetsereka kutsogolo kwa nsonga yarticular eminence, minofu yotseka nsagwada (**masseter, temporalis, ndi medial pterygoid **) imalowa m'malo opweteka oteteza. M'malo mokokera nsagwada cham'mbuyo muzitsulo zake, minofu yomwe ikugwedezeka imakoka kondomu yowongoka M'MWAMBA pamwamba pa nsonga ya articular eminence, ndikutseka nsagwada motsegula.

Bilateral vs. Unilateral Anterior TMJ Dislocation (Zowoneka Zowoneka)¶

• Bilateral Anterior TMJ Dislocation (Yodziwika Kwambiri): Ma condyle akumanzere ndi kumanja amalumphira kutsogolo kuchokera m'mabokosi awo. Pakamwa pamakhala lotseguka mokulirapo (\(3\mawu{mpaka }5\mawu{centimeters}\) pakati pa mano akutsogolo), nsagwada ya m'munsi imalowera kutsogolo (maonekedwe a prognathic), munthuyo amamezera malovu, amalankhula mawu osamveka, ndipo ali dzenje lamphako lomwe limamveka kutsogolo kwa makutu onse awiri.
• Unilateral Anterior TMJ Dislocation: Kondomu Imodzi yokha ndiyo imalumpha kutsogolo kuchokera muzitsulo zake. Pakamwa pamakhala potsegula, NDIPO chibwano chimawoneka cholunjika mbali YOTSWIRIRA (yathanzi).
• Kusiyanitsa ndi Kuthyoka kwa Khosi la Condylar:
  • Unilateral TMJ Dislocation: Chin imapatuka **KUCHOKERA kumbali yovulala ** (kumbali yathanzi), ndipo pakamwa pamakhala wokhoma **otseguka **.
  • Unilateral Mandibular Condylar Fracture: Chin imapatuka KUNJILA mbali yovulala (yosweka) ikatsegula pakamwa.

Nthawi Zonse Pewani Mankhwala Osokoneza Bongo Acute Oromandibular Dystonia (The Great TMJ Mimic)¶

Musanaganize kuti nsagwada zotseguka kapena zopindika zimangochitika mwangozi, funsani kuti: “Kodi wodwalayo wamwa mankhwala oletsa nseru, mankhwala oletsa kusokoneza maganizo, kapena mankhwala apamsewu mkati mwa maola 24 mpaka 72 apitawa?” - Mankhwala omwe amalepheretsa dopamine D2 receptors, makamaka **metoclopramide (Reglan), prochlorperazine (Compazine), promethazine (Phenergan), haloperidol (Haldol), risperidone, olanzapine, kapena aripiprazole **, akhoza kuyambitsa *acute extrapyramidal dystonic reaction (oromandibular) dystonia. - Chimene Chimachitika: Kugundana kosagwirizana ndi pterygoid, lilime, ndi khosi kumakoka nsagwada momasuka kapena cham'mbali (nthawi zambiri kumachotsa TMJ kachiwiri), limodzi ndi kutuluka kwa lilime kapena kukweza maso m'mwamba (oculogyric crisis). - Machiritso Adzidzidzi: Kupereka Mtsempha kapena Mumuscular Diphenhydramine (\(25\text{ mpaka }50\text{mg}\)) kapena Benztropine (\(1\text{ to }2\text{mg}\) IV/IM) kumaphwanya kugwedeza kwapakati mkati mwa 5 mpaka 15 mphindi kulowa mmbuyo, nthawi zambiri kugwedezeka.

Njira Zochepetsera Zipatala za Anterior TMJ Dislocation¶

*(Lamulo la Thandizo Loyamba: Osamenya nkhonya, mbama, kapena kukankhira kutsogolo kwa chibwano chotembenuzidwa m'mwamba, chomwe chingathyole khosi la condylar. Kuchepetsa kumafuna kusuntha mano a m'mbuyo *KUPANDA poyamba ** kuti achotse nsonga ya articular eminence, ndiyeno kutembenukira chammbuyo).

1. Njira Yosasokoneza "Hands-Free" ya Syringe-Roll (Njira Yamakono Yofulumira & Yosawawa Kwambiri, 95%+ Kupambana):
2. Palibe kulowetsedwa mtsempha komanso zala zazikulu za dotolo mkamwa zomwe zimafunikira.
3. Sing'anga amayika pulasitiki 5-millilita kapena 10-mililita mbiya ya syringe mopingasa pakati pa mano a msana wam'mbuyo ndi wam'mbuyo wa wodwalayo kumbali yomwe yasokonekera.
4. Wodwala amaluma mbiya ya syringe pang'onopang'ono ndi **kugudubuza syringe kutsogolo ndi kumbuyo pakati pa mano awo akumbuyo ngati pini yogudubuza **.
5. Mmene Imagwirira Ntchito: Kuluma pa mbiya ya syringe kumaigwiritsa ntchito ngati Kalasi I fulcrum kulondolera kumbuyo kwa nsagwada pansi kwinaku akugudubuza kondomu cham'mbuyo pamwamba pa chitsulo chachitsulo mkati mwake mkati mwa 60 mpaka masekondi 120.
6. Njira Yowonjezera: Kumbali imodzi, dokotala amakoka njira ya coronoid kumbuyo kunja kwa tsaya kwinaku akukankhira kondomuyo mofatsa, kupewa kuyika zala mkamwa.
7. Classic Intraoral Bimanual (Hippocratic) Reduction (Ndi Local TMJ Lidocaine Block kapena Sedation):
8. Dokotala amakulunga zala zala zala zazikuluzikulu, amamangirira mutu wa wodwalayo molimba pakhoma, amayika zala zazikulu zonse pa mitsinje yam'munsi yam'mbuyo (mzere wakunja wonyezimira), amakulunga zala pansi pa chibwano, amakankhira ** mwamphamvu PASI pa molars wakumbuyo ** kuti atsegule condyle pansi pa eminence ndikukweza pang'ono nsagwada. BWINO.
9. Chisamaliro cha Pambuyo Pochepetsa: Ikani zokulunga kumutu kofewa, tsatirani zakudya zofewa zosatafuna kwa masiku 7 mpaka 10, ndipo nthawi zonse ikani chibakera pansi pa chibwano nthawi zonse mukamayasamula kuti pakamwa musatsegule mokulirapo kuposa 2 centimita.

(Zindikirani pa Rare Superior and Posterior TMJ Dislocations: Ngati kugunda kwamphamvu kwamphamvu kugunda pachibwano, kondomu imatha kuthamangitsidwa POPWARD kulowa mkati mwa cranial fossa [Superior Dislocation] kapena KUBWERA mu ngalande ya khutu [Posterior Dislocation, kuchititsa khutu kutuluka magazi]. zizindikiro; kupeza CT scan yomweyo).

Chikhalidwe 2: Mandibular Fractures ndi Lethal "Flail / Bucket-Handle" Chibwano¶

Chifukwa Chake Mandible Amasweka M'malo Awiri Nthawi Imodzi (Lamulo la "Ring Bone")¶

Chibwano cham'munsi (** mandible**) ndi fupa lolimba lopangidwa ndi U-lomwe limamangiriridwa ku chigaza mbali zonse ziwiri za temporomandibular, kupanga mphete yotsekedwa ya biomechanical: - Lamulo la mphete yachipatala: Monga cholimba cholimba kapena mafupa a chiuno, **simumathyola mphete yolimba pamalo amodzi **. Kuposa ** 50 peresenti ya ma fractures onse a mandibular ndi apakati kapena angapo ** (mwachitsanzo, nkhonya yakumanja ku nsagwada imayambitsa kupasuka pa ** thupi lamanja la mandibular / parasymphysis ** molunjika pansi pa nkhonya NDI chigawo chachiwiri chotsutsana ndi kuphulika kwa ** kumanzere kwa mandibular kapena kumanzere kwa subcondylar khosi ** kumbali ina). - Nthawi zonse kuthyoka kumodzi kumapezeka mu mandible, madokotala ayenera kusaka fracture yachiwiri kumbali inayo.

Momwe Kuphwanyidwa kwa Mandibular Pawiri Kumachititsa Kupuma ("The Flail Mandible")¶

Minofu yayikulu kwambiri ya lilime la munthu (** genioglossus muscle , yomwe imakoka lilime patsogolo kuti pakhale njira yotsegula mpweya) imamangiriza ku mitsempha yaing'ono yaing'ono ( genial tubercles ) mkati mwa kumbuyo kwa fupa lakutsogolo la chibwano ( mandibular symphysis ): - Ngati kumenyedwa, kugunda kwa chiwongolero, kuwombera mfuti, kapena kugwa kuthyola nsagwada za m'munsi ** kumbali yakumanzere ndi kumanja kwa chibwano ** (a bilateral parasymphyseal kapena kuthyoka kwa thupi la "chidebe"), chidutswa chapakati cha chibwano chomwe lilime chimamangirira tsopano sichimalumikizana ndi chigaza chonsecho. - Zomwe Zimachitika Wodwala Akagona Pansi Pambuyo Pawo: Nthawi yomwe odwala opaleshoni kapena oimirira amagoneka wodwala ndi fracture ya mandibular kumbuyo kwawo, mphamvu yokoka ndi kutsika kwa minofu ya mylohyoid ndi geniohyoid kukoka komwe kunadula fupa lapakati la chibwano ndi tsinde lonse la lilime molunjika kumbuyo kapena kutka kumbuyo kwa khoma (acute mechanical glossoptosis). - **Kulumutsidwa Mwamsanga Kupulumutsa Moyo: 1. **Mukhazikitseni wodwalayo mowongoka ndi ksamira kotero mphamvu yokoka imakoka gawo la chiano ndi lilime kutsogolo kuchokera kukhosi. 2. Mwa wodwa chikomokere kapena wapampando: Musati osadalira kupendekera kumutu kwanthawi zonse (komwe sikumachita kalikonse pamene chibwano chachotsedwa ku chigaza). Gwirani **mano apansi akuogolo ndi chidutswa cha fupa la chibwano molunjika ndi dzanja lokhala ndi golovu (kapena kukulunga chopyapyala kuzungulira lilime lokha) ndi **kokerani gawo lapakati la chibwano chosweka ndi lilime molunjika PATSOGOLO (pambuyo pake) chadenga. M'malo otsitsimula, madokotala ochita opaleshoni amadutsa silika wandiweyani kapena chopukutira chopukutira kupyola lilime lapakati kapena kuzungulira symphysis kuti apitirire patsogolo mpaka njira ya mpweya ilowetsedwe kapena opaleshoni ya cricothyrotomy ikuchitika.

Zizindikiro Zam'mphepete mwa Bedi Za Kuthyoka Kwa Mandibular (Ndi "Kuluma Kwa Lilime")¶

Yang'anani wodwala aliyense yemwe wavulala kumaso chifukwa cha izi Zizindikiro Zisanu Zam'mbuyo za Chibwano Chosweka: 1. Subjective Malocclusion (Chizindikiro Chovuta Kwambiri): Funsani wodwala mofatsa kuti: "Mukabweretsa mano pamodzi mopepuka, kodi kuluma kwanu kumamveka bwino, kapena mano ena amagunda mofulumira kwambiri?" Mano aumunthu ali ndi mitsempha ya neuroreceptor yomwe imamva kusintha kosakwana 0.1 millimita; ngati wodwalayo akunena kuti kuluma kwake kumamveka "kuchoka," nsagwada imasweka mpaka kutsimikiziridwa mosiyana ndi CT. 2. Sublingual Hematoma (Chizindikiro cha Pathognomonic): Funsani wodwalayo kuti akweze nsonga ya lilime lake padenga la pakamwa pake ndikuyang'ana pansi pakamwa pansi pa lilime. Wakuda wofiirira kapena wofiira ** kuvulala (ecchymosis) kapena hematoma yokwezeka pansi pakamwa ** ndi pafupifupi 100 peresenti yodziŵitsa za thupi la pansi la mandibular kapena symphyseal fracture. 3. Kutsika kwa Milomo ndi Kumabwinja kwa Chin (Inferior Alveolar / Mental Nerve Anesthesia): Mitsempha ya m'munsi ya alveolar imayenda mkati mwa fupa la fupa lomwe lili pakati pa nsagwada za m'munsi musanatuluke pachibwano. Kuthyoka kupyola mu ngodya, thupi, kapena parasymphysis kumatambasula kapena kumadula mitsempha iyi, kusiya theka la mlomo wam'munsi ndi chibwano zanzi. 4. Kutsika kwa Gingival ndi Kutuluka Magazi Pakati pa Mano: Mpata woonekera wa masitepe kapena kung'ambika kwa chingamu pakati pa mano awiri akumunsi. *(Lamulo Lofunika Lopatsira Matenda: Chifukwa chakuti malo a periodontal ligament kuzungulira dzino lililonse amalumikizana mwachindunji ndi nsagwada zapansi, KUthyoka kulikonse kwa mandibula komwe kumadutsa gawo lobala dzino kumakhala OKUSEGUKA (COMPOUND) PHACTURE pokumana ndi mabakiteriya a malovu, omwe amafunikira amptacinous antibacterial ampicillin kapena antibayotiki ya mtsempha. 5. Kuyesa Kuluma Lilime (95% Negative Predictive Value in Clinical Studies): Ngati wodwala akumva kupweteka pang'ono kwa nsagwada ndi mano ooneka ngati abwinobwino, dokotala wachipatala amaika chopondereza lilime chamatabwa kukhala chophwanthira pakati pa minyewa yakumanzere, ndikumauza wodwalayo kuti alume mwamphamvu, ndikupotoza chitsulocho. Ngati wodwalayo akhoza kuluma mokwanira ** kumanzere ndi kumanja ** kuti adokotala akhoza kuthyola lilime lamatabwa pakati pa theka mwa kulipotoza, kuphwanya kwakukulu kwa mandibular kumachotsedwa ndi $ 95 \% $ yotsimikizika.

Chikhalidwe 3: Le Fort I, II, ndi III Midface Fractures¶

Pakuwombana kwa magalimoto othamanga kwambiri, kuwonongeka kwa njinga zamoto, kuwonongeka kwa mafakitale, kapena kugwa koopsa, mphamvu yosasunthika yomwe imagunda pakati pa nkhope imasweka maxilla (nsagwada zakumtunda), mafupa amphuno, ma orbits, ndi mbale za pterygoid za fupa la sphenoid pamodzi ndi mizere itatu yofooka yofowoka yofotokozedwa ndi French surgeon.

Kuyerekeza kwachipatala kwa Le Fort I, II, ndi III fractures¶

Kuwongolera Mwadzidzidzi kwa Torrential Maxillofacial Bleeding ndi CSF Leak Recognition¶

1. Chifukwa Chake Le Fort Fractures Imatulutsa Magazi Mochuluka: Pakatikati amaperekedwa ndi mtsempha wamkati wamkati wamkati (nthambi yayikulu yomaliza ya mtsempha wakunja wa carotid womwe ikuyenda kuseri kwa mbale zosweka za pterygoid) ndi mtsempha wapambuyo/wombuyo wa ethmoidal (kuchokera mkati mwa carotid). Pamene kuthyoka kwa Le Fort II kapena III kuphwanya chigawo chakumbuyo kwa maxilla, magazi amatuluka nthawi imodzi kuchokera m'mphuno zonse ziwiri ndikulunjika kumbuyo kwa mmero, ndikudzaza m'mimba mwachangu komanso njira yodutsa mpweya.
2. Pre-Hospital / ER Hemorrhage Control: Khalani pansi wodwalayo mowongoka ndikutsamira patsogolo ngati ali maso, kapena pamalo ochiritsira pambuyo pake ngati sakudziwa. Kachubu kamene kamakhala pakamwa kapena opaleshoni ya cricothyrotomy ikateteza njira yodutsa mpweya, madokotala odzidzimutsa amaika ** baluni awiri kumbuyo / kutsogolo kwa mphuno epistaxis catheters (kapena Foley catheters) *, sungani pakamwa ndi pharynx molimba ndi yopyapyala motsutsana ndi kukhazikika kwa mandible, ndi kukokera pamanja fupa la maxidug kuchedwetsa kung'ambika kwa mtsempha) kwinaku akuyambitsa ma radiology a transcatheter arterial embolization.
3. Mmene Mungadziwire Kutuluka kwa Cerebrospinal Fluid (CSF) Kusakanikirana ndi Magazi a M'mphuno:
4. Pakuthyoka kwa Le Fort II kapena III, madzi owoneka bwino cerebrospinal fluid akutuluka kuchokera ku nembanemba yong'ambika padenga la mphuno amasakanikirana ndi magazi.
5. Zizindikiro: Wodwalayo amawona kudontha kwamadzi** kwachitsulo kapena kwamchere komwe kumadutsa kumbuyo kwa mmero wake akakhala mmwamba, kapena madzi omveka bwino akuchucha mofulumira kuchokera kumphuno akamatsamira kutsogolo. Ngati dontho lamadzi am'mphuno lamagazi ligwera pa pillowcase yoyera kapena pepala lopyapyala, CSF yamadzi owoneka bwino imasunthira kunja mwachangu kuposa maselo ofiira amagazi, ndikupanga mphete yonyezimira yachikasu-pinki kuzungulira pakati pamagazi (chizindikiro cha "Halo" kapena "Double-Ring"; chotsimikiziridwa mu labu yachipatala kudzera kuyesa kwa Beta-2 Transferrin).
6. Lamulo Lothandizira Loyamba la CSF Rhinorrhea: Musamange mphuno mwamphamvu kunyumba, musawombe mphuno, ndipo musayese kumangitsa mphuno kuti madzi otuluka asatuluke. Kutsekereza kuchucha kwa CSF kumapangitsa kuti mabakiteriya a m'mphuno aipitsidwe m'mwamba kudzera mu misozi yapakati kulowa muubongo, kuchititsa imfa bacterial meningitis pneumocephalus**). Gwirani momasuka madzimadzi akudontha pa chotchinga chopyapyala chomangidwa pansi pa mphuno.

Zochitika Zapadera: Chisamaliro Chadzidzidzi kwa Odwala Okhala Ndi Mawaya Nsagwada (Maxillomandibular Fixation)¶

Odwala omwe akuchira ku mandibular kapena opaleshoni ya Le Fort fracture nthawi zambiri amabwerera kunyumba kwa 2 kwa masabata a 6 ndi zitsulo mipiringidzo yokhotakhota yolumikizidwa kumtunda wawo wam'munsi ndi m'munsi ndipo imagwirizanitsidwa pamodzi ndi mawaya achitsulo osapanga dzimbiri kapena magulu olemera a mphira a orthodontic (Maxillomandibular Fixation [MMF]).

Protocol ya Kusanza ndi Kutsamwitsa kwa Odwala a Wired-Jaw¶

1. Chifukwa Chake Kusanza Nthawi zambiri Simafunika Kudula Mawaya Mokha: Masanzi amadzimadzi ndi asidi wa m'mimba amatha kudutsa m'mipata ya kumbuyo kwa molars wam'mbuyo (the retromolar trigone), pakati pa mano, ndi m'mphuno ** NGATI wodwala amakhala nthawi yomweyo mowongoka ndikuweramitsa mutu ndi torso patsogolo pa sinki kapena beseni**. Wodwala aliyense wa nsagwada za mawaya ayenera kupatsidwa mankhwala amkamwa kapena osungunuka ang'onoang'ono ondansetron (Zofran) kunyumba kuti apewe nseru isanayambe.
2. Lamulo Loyenera Lodula Waya: Wodwala aliyense amene ali ndi mawaya osapanga dzimbiri a intermaxillary amayenera kunyamula zodulira mawaya odzipatulira (kapena sheya zotchingira zolemetsa) pansalu yozungulira khosi, m'thumba, kapena zojambulidwa kumutu kwa bedi lawo maola 24 patsiku.
3. Komwe Mungadutse Pangozi Yowopsa ya Msewu Wapamlengalenga: Ngati wodwala chibwano cha waya apuma masanzi olimba, sangathe kuchotsa njira yake yolowera m'mwamba, akusanduka buluu (buluu), kapena kukomoka:
4. Kokani milomo yakumtunda ndi yakumunsi motalikirana kuti muwonetse zitsulo zotchingira mkamwa.
5. **Dulani mawaya ofukula OKHA (kapena magulu a rabala) omwe akuthamanga Mmwamba-NDI-PANSI pakati pa nsagwada zakumtunda ndi zapansi ** (nthawi zambiri mawaya 2 mpaka 3 kumanzere ndi malupu 2 mpaka 3 kumanja).
6. OSATI kuyesera kudula mawaya opingasa okulungidwa pansi pa mano amodzi, omwe samatseka nsagwada. Mitsempha yoyima ikadulidwa, nsagwada zapansi zimatseguka nthawi yomweyo.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911. Pansi pa ACS ATLS ndi AAOMS ma protocol a trauma, maxillofacial trauma with airway compromise amanyamulidwa molunjika/kutsamira kutsogolo (ngati ali maso ndi c-spine achotsedwa) kapena ndi kuyamwa ndi kuima kutsogolo kupita ku Trauma Center yokhala ndi kanema laryngoscopy ndi cricothyrotomy ya opaleshoni.
• United Kingdom: Imbani 999 (kapena 112). Tsatirani **Resuscitation Council UK **, NICE Major Trauma (NG39), ndi BAOMS malangizo a maxillofacial hemorrhage control, kupewa mphuno ya mpweya mu chigaza cha chigaza, ndi kuchepetsa TMJ.
• European Union: Imbani 112. Tsatirani ERC ndi EACMFS malangizo amtundu wa trauma.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand. Tsatirani ndondomeko za ANZCOR ndi ANZAOMS.
• India ndi Asia-Pacific: Imbani 112 ku India, 119 ku Japan ndi South Korea, kapena 995 ku Singapore. Pa ngozi za njinga zamoto zophatikizika ndi mandibular ndi Le Fort fractures, sungani wovulalayo atatsamira kutsogolo kapena kumbali yawo panthawi yoyendetsa kuti magazi amkamwa atuluke kunja.

Mwaona manambala angozi manambala onse otumizira mwadzidzidzi padziko lonse lapansi.

Mafunso omwe amafunsidwa pafupipafupi¶

Chifukwa chiyani loko ya nsagwada yanga idatseguka kwambiri nditayasamula kwambiri, ndipo bwanji sindingathe kukankhira chibwano changa kuti nditseke?¶

Mukatsegula pakamwa panu mozama kwambiri panthawi yoyasamula, kuseka, kapena mano, mpira wozungulira kumbuyo kwa nsagwada zanu zam'munsi (** mandibular condyle **) umayenda pamwamba pa nsonga ya phiri lomwe lili kutsogolo kwa thumba la khutu lanu (** the articular eminence **). Nthawi yomweyo, minofu yam'masaya anu (**masseters**) imagwedezeka ndikukokera kondomu m'mwamba kutsogolo kwa phiri la mafupa, ndikuligwira. Kuyesera kukankhira kutsogolo kwa chibwano chanu molunjika kumapangitsa kuti fupa likhale lolimba kwambiri paphiri; adotolo ayambe akanikizire **mano ammbuyo kunsi** (kapena mutembenuzire syringe mbiya pakati pa minyewa yakumbuyo) kuti muchotse fupa la fupalo nsagwada zisanalowe cham'mbuyo muzitsulo zake.

Kodi mapiritsi oletsa nseru ngati Reglan kapena Compazine angapangitse bwanji nsagwada zanga kusweka?¶

Mankhwala oletsa nseru monga metoclopramide (Reglan) ndi prochlorperazine (Compazine), komanso antipsychotic mankhwala monga haloperidol kapena risperidone, amalepheretsa dopamine receptors mu basal ganglia ya ubongo. Mwa anthu ena, makamaka ana, achinyamata, ndi achikulire, izi zimayambitsa kugunda kwa minofu mwadzidzidzi komwe kumatchedwa **acute dystonic reaction (oromandibular dystonia)**, kumene minofu ya pterygoid imakoka nsagwada mwamphamvu motsegula kapena chammbali. Kulowetsa mtsempha wa **diphenhydramine (Benadryl) kapena benztropine** m'chipinda chodzidzimutsa kumapangitsa kuti minofu ikhale yochepa.

N’chifukwa chiyani kumugoneka munthu chagada chagada pa machira kuli koopsa kwambiri pamene nsagwada za m’munsi zathyoka mbali zonse ziwiri?¶

Lilime lanu limakhazikika kumbuyo kwamkati kumbuyo kwa chibwano chanu chakutsogolo (** mandibular symphysis **). Nthawi zambiri, chibwano cholimba cha nsagwada zanu zam'munsi chimagwira chibwano chanu ndi lilime patsogolo kutali ndi chitoliro chanu. Pamene nsagwada ya m'munsi yathyoledwa mbali zonse za chibwano (** a mayiko awiri "flail" kapena "ndowa-chogwirira" fracture **), kutsogolo chibwano chidutswa amachotsedwa. Kugoneka wovulalayo chagada kumapangitsa mphamvu yokoka kugwetsa chidutswa cha chibwano chosweka ndi lilime molunjika kukhosi, kumawafooketsa pokhapokha atakhala atatsamira kutsogolo kapena wina akukoka chibwano ndi lilime patsogolo.

Kodi nchifukwa ninji nsagwada iliyonse yothyoka pamene m'kamwa mukutuluka magazi pakati pa mano awiri imakhala ngati "kuthyoka kwapawiri"?¶

Ngakhale khungu lakunja la tsaya ndi chibwano chanu lili ndi ziro, thumba la microscopic ligament kuzungulira muzu wa dzino lililonse (**the periodontal ligament**) limalumikizana mwachindunji ndi fupa la nsagwada. Nthawi zonse mzere wothyoka pakati pa mano awiri ndikung'amba chingamu m'kamwa, malovu aumunthu, omwe ali ndi mazana mamiliyoni a mabakiteriya pa millilita imodzi, amasefukira mwachindunji mu fupa lakuda losweka, ndikupangitsa kuti ** fracture yotseguka ** yomwe imafuna mankhwala opha tizilombo kuti ateteze matenda a mafupa (** osteomyelitis **).

Chifukwa chiyani madotolo ndi azachipatala amaletsedwa kuyika chubu chopumira kapena chubu cham'mimba kudzera pamphuno pambuyo pa ngozi yapakati (Le Fort)?¶

Kuphulika kwapakati pa Le Fort II kapena Le Fort III, kapena kuvulala kulikonse komwe kumayambitsa maso akuda ("maso a raccoon"), kuvulaza kuseri kwa makutu ("chizindikiro cha Nkhondo"), kapena mlatho wophwanyidwa wamphuno, nthawi zambiri umaphwanya pepala-woonda ** mbale ya fupa la ethmoid ** yomwe imapanga denga la mphuno ndi pansi pa chipinda cha ubongo. Kukankhira njira yapamphuno yosinthasintha kapena chubu champhuno m'mphuno pamene fupa la fupa lasweka kungathe kutumiza chubu molunjika padenga la mphuno **kumaloko a ubongo**; machubu onse ayenera kudutsa mkamwa m'malo mwake.

Chibwano changa chosyoka chikangotulukanso m'chipinda chachipatala, ndingaletse bwanji kuti zisachitikenso?¶

Nthawi zonse pamene mgwirizano wa temporomandibular umasweka, kapisozi wa ligament yemwe ali ndi mpirawo amatambasula, zomwe zimapangitsa kuti kubwereza kukhale kosavuta pa masabata awiri oyambirira. Musamamatire ku zakudya zofewa zomwe zimafuna kuti musalumidwe kwambiri kwa masiku 10 mpaka 14, pewani kutsegula pakamwa mokulirapo kuposa m'lifupi mwa chala chimodzi, ndipo **nthawi zonse kanikizani chibakera pansi pa chibwano chanu nthawi zonse mukamva kuyasamula, kuyetsemula, kapena kuseka kuyambira ** kuti nsagwada zisatsegule kwambiri.

Maupangiri ogwirizana¶

• Matenda adzidzidzi a mano ndi chisamaliro chochotsedwa
• Kutsekeka ndi kutsekereza mpweya wothandizira woyamba
• Kuvulala kumutu ndi kugwedezeka
• Kuvulala kwa msana ndi kusasunthika

Magwero ndi malangizo ovomerezeka¶

• Komiti ya American College of Surgeons (ACS, United States) Komiti Yokhudza Zovulala: Advanced Trauma Life Support (ATLS) Buku Laphunziro la Ophunzira (Maxillofacial trauma airway positioning, flail mandible traction, contraindication of nasopharyngeal/nasogastric chubu mu cribriform plate/ midface fractures, and control kutulutsa magazi).
• American Association of Oral and Maxillofacial Surgeons (AAOMS, United States): Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery (Trauma and Temporomandibular Joint Dislocation Management).
• British Association of Oral and Maxillofacial Surgeons (BAOMS) ndi National Institute for Health and Care Excellence (NICE, United Kingdom): Major Trauma: Assessment and Initial Management (NG39) ndi Emergency Management of Maxillofacial Hemorrhage and Airway Obstruction.
• European Resuscitation Council (ERC) ndi European Association for Cranio-Maxillo-Facial Surgery (EACMFS): Malangizo pa Airway Management mu Traumatic Maxillofacial Injuries.
• American College of Emergency Physicians (ACEP, United States): Njira Zachipatala mu Emergency Medicine: Kuchepetsa kwa Temporomandibular Joint Dislocation (Syringe-Roll, Extraoral, and Intraoral Techniques) ndi Tongue Blade Bite Test Validation.