Download - Maxfac Fracture
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Andhik KusbiantoroAndhik KusbiantoroSMF Ilmu Bedah SMF Ilmu Bedah
RSUD.Dr.R.Soedjono SelongRSUD.Dr.R.Soedjono Selong
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PEMERIKSAAN AWAL
1. BEBASKAN JALAN NAFAS2. KONTROL PERDARAHAN3. PROBLEM MENGANCAM JIWA
(THORAX, ABDOMEN, KEPALA, EXTREMITAS )
4. STABILISASI CERVICAL SPINE5. PEMERIKSAAN NEUROLOGI
(GCS)
PEMERIKSAAN TELITI KEALIANAN MAXILLOFACIAL
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Trauma maksilofasial menyebabkan cidera pada : - kulit kepala - jaringan lunak - tulang kepala - otak - tulang wajah
Cidera ditempat lain
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• Obstruksi jalan nafas• Perdarahan
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Bebaskan jalan napas Kontrol perdarahan Cegah dan kontrol syok Stabilisasi servikal Kontrol trauma yang mengancam jiwa
Cedera otak, trauma toraks, fraktur ekstremitas terbuka, intra-abdominal bleeding
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Gejala
Frekwensi napas > 24/menit Suara napas tambahan Gelisah Retraksi supraklavikula, suprasternal Sianosis
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1. Bekuan darah, muntahan, saliva, fragment
tulang, gigi, prostese
2. Penutupan nasofaring dan orofaring oleh lidah
(fr. Mandibula)
3. Displacement ke bawah fr. Maksilla
4. Edema / trauma masive pada lidah dan dasar
mulut
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Fraktur maksilla impresif
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Fraktur mandibula segmentalTrauma/edema lidah dan dasar mulut
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Penanganan Rongga mulut bersihkan dari darah, lendir,
benda asing Palpasi apakah masih ada benda asing yang
tertinggal Chin lift/ jaw trust Darah dan lendir dalam rongga hidung/ mulut
dihisap secara frekuen dan gentle
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bila ada obstruksi, bebaskan lakukan chin lift (1) atau jaw thrust (2), atau yang sesuai indikasi. Menggunakan oropharengeal
(3) atau nasopharengeal tube
(4).
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Fraktur parasimfisis mandibula bilateral Lidah ditarik kearah depan Jari tangan Jepit jemuran Peniti besar Jahit
Pipa nasofaring
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Fraktur maksila impresif
Reposisi manual, maksila ditarik ke anterior (disimpaksi)
Pipa nasofaring bilateral Hisap frekuen daerah orofaring
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Intubasi endotrakeal Intubasi orotrakeal Trakeostomi
Dalam keadaan sangat gawat krikotoroidotomi insersi jarum no.12-14
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krikotirotomi
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Indikasi :
1.Fraktur maksilofasial dengan perdarahan yang sulit dikontrol
2.Fraktur maksilofasial dengan obstruksi/potensial obstuksi jalan napas
a. fraktur mandibula anterior segmentalb. fraktur maksila impresif
3.Disertai trauma penyerta yang memerlukan respirator- flail chest, kontusio paru, shock lung, emboli
lemak, cedera otak berat
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Memudahkan anaestesi Lapangan operasi tak terganggu pipa
endotrakeal Menghindari edema pasca ekstubasi Menghindari aspirasi pasca bedah
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BIASANYA CUKUP HEBATTAPI JARANG MENYEBABKAN SYOK HIPOVOLEMIK
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Sumber perdarahan
1. a. palatinus2. a. fasialis3. a. etmoidalis4. a. maksilaris interna5. pleksus Haselbach
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vascularisasi
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Mengatasi perdarahan Mekanik
Penekanan Klem dan ligasi Klem dan bebat tekan Packing
Posisi kepala lebih tinggi Sedatif & analgesik
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Jangan lupa mengganti cairan yang hilang
KristaloidKoloidDarah
Jangan lupa oksigenasi
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Perdarahan hidung Biasanya berhenti spontan Bila tidak berhenti
2 kateter Foley untuk nasal posterior Tampon nasal posterior + anterior Ligasi a.karotis eksterna &
a.etmoidalis
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Tampon nasal
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Perdarahan rongga mulut Laserasi intraoral
Pembuluh darah besar diklem dan ligasi
Luka didebrideman dan dijahit A. palatinus majus
Jahit mukoperiosteal Bone-wax pada foramen palatinum
major
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Angiografi dan embolisasi
Bila perdarahan tidak berhenti dan sumbernya sulit
diketahui
Fraktur maksilofasial akibat luka tembak
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Jejas yang sering terjadi pada trauma maksilofasial
Hematoma palpebra kanan kiri (briel-hematoma)
Kontusio/ Bengkak/ swelling
Abrasi
Ptechiae
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Maloklusi karena fraktur maksila dan mandibula, disertai laserasi pada bibir atas
Deformitas karena fraktur zygoma dextra
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Palpasi calvaria, dahi dan rima orbita
hematoma? vulnus? nyeri? deformitas? perdarahan? (krepitasi?)
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Palpasi rima orbita mulai dari atas
kesamping bawah lakukan dengan seksama,
bandingkan kanan kiri, evaluasi apakah ada deformitas (step ladder)? nyeri? (krepitasi?)
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lanjutkan kebelakang menyusuri arkus sigomatikus, adakah deformitas?
nyeri? (krepitasi)?
TM - joint, evaluasi sambil penderita disuruh buka-tutup mulutnya. Nyeri? deformitas/dislokasi?
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Ramus, korpus sampai mentale mandibula
diselusuri secara urut bandingkan kanan kiri
lakukan evaluasi deformitas? nyeri? (krepitasi)?.
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perhatikan susunan gigi maksila dan mandibula
deformitas? susunan/konfigurasi saat menutup dan membuka mulut rapi? ada gigi yang hilang/fraktur?
palatum durum dan mole luka? perdarahan? deformitas? corpus alienum?
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Floating maksila :
Dahi difiksir dgn tangan kiri, maksila dipegang dgn ibujari dan telunjuk pd. pal.durum kemudian digerakkan, bila goyang maka terdapat disjunction antara maksila dan cranium.
Bisa dilakukan tanpa narkose, lakukan pelan2 dan hati2 serta komunikasi dgn penderita.
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False movement mandibula :
pegang kedua corpus mandibula kanan kiri dengan ibujari didalam, keempat jari lainnya diluar.
Kemudian gerakkan keatas-kebawah(↕) secara berlawanan sambil diamati bila ada pergerakkan pada mandibula yang tidak sinkron(↑) antara kanan dan kiri maka ada fraktur mandibula ditempat tsb.
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NyeriEdema, deformitasMaloklusiAnestesi bibir bawah dan daguMobilitas fragmen, unstable mandibulaTrismusDeviasi ke arah fraktur saat buka mulutAnterior open bite kontralateral frakturHematom/laserasi dasar mulutLaserasi mukosa ginggiva
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Open bite, edema
Gap mandibula, maloklusiGigi hilang
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evaluasi intra oralGigi tanggal ?
Laserasi mukosa ?
Oklusi ?
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menyusuri ramus mandibula sampai angulus, kemudian kedepan sampai dagu
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Step defect
False movement
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Fraktur mandibula segmental
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PEMERIKSAAN FISIK FRAKTUR NASAL
Epistaksis setelah trauma hidungEdema dorsum nasalEkimosis periorbital
Deformitas nasalNyeri tekan
Krepitasi os nasalHematom mucosa cavum
/ septum nasiLaserasi kulit / mucosa
telecanthus
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PEMERIKSAAN FISIK PADA Fr. ZIGOMA
TRAUMA LANGSUNG PADA ZIGOMA
NYERI SAAT BUKA-TUTUP MULUT
TRISMUS
RASA TEBAL DIPIPI
DEPRESI EMINENTIA ZIGOMA
PERDARAHAN SUBCONJUNGTIVA
DIPLOPIA
TERABA FRAKTUR
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Deformitas, depresi zigoma
Hematom subconjungtiva
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FRAKTUR ZYGOMA DEXTRA
Teraba gap atau step defectTampak Racoon eye
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Mulai rima orbita superior adakah deformitas atau stab-off pada perabaannya.
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Palpasi rima orbita bagian medial juga pada pangkal hidung kanan dan kiri simultan
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Palpasi pada arcus zygomaticus kanan dan kiri, dari depan ke belakang sampai TMJ
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1. RIWAYAT TRAUMA MIDFACE2. PERDARAHAN DAN OBSTRUKSI NAFAS3. NYERI4. PERIORBITAL EDEMA DAN EKIMOSIS5. MALOKLUSI6. NASAL FLATTENING7. TRAUMATIC TELECANTUS8. DEFORMITAS, DEPRESS MAXILLA, DISH FACE9. FLOATING MAXILLA
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RACOON EYES PADA FR. MAXILLA
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Nasal flattening, dish face
Telecantus
Edema, hematom
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FLOATING MAXILLA
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Fraktur Le Fort I
Fraktur Le Fort II
Fraktur Le Fort III
FRAKTUR MAKSILA
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TERBATASNYA GERAK MATA
PENURUNAN SENSASI DISTRIBUSI N. INFRAORBITA
ENOPHTALMUS
DIPLOPIA, TERUTAMA SAAT MELIRIK KE ATAS
DISKONTINUITAS RIMA ORBITA INFERIOR
SERING DISERTAI Fr ZIGOMA
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FRAKTUR BLOWOUT
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TERIMA KASIHTERIMA KASIH