Introduction

Dr. Dewi Haryanti K, SpBP-RE

Sub Bagian Bedah Plastik
RSUD dr. Moewardi/ FK UNS Ska

ISTILAH PLASTIK
PLASTICOS

TO MOLD
(MENGOLAH)

TO FORM
(MEMBENTUK)

BEDAH PLASTIK : Alternatif memberi

nilai tambah pada tubuh yang dianggap
KURANG

BEDAH PLASTIK

ESTETIK
esteti
k

REKONSTRUKSI

CACAT

NORMAL

SUPERNORMAL

 OPERASI BEDAH REKONSTRUKSI : memperbaiki

kelainan baik fungsi ataupun penampilan yang tidak
normal menjadi mendekati atau normal kembali
OPERASI BEDAH ESTETIK : memperbaiki keadaan
yg normal sesuai dengan kondisi lingkungan
setempat menjadi lebih dari normal (supernormal)

TRAUMA MAXILLOFACIAL

Dr. Dewi Haryanti Kurniasih, SpBP

Sub divisi Bedah Plastik
SMF Bedah RSUD dr. Moewardi/FK UNS
2012

PENDAHULUAN
Insiden >>
Bisa disertai keluhan : neurologis,
ophthalmologis, aerodigestive, skeletal, soft
tissue, atau otologis
Multiple organ system

INITIAL MANAGEMENT
PRIMARY SURVEY

Airway & control of Cx spine : Open &

secure, Jaw thrust & chin lift, remove foreign
bodies, cricothyrotomy if necessary
Breathing : Ass of adequacy of ventilation
Circulation : Control of bleeding, IV fluid
rescuscitation
Disability : Level of consciousness &
pupillary evaluation
Exposure : Complete expose of the px

SECONDARY SURVEY

Complete Anamnese
Complete head to toe examination
Head, maxilofacial and neck
Thorax
Abdomen, perineum and genital
Musculoskeletal
Neurological Examination

Maxillofacial Trauma
Life-threatening Emergency
Treatment :
1.
2.
3.
4.

Maintenance of the airway

Prevention of the hemorrhage
Identification & prevention of aspiration
Identification of other (occult) injuries, such as
eye, brain and cervical spine

Maxillofacial Trauma :
Soft tissue injury
Fractures of frontal sinus
Fractures of the zygoma
Fractures of the nose
Fractures of the orbit & nasoethmoid
Fractures of the maxilla
Fractures of the mandible

Scalp loss

Soft tissue laceration

Windshield injury

Fractures of The Zygoma

Most common injury after Nasal Fracture
Prominent position Susceptible to
traumatic injury
Changes in facial appearance & function
Associated with ocular & periocular injury

Signs & Symptoms

Symptoms :
- Anesthesia/ hypesthesia
- Diplopia
- Limitation of mouth
opening

Signs :
- Depression of cheek convexity
- Edema
- Subconjuctival & periorbital
ecchymosis
- Limitation of mandibular
movement
- Deformity & tenderness along
the orbital rim
- Unilateral epistaxis

Roentgenographic views :
Plain photo
Waters View
Submentovertex View
Caldwell view
CT :
Axial & Coronal projections

Foto (AP/Lat/Waters)

Treatment
Reduction/ reposition
closed ( Gillies Approach )
open

Fixation (interfragmented wiring/ IFW, plating)

Immobilitation (MMF)
Rehabilitation

Fractures of the Nose

* The most frequent fracture of facial bone
* The most personal & identifiable feature of
human face
*Dx , Tx, & follow-up care important to
reduce incidence of unfavourable sequele

Diagnosis
History of MFT
Symptoms : deformity, tenderness &
bleeding
Roentgenography are limited value
The decision to operate depends on
physical findings

Treatment
Reduction : Simple & straightforward
procedure
Reduce by close technique
Timing : Not a surgical emergency, except
immediately come after injury
The usual timing : 3-5 days after injury
Anaesthesia : GA in children, LA in adults

Fractures of The Maxilla

CLASSIFICATIONS
Simple & isolated fractures
Complex & associated fractures : Le
Fort I,II,III (Renee Classification)

Le Fort I Fracture :
Horizontal fractures above the apices of
the teeth or Transverse fracture
separating alveolus from upper midface

LeFort II Fracture:
Pyramidal fracture,extends from the pterygoid
plates under zygoma through the inferior &
medial orbital walls across the nasal bones

Le Fort III Fracture:

Complete craniofacial separation,
extends from zygomatic arches, lateral
orbital wall, orbital floor & medial wall
across the nasal bones

Clinical Findings

Periorbital hematomas
Profuse nasopharyngeal bleeding
Pain
Malocclusion
Intraoral lacerations
Symptoms of zygomatic, orbital, or nasoethmoidal
fractures
Facial elongation & retrusion
Cerebrospinal fluid rhinorrhea (LF II & III)

Clinical Findings
Step-off on palpation
Split palate : in 10% of cases
Mobility of maxillary dental arch
(floating maxilla)

Roentgenographic
Plain Photo : Skull PA / Lateral &
Waters
CT Scan

Treatment
Maxillo-mandibular fixation (MMF) :
Arch Bar
Fracture reduction : Interosseus wires
Plate & screw stabilization
Primary bone grafting

Maxillo-Mandibular Fixation
(archbar-rubber)

FRACTURES OF THE
MANDIBLE
Prominent position succeptible to
trauma
Caused by traffic or sport accidents
and pathologic fractures

Classification

Alveolar bone alone or involve basal bone

Single, bilateral & multiple fractures
According to the region of mandible
Close or open

Signs & Symptoms

Tenderness, limitation of mouth opening

Deformity, deviation of midline
Open bite malocclussion
Palpable step defect of the jaw
Pathologic / unnatural mobility of the
mandible
Sublingual hematome

Malocclusion

Roentgenography

Plain photo : Skull PA / Lateral oblique

Plain photo : Townes view
Panoramic view
CT Scan

Principles of Treatment
Reduced & fixed earlier, the better is the
outcome
Antibiotics should be administered
Fractured & caries teeth must be extracted
The first measure : Restoring & securing
occlussion

Treatment
Circumdental wiring : Stability of mobile
fractures
Interdental wiring : Fixation of whole
mandible to the maxilla
Intermaxillary fixation : Arch Bar
Bone wiring : Transosseus wiring
Bone plate

CONCLUSIONS
Initial management of MFT is very important
Initial rescuscitation to secure airway, ventilation
& stabilized circulation
Successful management is by complete
examination ,failure often from the inability to
recognised extent of an injury,then from the
inability to treat the recognized an injury

Thank You