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Oral And Maxillofacial Trauma Fonseca Freedownload REPACK

Describing the diagnosis and management of maxillofacial and associated traumatic injuries step by step, Oral and Maxillofacial Trauma, 4th Edition takes you beyond the surgical management of head and neck trauma to cover the general management of traumatic injuries, systemic evaluation of the trauma patient, and special considerations associated with maxillofacial trauma patient care. New to this edition are over 700 full-color illustrations showing details of traumatic injuries and their treatment. Edited by head and neck trauma expert Dr. Raymond J. Fonseca, along with over 80 highly respected contributors, this comprehensive reference provides all of the information you need to offer the best care possible to maxillofacial trauma patients.

Oral And Maxillofacial Trauma Fonseca Freedownload

The authors have submitted chapters that reflect the state of the art in their areas of responsibility. This text is a comprehensive resource on oral and maxillofacial surgery. Every area in our specialty has been addressed. It defines the scope of the specialty. Every surgical procedure performed by an oral surgeon is covered in this text. This multi-volume text provides coverage of a wide range of issues related to surgical care, such as anesthesia, diagnostic imaging treatment planning, rehabilitation, physical therapy, and psychological considerations. Fonseca Oral and Maxillofacial Surgery PDF

Since past many years management of facial trauma has evolved greatly. To provide stable fixation various plating system have been developed. To reconstruct the chin and mandibles, craniofacial skeleton surgery and midface fractures, the maxillofacial plating system is designed. There are various forms of plates and screws for fixation of maxilla, mandible and midface including fractures of orbit and zygoma. They also involve plates for mandibular reconstruction after tumor resection. Different sizes and shapes of plates are available as per the needs.

In 1967, mandibular compression screw (MCS) was used in oral and maxillofacial surgery (OMFS) in edentulous fractured mandible while performing first compression osteosynthesis. Self-tightening/automatic MCS plate was developed by Luhr in 1968. Later, dynamic plates were advocated for surgery of long bones with subsequent application in mandibular fractures.

In oral and maxillofacial surgery, Brons and Boeriing introduced lag screw fixation for the first time in 1970. According to them two lag screws prevent rotational movements of the fracture fragments in oblique mandibular fractures [16].

With this type of fixation, there is adequate stability to allow direct bony union and is called as functionally stable fixation. There are many fixation techniques used in oral and maxillofacial surgery (OMFS) which are not rigid fixation truly but classified as functionally stable fixation.

Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock. These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists. Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries. Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the intensive care unit (ICU) and subsequent reexploration and definitive repair following restoration of normal physiology. Damage control resuscitation (DCR) consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation. Both strategies should be administered simultaneously in all of these patients.

Severe maxillofacial and neck trauma, both blunt and penetrating, may be sustained in various military and civilian circumstances. Civilian trauma settings such as motor vehicle accidents (MVAs), falls, altercations, sports and occupational injuries, etc. may cause blunt trauma of various degrees, usually resulting in closed fractures and soft tissue lacerations or mild to moderate penetrating trauma. Blast injuries (tertiary effect) may cause variable degrees of maxillofacial and neck blunt trauma in military combat or civilian terrorist conflicts. In such circumstances, severe penetrating maxillofacial and neck injuries are often encountered, usually inflicting complex lacerations, open fractures and wounds complicated by tissue avulsions and wounds [33]. Nowadays, modern body armor and improved cranial protection allow a relatively high percentage of military head and neck trauma casualties to survive their initial injuries pending arrival at a Level III trauma care center. Civilian MVA casualties also portray high survival rates owing to modern car safety measures such as airbags, early warning systems, etc. Civilian head and neck casualties nowadays benefit from high relative proximity of most civilian injuries to Level III trauma care centers when compared to previous eras, thus enhancing emergency room (ER) arrival survival rates. Initial management of these injuries involves: 1) airway management 2) control of hemorrhage 3) prevention of disability from central nervous system injuries. Penetrating maxillofacial and neck injuries result in a complex of lacerations, open fractures, profuse bleeding, tissue avulsions, eye injuries and burns. These highly visible injuries, although bloody, are rarely the sole cause of hemorrhagic shock. The critical immediate life-threat following maxillofacial injury results from airway compromise due to oropharyngeal bleeding, swelling, and loss of mandibular structural integrity. The airway is maintained and secured by oro-tracheal intubation, cricothyroidotomy, or surgical tracheotomy. Once the airway is secured, direct pressure and aggressive packing of open bleeding wounds will control all but the most catastrophic hemorrhages. Previously stated rationale dictates that direct manual pressure and aggressive packing of open bleeding wounds or bleeding nasal and oropharyngeal cavities should be implemented without further delay in order to minimize further blood loss. External fixation of unstable anterior mandibular fractures using available means (orthopedic pin fixators, wire ligatures etc.) may assist in preventing airway compromise, as well as reduce profuse bleeding, pain and morbidity often associated with such injuries. More significant bleeding can be controlled by angiographic embolization or selective ligation of the external carotid artery, while simultaneously protecting the brain, cervical spine, and the eyes from further injury. Early fixation of a flail mandible is also mandatory because it may destabilize tongue musculature insertions thus compromising the airway and also cause bleeding, significant pain and morbidity. Head and neck injuries should be copiously irrigated, wound contaminants removed, clearly nonviable tissue fragments should be debrided and the wounds covered to prevent further contamination. Suturing of soft tissue lacerations covering underlying bone fractures should be deferred so that such fractures should not be overlooked during subsequent examination of the patient.

Effective airway management often makes the difference between life and death in severe maxillofacial trauma and takes initial precedence over all other clinical considerations. There are fundamental differences in the management of casualties arriving at treatment facilities with blunt trauma versus penetrating injury to the face. Patients with isolated blunt trauma to the face and neck, typically undergo standard spinal immobilization measures (in-line traction) during initial airway management. Penetrating maxillofacial and neck injuries often pose significant airway visualization challenges, and the primary priority in such patients, with immediate risk of airway obstruction, is securing a stable airway. Studies performed in civilian and combat settings suggest that patients with normal neurological motor function will not suffer from a mechanically destabilized spinal column that may be compromised by head manipulation during airway control following isolated penetrating trauma to the neck [35].

Vascular injury is noted in 20 % of cases of penetrating neck trauma, and exsanguinating hemorrhage is the primary cause of death in such cases [46]. Life threatening facial hemorrhage in maxillofacial surgery has an approximate incidence of 1 % in the trauma patient [47]. Conservative measures such as anterior and posterior nasal packing are recommended as first attempt to control traumatic midface hemorrhage. Temporary reduction of facial fractures is also effective in control of massive facial hemorrhage. Zone II neck injuries with hard signs of vascular injury require immediate surgical exploration. Vascular injuries in zone II mandate a high index of suspicion towards tracheal and esophageal injuries. Suspected proximal (Zone I) carotid injuries require partial sternotomy for proximal control. Injuries to the common or internal carotid arteries may be repaired using lateral arteriography, patch angioplasty, end to end anastomosis or bypass [48]. If the patient is in extremis, the common or internal carotid vessels may be ligated. This approach leads to dismal outcomes, with stroke rates exceeding 20 % and mortality approaching 50 % [49]. An alternative approach to ligation would be the placement of a temporary shunt between the two ends. In case of distal internal carotid (Zone III) injury, ligation is appropriate if the distal end can be also ligated. In case the distal end is within the skull base, a size 3 Fogarty embolectomy catheter can be used to occlude the distal end allowing it to thrombose [50]. Embolization of the bleeding vessel was also recommended as the most reliable technique for the control of hemorrhage [47]. External carotid artery injuries may be repaired using standard techniques or ligated. Transposition of external to internal carotid artery is particularly useful when the internal carotid artery cannot be repaired, as an alternative treatment method to ligation [50].


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