craniofacial injuries (anat, fraktur frontal dan orbita)

8/17/2019 Craniofacial Injuries (Anat, Fraktur Frontal Dan Orbita)

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Craniofacial injuries


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Outline

Anatomy of Cranium and Face

Treatment of craniofacial injuries ingeneral

Frontal fracture

Orbital fracture


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Anatomy of cranium and face•

Cranium consists of neurocranium (calvaria andcranial base) and viscerocranium (facial bones)• There are four aspects and two surfaces of

cranium : facial lateral occipital and superioraspect and internal and e!ternal surface

• Face is the anterior aspect of the head from theforehead to the chin and from one ear to theother" The face involves in communication(facial e!pression) and identity for humans"

• #calp cover the neurocranium that consists ofs$in and subcutaneous tissue" The scalp iscomposed of %ve layers (s$in connectivetissue aponeurosis loose areolar tissuepericranium)

#umber: &oore ' alley AF Agur A&*" &oore Clinically Oriented Anatomy" +th ed" ,#A: ippincott-illiams and -il$ins. /012" p" 3/04530


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Facial and lateral aspect of cranium

#umber: &oore ' alley AF Agur A&*" &oore Clinically Oriented Anatomy" +th ed" ,#A: ippincott -illiams and -il$ins. /012" p"


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Occipital and superior aspect ofcranium



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6!ternal and internal surface ofcranium



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&uscle of face and scalp



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7erves of face (cranial nerves)



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Cranial nerves and 8aranasal#inuses

#umber: ra$e * 9ogl A- &itchel A-&" ray;s Anatomy for#tudents"


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#uper%cial arteries and veins of face



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ymphatic drainage of face and#CA 8



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Treatment of craniofacial injuries ingeneral• >nitial Assessment

• 8reparation prehospital phase and hospital phase• Triage multiple casualties and mass casualties• 8rimary #urvey A?C 6s• *esuscitation• Adjuncts to primary survey and resuscitation 6C monitoring urinary and gas

catheters ventilatory rate arterial blood gases pulse o!imetry blood pressure !4raye!am and diagnostic studies

• Consideration of the need for patient transfer• #econdary survey head4to4toe evaluation and patient history• Adjuncts to secondary survey• Continued post resuscitation monitoring and reevaluation monitoring vital

urinary output relief of severe pain• e%nitive care

#umber: American College of #urgeons Committees on Trauma" Advance Trauma ife #upport #tudentCoarse &anual" 5th ed" /01/


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8rimary #urvey (A?C 6s)• Airway maintenence with cervical spine protection chin4lift or jaw thrust

(obstruction @) C# 3@ (reBuire placement of defnitive airway ) usingimmobili ation device for protection patient’s spinal cord (or inline immobtechniBues)

• B reathing and 9entilation e!pose patient;s nec$ and chest (assess jugular venousdistention position trachea chest wall e!cursion) visual inspection and palpation(detect injuries) auscultation (gas Dow in the lungs)

• Circulation with hemorrhage control altered levels o consciousness @facial skin (color) @ 8ale e!tremities@ >rregular rapid thready pulse @ (bloo

and cardiac output) e!ternal and >nterial bleeding (chest abdomen retroperitopelvis long bones)@• D isability (neurologic evaluation) values of Glasgow Coma cale @ (leve

consciousness)• ! !posure and 6nvironmental control undressed the patient to facilitate a thorough

e!am and assessment covering with warm blan$ets ( prevent "ypot"ermiaimportant than the comfort of the healthcare providers)



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*esuscitation• Airway a de%nitive airway (intubation) should be established if there is any

doubt about the patient;s ability to maintain airway integrity" >f intubation iscontraindicatedEcannot be accomplished an airway should be establishedsurgically

• ?reathing ventilation and o!ygenation chest decompression should folimmediately in patient suspected tension pneumothora! supplementalo!ygen for every injured patient pulse o!imeter (monitor adeBuancy of #aO

• Circulation with hemorrhage control (shoc$ and hypothermia) repof intravascular volume (rate of Duid administration based on internaldiameter and length of catheter) type and crossmatch of patient;s bloodobtaining blood gasses andEor lactate level (assess the presence and degreeof shoc$) initiated with >9 Duid therapy with crystalloid >9 solutions should bewarmed (


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#econdary #urvey•

?egin if primary survey is completed resuscitativeeGort are underway the normali ation of vital functionshas been demonstrated

• Head4to4toe e!am complete history ta$ing and physicale!am reassessment of all vital sign completeneurologic e!am ( C# score obtained !4ray asindicated by e!am or specialEspeci%c procedure)



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Frontal (sinus) fracture• iagnosis and 6!am

• #igns and symptoms: obvious contour deformities of the forehead swelling withinjury blunts associated with central nervous system A!ial cuts of CT #(determine degree of injury involvement of anterior and posterior table andnasofrontal duct)

• Anterior table fractures treated by reduction and plate %!ation via coronalincision or through e!isting cuts in the forehead or obliteration frontal sinus (step:removing anterior table entirely removing all mucosa from sinus p

nasofrontal drainage system from ethmoid sinus and nose below)• 8osterior table fractures ris$ of acute meningitis and late intracerebral mucocele

formation caused by fragment of fracture (trapdoor4type phenomena) leavingsmall bits of mucosa within cranical cavity (ris$ of mucocele formation)" 8osteriordisplacement or cerebrospinal lea$ frontal craniotomy and removing foreheadbone Dap removing posterior table and mucosa of anterior table"

• Complication infection mucocele formation#umber: Chung 'C osain A' urtner C &ehrara ?I *ubin I8 #pear # " rabb and #mith;s 8lastic#ur er " +th ed" ,#A: i incott -illiams and -il$ins. /012" "


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Orbital fracture• Orbital 6!amination:

• History of iatrogenic globe penetration(cataract surgery or radial $eratotomy) ris$ glo

increase• visual e!am damage optic nerve manifestation of visual %eld K visual acuity problem• Test color desaturation compression of optic nerve (red color desaturation)• irect and consensual pupillary response function of second and third cranial nerves• Anisocoria damage of second or third cranial nerves or direct trauma of iris• #winging Dashlight test optic nerve injury• *ange of motion of eye function of third fourth and si!th cranial nerves

• >ndication for #urgery: Orbital Door mechanical entrapment of an e!traocular muscle

enophtalmus defect si e of orbital Door K 1 cm / "• >ncisionsEtechniBue subciliary approach (highest ris$ of lid retraction) transconjungtival

approach (decrease ris$ of lid malposition) lateral canthotomyLcanthope!y (improvese!posure) subtarsal incision (for older patients with prominent lower lid rhytids)

• Floor >mplants very large orbital defects (involving medial wall)" isadvantage areinfection and e!trusion" Avoid silastic (high ris$ of infection and e!trusion)

• Complications lower lid retraction enophthalmus persistent diplopia

#umber: Chung 'C osain A' urtner C &ehrara ?I *ubin I8 #pear # " rabb and #mith;s 8lastic#ur er " +th ed" ,#A: i incott -illiams and -il$ins. /012" "

craniofacial injuries (anat, fraktur frontal dan orbita)

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