6. Table of contents of lecture material Classification of damages of maxillufacial area

І. the Mechanical damages of overhead, middle, bottom and lateral zones of face

ІІ. After localization:

А. of Trauma of soft fabrics :

1. Isolated with a damage:

а) tongue; б) of salivary glands; в) of large nerves; г) of large vessels.

2. United.

Б. of Trauma of bones :

а) of bottom jaw; б) breaks of supramaxilla;

в) of bones; г) bones of nose; д) two and more bones.

ІІІ. By the nature of wound :

а) through	б) blind	в) tangents
What get to the cavity:
а) company	б) nose	в) supramaxillary sine

IV. After a mechanism:

1. Fire wounds: bullet, to the splinter, by arrow-shaped elements

2. Unfire damages:

hammered, cut, chopped

3. Combined damages.

4. Burns.

5. Getting frost-bitten.

Unfire damages of soft fabrics

A scratch is a superficial damage of skin without violation of her integrity and adherent fabrics.

Periods of cicatrization of scratch :
to 10-12 g	- formation of scratch is to appearance of skin;
12-24g	- closing of bottom of scratch is to the level of skin;
6-10 days	- drop-back of skin;
7-14 day	- disappearance of tracks of scratch.

Treatment:

Antiseptic treatment 0,12% , 2-4% of iodine.

From 2-4 days conduct an open method.

Coalfaces - the mechanical damage of soft fabrics is closed without visible violation them anatomic integrity.

• Bruise

• Haematoma

• Syndrome of position clench

A bruise is a hemorrhage in the layer of skin or mucous membrane

A haematoma is the limited accumulation of blood in fabrics with education in them of cavity that contains liquid or convolute blood

Classification of haematomas :

On a location:

• hypodermic

• submucous

• subperiosteum

• intermuscular

• subfascial

On the state the outpoured blood:

• unrotted haematoma

• infected haematoma

• incapsulated haematoma

After attitude toward the road clearance of blood vessel :

• unpulsating

• pulsating

• роспираюча

A syndrome of position clench is the closed damages of soft fabrics without their considerable squashing that arises up at an of long duration clench mass of own body.Treatment: the first 24-28 hours cold, с of 3-ї twenty-four hours thermal procedures, ointment and other

A wound is violation of integrity of skin or mucous membrane on all their thickness, that it is caused by a mechanical action

• hammered

• cut

• chopped

• bitten

• squashed

• scalped

Hammered in wounds :

• unequal edges

• point hemorrhages

• bruises

• zone of regional necrosis

• gaping of edges of wound

Lacerated wounds:

• wrong form of edges

• removing layer by layer or tearing away of fabrics

• hemorrhages

• often through

Sword-cuts:

• linear or fusiform form

• practically even edges

• gaping of wound

• bleeding

of wound :

• narrow and long channel

• insignificant dihescence

• formation of haematomas and pockets

Chopped wounds:

• considerable damages

• no-bottom

• accompanied by the breaks of bones

Bitten wounds:

• unequal squashed edges

• traumatic amputation

• infecting of cavity of mouth a microflora

Features of wounds of soft fabrics of face

1. Plenty of loose cellulose, presence of thick capillary net, elasticity of skin canopies (is a considerable edema of fabrics, that develops quickly)

2. A thick capillary-venous net, channel of salivary gland, muscular mass of tongue (the bleeding, violation of breathing)

3. Paralysis or paresis of mimic muscles (of distortion of face)

4. A loss of locking function of circular to the muscle mouth or eyeball (is a permanent salivation and of skin, conjunctivitis)

5. The presence of glandular structures (proof salivary)

6. The damages of main vessels (are sleepy, language, internal, facial veins (air embolism, haematoma)

7. In the period of cicatrization of wounds cicatrical penalties can cause the wrong side never, wings of nose, lip with development , lacrimation of distortion of face).

Phases of cicatrization of wounds of soft fabrics :

1. Initial period of microbal contamination and cleaning of wound (0-48 hours)

2. Period of the degenerative-used for setting fire changes (forming of granulation fabric, increase of amount of desmocytes, formation of matrice) - (3-5th twenty-four hours)

3. Period of active height of fibrotic, ephithelial fabric, retraction of wound, primary scar (5-12th twenty-four hours)

4. Completion of forming of primary scar, disappearance of edema, infiltration of surrounding fabrics is dehydration, rapid growth of fibrotic and collogen fibres (12-18th twenty-four hours)

5. Period of the final forming of scar (0,5 - 1 to).

Surgical roughing-out of wound

– it is the first surgical interference that is conducted after primary testimonies with the aim of prophylaxis of infection.

For to the terms of realization :
primary	1-and twenty-four hours
deferred	to 3th twenty-four hours
late	over 3-и twenty-four hours

Components:

• dissecting of wound is for a revision, liquidation of pockets, breaks

• carving of nonviable fabrics

• imposition of guy-sutures

Methodology:

• tooling of skin is in the area of wound

• mechanical cleaning of wound

• stop of bleeding

• moving away of extraneous bodies;

• imposition of guy-sutures

Testimony to moving away of extraneous bodies :

• their superficial location

• localization in the crack of break or near-by large vessels

• limitation of motions of bottom jaw

• violation of functions of breathing and use of meal

• origin and support of inflammatory process

• localization in the cavity of nose or in a supramaxillary sine

Types of guy-sutures :

– primary deaf guy-sutures - laid on in the first 24-36 gs in default of the used for setting fire phenomena in a wound and realization of antibacterial therapy

– primary deferred guy-sutures - laid on in the first 36-72 gs at insignificant passionately-infiltration processes

– secondary early guy-sutures - laid on 5-12th twenty-four hours in default of inflammatory process in a wound

– secondary late guy-sutures - laid on 12-20th twenty-four hours after carving

– guy-sutures:

• drawings (ordinary) together for permanent rapprochement of edges wounds are with the defect of fabrics

• directing for diminishing to the pull

• off-loading for temporal maintenance of musculocutaneous shreds

• holding

• guy-sutures for the deaf closing granulating wounds

• «overseaming« of wound - in the cases of vast damages of soft fabrics, that combine with the simultaneous damage of jaws. The edges of skin unite guy-sutures with the mucous membrane of cavity of mouth (of warning of infecting of wound and development of cicatrical)