fracturi mandibula

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Traumatismele regiunii OMF

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Traumatismeleregiunii

OMF

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 TRAUMATISMELE ORO-MAXILO-FACIALE

Traumatismele partilor moi

Fracturi de mandibula

Fracturile etajului mijlociu al fetei

Fracturile complexului zigomatico-maxilar

Traumatismele priamidei nazale

Traumatismele dento-parodontale

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I. Traumatisme de parti moi

Caracteristici :

Derm elastic

Strat grasos sarac eceptie ge!ia!"maseteri! #asculari$atie %ogata &re$e!ta di!tilor Mucoasa adere!ta Raporturi cu caile aero-digesti'e"!eurocra!iu Risc mare de i!(ectie &ot duce la des)gurari * importa!ta asupra

psi+icului pac ,

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Etiopatoge!ie/ le$iu!i traumatice0-1/ traumatisme ce(alice

2/ %ar%ati3-4 a!i3/ accide!te rutiereAgresiu!i uma!e

Accide!te de mu!ca5sporti'e5 muscaturiIatroge!ii stomatologiceArme de (oc * rar 6pe timp de pace7Automuscare

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Forme a!atomo-cli!ice

  Clasi)care 8  - i!c+ise 9 co!tu$ii 8 ec+imo$e5+ematoame5etc  - desc+ise 9 plagile 8

  - ecoriatii  - li!iare  - $dro%ite  - muscate5s(asiate5smulse  - asociate cu (racturi  - mutila!te  Arsurile * 'eci!atatea cu caile aero-digesti'e

superioare ,

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SimptomatologieDurereaSolutia de co!ti!uitate 8 (orma margi!ilor

plagii5 particularitatile plagilor pri! arme de(oc

A!este$ia locala&arali$ia localaFistule sali'are:ipersialie Tul%urari (u!ctio!ale

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 Tul%urari asociate:emoragiaSoc traumatic 8

I!su)cie!ta resp. ac. 8 o%structia CAS5edem CAS

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Complicatiile Secundare :

. I!(ectii

3. :emoragii secu!dare

;. Fistule sali'are

0. Complicatii septice4. Complicatii !er'oase 8

a!este$ie5+ipo<+ipera!este$ie5pare$e

 Tardive. Cicatrici 'icoase

3. De(ecte de parti moi

;. Co!strictia de ma!di%ula

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 Tratame!t de urge!ta al

complicatiilor:emoragia 8

- +emosta$a de urge!ta

  - ligaturi i! masa 6dispo$iti' =a$a!>ia!7  - compresiu!e digitala 6ACE5ramuri7

  - repletie 'olemica

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 Tratame!tul de urge!ta al

plagilorFara eci$ii largi

Se 'a (ace imo%ili$area (racturilor

Lam%ouri )ate cat mai asema!ator cu!ormalul

Fragme!te adere!te de periost se pastrea$a

Se etrag doar di!tii (oarte mo%ili

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 Tratame!tul plagilor Timpii 8

  - curatarea

  - imo%ili$area (ragme!telor osoase  - sutura 8 per prima5 de po$itie5 primara

i!tar$iata5 secu!dara

  - com%aterea i!(ectiilor 8 dre!a>5 pa!same!t5

igie!a  - alime!tatie

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 Tratame!t asociat

A% Seropro)laie teta!ica

#acci!are a!tira%ica

 Tratame!t reparator tardi'

Sec+ele plagilor 8 cicatrici c+eloide5etc

Supuratii sti!se

&laga complet cicatri$ata

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 TRAUMATISMELE ORO-MAXILO-

FACIALEI. Traumatismele partilor moi

I.3 Fracturi de ma!di%ula

I.; Fracturile eta>ului mi>lociu al (eteiI.0 Fracturile compleului $igomatico-mailar

I.4 Traumatismele priamidei !a$ale

I.1 Traumatismele de!to-parodo!tale

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I.3 Fracturi de ma!di%ulaEtiologie 8 agresiu!i5accide!te.

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Meca!isme de producereSediul este co!ditio!at de Locul de aplicare a F Directia I!te!sit age!tului Re$iste!ta osului data de8  - (orma

  - grosime  - co!)guratia osului  - 'arsta  - %oli ge!erale

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Deplasarea (ragme!telor&rimara 8 soc traumaticSecu!dara 8

  - co!tractia musculara  - directia " !r li!ilor de (ractuta

  - statusul de!tar

Deplasari 8

  - 'ertical9decala>  - ori$o!tal9i!calecare

  - sagital9rastur!are #<O

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Forme a!atomo-cli!iceFu!ctie de sediu5grad de i!teresare5!r li!ii

(ract.

Simple

Li!iare

Comi!uti'e

Complete < i!complete

 Totale 8 media!e5paramedia!e5laterale5 deu!g+i5 de ram5 de co!dil5 de apo)$acoro!oida.

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Fracturi media!e

I!c+iderea<desc+id eagerata a arculuime!tO?IER

De o%icei ocoleste sim)$aDeplasare secu!dara redusaDeplasare primara datorita (ortei age!tului

Clinic 8 ec+imo$e me!to!iere

  plaga )%romuc me!t media!  oclu$ie i! armo!ica

  (ractura i! lamda

Rx OT

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Fracturi paramedia!eIC-C

454/ (racturi ma!d

Deplasari secu!dare  (ragme!tul mare * postero-i!(erior

  (ragme!tul mic - a!tero-superior

R!-OT

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Fracturi laterale

C-M;

@-;/ (racturi ma!di%ulaDeplasari primare si secu!dare

I!teresarea ca!alului ma!di%ularClinic 8- tume(actie ge!ia!a si su%ma!d

  - ec+imo$e i! pla!seu %ucal

  - dis(agie  - deplasare ori$o!tal 8 scurtari dema!d5de'ieri de me!to!Mandibula de"lata#panoramica# axiale

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Fracturi de u!g+i

Cur%ura osului " eruptia M;

-34/ (ract de ma!dDirect " i!direct 6%ar%ie 7Deplasari (u!ctie de i!teresarea i!sertiilor

musculare pterigoid"maseterClinic 

- tume(actie marcata a reg parotideo-maseteri!e

  - trismus  - dis(agie  - durere la apasare pe u!g+i sau me!to!  - daca apar deplasari 8 tume(actii

marii5+ematoame de pla!seu

Mandibula de"lata

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Fracturi de ram

3-4/#erticale 8 marg %a$-i!ci$ura sigm  (ara deplasari

Ori$o!tale 8 <; mi>lociuO%lice 8 i!ci$ sigm * marg post ramScurtari ale ramului * de'ierea li!iei

media!eClinic 

- tume(actie parotideo-maseteri!a  - durere  - i!oclu$ie (ro!tala

  - oclu$ie i! 3 timpi-

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Fracturi de co!dil

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Fracturi de co!dil

@5-;1/Fractura intracapsulara  - $dro%irea capului co!dilia!  - i!teresarea co!ductului auditi'  - limitarea misc ma!d5dureri5otoragie

  - ma!di%ula de)lata5&arma5BealFractura extracapsulara  - su%co!dilia!a i!alta  - me!to! de'iat de partea (racturata

  - palparea co!ductului 8 a%se!tamiscarilor  - oclu$ie i! 3 timpiFractura subcondiliana joasa 8 li!ie postero-

i!(erioara

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Fracturile apo)$ei

coro!oideI!(u!darea arcadei temporo-$igomatice

Directie o%lica pri! i!ci$ura sigmoida i! >os sia!terior

Limitare dureroasa a desc+iderii gurii

Fara deplasare 8 e'ide!tiere strict RX6ma!di%ula de)lata5 aiala :irt$7

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Fracturi multipleDeplasari mari ale (ragme!telor

&aramedia!e " laterale sau u!g+i

Laterale du%le

Media!e<paramedia!e " ram<apo)$a

Du%le de apo)$a

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Fracturi comi!uti'eLocali$ari multiple

#arietate (oarte mare a li!ilor de (ractura

Le$iu!i marcate ale partilor moi

Age!t puter!ic 8 metal5eplo$ii5proiectile

De(ecte osoase

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Fracturi partialeCo!ti!uitate pastrataFracturi de creasta5 (ro!taleSimptome 8

  - impote!ta (u!ctio!ala

  - durere 'ie

  - sialoree

  - de(ormare a co!turului (acial

  - tume(actie5ec+imo$e

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Fracturi partialealpare 8  - mo%ilitate a!ormala  - a%se!ta tra!smiterii miscarilor

  - +ipoeste$ie5a!este$ie5pareste$ie$iagnostic 8

- de(ormatii osoase  - crepitattii osoase  - lipsa tra!smiterii miscarilor  - tul%urari oclu$ieOT #tomogra"e#arma#%eal&

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E'olutia (racturilor. Calus )%ri!oproteic 9 posttraumatic 4-$

3. Calus )%ri!os pro'i$oriu 0-1$

;. Calus osos primiti' 9 em%rio!ar

0. Calus osos de)!iti' 9 propriu-$is ;-0$

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Complicatiile

. Complicatii imediate

3. Complicatii secu!dare

;. Complicatii tardi'e

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Complicatiile imediateComotia cere%rala

:emoragia

 Tul%urari respiratorii acute

Soc traumatic

 Tul%urari de a!este$ie a %u$ei i!(erioare

- sem!ul #i!ce!t dAlger

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Complicatiile secu!dareI!(ectii

Supuratii 8 a%cese sau osteite5osteomieliteRar a%cese pulmo!are

Complicatiile tardi'e 9

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Complicatiile tardi'e 9SEC:ELE

I!atar$ierea i! co!solidare * dupa 2 s

&seudoartro$a * dupa 1-2 lu!i

  - stra!sa5laa5%ala!ta

  - cli!ic 8 de(ormare5tul% (u!ctio!ale5mo%ilita!ormala5 oclu$ie patologica

  - tratame!t c+irurgical

Co!solidare 'icioasa * de(ormare5tul% deoclu$ie

Co!strictie de ma!di%ula * %ride cicatriciale

A!c+ilo$a ATM * (racturi i!tracapsualre copii

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 Tratame!tul (racturilorDe urge!ta 8 tul%urari ge!erale gra'e

Urge!ta al plagilor

De)!ti' al le$iu!ilor osoase si de parti moi

Reparator tardi'

,, Atitudi!ea (ata de di!tii di! (ocarele de

(ractura

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 Tratame!tul de urge!ta al (racturilor

Ba!da> me!toce(alicFro!da me!to!ieraImo%ili$are ma!di%ulo-mailara

  - elastica 8 atele #esti%ulare5)re de sarma5i!elecauciuc

  - rigida 8 - Le%la!c 8 ligat colet %ima

  - I' 8 3dd ma la a!tago!istii

  - Stout 8 colet ultimul M5%uclei!terde!tare

 

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Imo%ili$area de)!iti'aCo!te!tieMe!a>area parodo!tiuluiIgie!a %u!a5 alime!tatie adec'ata

Metode 8  - mo!omailare 8 atele metalice #5 si!e L5

si!e du%le #-L6=ersti!g75 prote$e5 gutiere acrilice

  - %imailare 8 elastica 8 atele metalice

:auptmaer  rigida 8 ligaturi

  - dispo$iti'e preco!(ectio!ate 8i!estet5Darcisac

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 Tratame!tul c+irurgical al

(racturilor I!dicatii 8

  - (racturi comi!uti'e5 cu deplasari

  - (racturi asociate (aciale

  - (racturi pri! arme de (oc

Co!trai!dicatii 8

  - iradiere

  - tesuturi co!tami!ate  - a!omalii

  - plagi !ei!c+ise si i!ti!se

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 Tratame!tul c+irurgical al

(racturilor&roceduri 8

  - osteosi!te$a

  - )atori eter!i

  - sercla> perima!di%ular

  - suspe!dari la dista!ta

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Fracturi media!e si

paramedia!e (ro!de

atele

dc lipsesc (ragme!te 8 imo%ili$are i!termailara

  Fracturi laterale

imo%ili$are i!termailara cu atele # cu %uto!i si!a L pt asce!sio!ari

imo%ili$ rigida a!tirotatio!ala

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Fracturi de u!g+iAtele #

 Tractiu!e elastica

 Tractiu!e rigidaOsteosi!te$a cu )r metalic

 

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Fracturi de ramFara deplasare 8 ap me!toce(alic<imo%ili$

rigida Tra!s'ersale 8 imo%ili$ i!terma"tractiu!e

elast

 Fracturi de apo"za Asema!ator cu cele de ram

Imo%ili$ tre%uie scurtata dupa $ 0

Fract i!tracapsulare 8 ap me!toce(alic sireluarea miscarilor dupa -3$

Fracturi co!dil cu deplasari mari 8

F t i l ii

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  Fracturi la copii

 anestezie generala gutiere acrilice

  Fracturi la varstnici

 proteze sau sabloane de ocluzie

 osteosinteza

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  Cazuriclinice

Fracturi demandibula

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FRACTURI ALE ETAJULUI

MIJLOCIU AL FE EI= ALE MASIVULUI FACIAL

FRACTURI ALE ETAJULUI

MIJLOCIU AL FE EI= ALE MASIVULUI FACIAL

Etiologie

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accidente de circulaţieaccidente de muncăaccidente prin agreiuniaccidente de p!rt

accidente pr!due de animaleaccidente prin arme de "!c

 

Frec#enţă$ %ăr&aţi '()* de + !ri mai puţine "aţă de mandi&ulă,

 Acţiunea traumatimului - ./+ medie 0agital1 2 "racturi liniare tran#erale

l t l " t i l i t &it

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 - lateral 2 "racturi c!mple3 4ig!mat!-!r&itar 

 Traumatim #i!lent 0accident de circulaţie1 2 "racturipan"aciale

Le4iuni traumatice - părţile m!i - muc!aa ca#ităţil!r 

  - pielea 5i mu5c6ii

  - #aele

  - peri!tul

  - dinţii 5i par!d!nţiul marginal

  - c6eletul !!Liniile de "ractură - perpendiculare pe t7lpii de

re4itenţă

  - la ni#elul plat"!rmel!r !ri4!ntale

Clasificare

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Fracturi parţiale:de pr!ce al#e!lar 

tu&er!4itate

&!ltă palatină

ap!"i4ă acendentăperete anteri!r al inuului

arcadă 4ig!matică

! malar 

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Fracturi t!tale $

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 - "racturile !ri4!ntale - in"eri!are 2 Le "!rt I

  - mi8l!cii 2 Le F!rt II  - uperi!are 2 Le F!rt III

 - "racturi #erticale 5i !&lice - "ractura medi! agitală  - "ractura laterală

 - "racturi c!m&inate

 - "racturi multiple 5i c!minuti#e

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II, Fracturi centr!-"aciale

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Fracturi t!tale "racturi ale !ael!r na4ale$

- unilaterală 5i &ilaterală

 "ractura c!mple3ului na4!-etm!id!-ma3ilar 0C,9,E,M1

Fracturi parţiale

 ap!"i4a acendentă a ma3ilarului

 eptului na4al &!lţii palatine

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Fracturi latero-faciale.,Fracturi ale c!mple3ului 4ig!matic 0=!r&it!-4ig!matice1

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  Fracturi anterioare

 t!tale$ - inc!mpletă  - di8uncţie ma3il!-malară

  - c!minuti#ă

 parţiale$ - a re&!rdului !r&itar in"eri!r 

  - a re&!rdului !r&itar lateral  - a plan5eului !r&itar 0&l!:-!ut1

  Fracturi posterioare "ractura arcadei 4ig!matice

  Fracturi anterioare şi posterioare

  3.Fractura peretelui anter!-lateral al inuului ma3ilar  

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Fracturi asociate$

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Fracturi asociate$ 

- pan"aciale 0; ! "r!ntal* mandi&ulă1- crani!-"aciale 0; cal!ta 5i &a4a craniului1-medi!-crani!-"aciale0C,9,E,F,M,1

- later!-crani!-"acială$- "r!nt!-ma3il!-malară-"r!nt!-"en!-temp!r!- ma3il!-malară-4ig!mat!-"en!-temp!rală

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Deplasarea fragmentelor osoase

primară 0&l!cul "acial ete retrudat* c!&!r7t* r!tat1

secundară 0prin tracţiunea mu5c6il!r1

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Examenul clinic exo-bucalSemne clinice$edemul 2 <"acie n &ut!i>ec6im!4e - n !c6elari ?!c6i de rat!n/panda>

  - n m!n!cluc6em!4iul6emat!mulec!riaţiiplăgile părţil!r m!ide"!rmaţia "eţei 2 pră&u5irea eta8ului mi8l!ciu

  - alungirea eta8ului mi8l!ciu

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Examenul clinic exo-bucalSemne clinice$Deplasările osoase -inpecţie 0nc6ide* dec6ide gura1

-palpare - de"!rmare

- dic!ntinuitate  - m!&ilitate !!aă Emfizemul subcutanatTulburările de sensibilitate$ - 6ip!ete4ii

  - anete4ii

  - durere

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Examenul clinic exo-bucalSemne clinice$EpistaxisulRinolicoreea 0lic6id ce"al!ra6idian n "!a na4ală1

Tulburări oculare: -dipl!pie  - midria4ă

  - de#ierea a3ului gl!&il!r !culari

  - căderea acuităţii #i4uale

  - cecitateEpifora

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Examenul clinic endo-bucalSemne clinice$

Ec!imoze " plăgiDeformarea arcadelor dentareTulburări de ocluzie#obilitate osoasă anormală

$imitarea desc!iderii gurii

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Examenul clinicTulburări funcţionale:Repiraţie

MaticatieF!natie

@eglutiţie

iperali#aţie

SE#%E &' S'#(T)#E DE $)C*$'+*RE

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Fracturile ocluzo-faciale

  Fracturile transersale ,oase $e Fort '.: 

'c(imoze: n 5anţurile na4! 5i la&i!geniene*

 n muc!aa #eti&ulară 0n p!tc!a#ă1*

 n &!lta 5i #ălul palatin 

Tulburări de ocluzie  uncte dureroase /n 0anţul estibular1 retrotuberozitar 

 

Rx-)(T

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Fracturile transersale mi,locii $e Fort ''.:

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tume"ierea "eţei* edem* ec6im!4e palpe&rale* c6em!4i*ec6im!4e n "undul de ac #eti&ular 

de"!rmarea "eţei 2 na turtit epita3i 2 epi"!ra

tul&urări de !clu4ie em"i4em u&cutanat dic!ntinuitate !!aă m!&ilitate an!rmală a !ael!r na4ale 5i ap!"i4el!r

acendente ale ma3ilarel!r* a &l!cului al#e!l!-palatin parete4ii* 6ip!ete4ii* anete4ii pe ner#ul in"ra!r&itar,

Fracturile transersale mi,locii $e Fort ''.:

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Fracturile transersale mi,locii $e Fort ''.:

Rx: - semiaxială antero-posterioară  - S2*2F2

  - de profil a masiului facial  - C2T2  - R2#2%

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Fracturile transersale /nalte $e Fort '''.:

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- de"!rmaţia "eţei 2 n"undare mare 0deplaare p!teri!r 5i n 8!1

- "ală pr!genie - ec6im!4e palpe&rale &ilaterale

- c6em!4i c!n8uncti#!-&ul&ar  - epi"!ra 2 epita3i - curgere de lic6id ce"al!-ra6idian - 6emat!ame retr!&ul&are

- tul&urări !culare$ - e3!"talmie  - dipl!pie

  - tra&im

  - cecitate

 m!&ilitate an!rmală 2 mai#ul "acial e ridică 5i e

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c!&!ară la nc6iderea 2 dec6iderea gurii

 tul&urări de !clu4ie - !clu4ie dec6iă

  - !clu4ie ncruci5ată

 tul&urări "uncţi!nale 

Rx: - semiaxială

  - S2*2F2  - C2T2

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Fracturile erticale:

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#ediane:

tume"iere 5i ec6im!4ă a &u4ei uperi!are

!luţie de c!ntinuitate ntre I,C, a "i&r!muc!aei tul&urări de !clu4ie 2 n en lateral m!&ilitate !!aă an!rmală

Fracturile erticale:

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- (aramediane  !luţie de c!ntinuitate la&ială* gingi#ală* pe &!ltă deplaare pre na"ară* n 8! tul&urări de !clu4ie

m!&ilitate !!aă 6em!ragii intrainuale* na4ale  re"luarea alimentel!r pe na

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Fracturile complexe:

deplaări* de"!rmări mari

6em!ragii

di"icultăţi repirat!rii tul&urări de !clu4ie

Rx: - C2T2 0i R2#2%2

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Fracturile parţiale$-

De rebord aleolar

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De rebord aleolar 

 - "ragmentul "i3at la peri!t au deprin

 - le4iuni dent!-par!d!ntale  - dec6iderea inuului ma3ilar - c!municări  - ec6im!4e  - tul&urări de !clu4ie

- epita3i

De tuberozitate - deprinderea "ragmentului !! - dec6iderea inuului - 6em!ragii - 6emat!ame - tul&urări de !clu4ie - epita3i - c!municări &uc!-inuale

Fracturile posterioare (ale arcadei zigomatice):

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p ( g )

 - ec6im!4e - ec!riaţii

 - puncte durer!ae

 - n"undare

 - limitarea dec6iderii gurii

 - edem 2 tume"acţie

Rx: - incidenţa axială 0i semiaxială

Fracturile parţiale: - de re&!rd !r&itar lateral au in"eri!r - treaptă* 5anţ

ec6im! ă

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  - ec6im!4ă

  - 6emat!m  - e3c!riaţie - plagă

  - de"!rmare

  - durere

- de plan5eu !r&itar - edem  - ec6im!4ă palpe&rală

  - c6em!4i

  - en!"talmie

  - dipl!pie

  - tra&im

  - epita3i

Fracturi asociate (cranio-faciale)

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- le4iuni ence"alice - c!m!ţia cere&rală  - c!ntu4ia cere&rală

  - dilacerare cere&rală

  - edemul cere&ral

- le4iuni meningeale

- le4iuni neur!l!gice

- tul&urări !l"acti#e

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EVOLUBIE

  C!n!lidare rapidă - calu "i&r! 2 '-.( 4ile  - calu !! 2 (-+( 4ile

COMDLICABII

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 I, IME@IATE

.  'nsuficienţa respiratorie acută prin$

- retrudarea mai#ului "acial

  - c!rpii trăini

  - ali#ă - 7nge  - 6emat!m peri"aringian

  - edemul na4al 5i "aringian

  - căderea lim&ii

 

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3. !cul 6em!ragic- 6em!ragii mai#e

;. !cul traumatic 2 prin timularea recept!ril!r ner#!5i, 

, Edemul cere&ral

 

''2 SEC3%D*RE 2 in"ecţiile

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'''2 T*RD'4E:- c!n!lidare #ici!aă - tul&urări de !clu4ie

  - tul&urări "i4i!n!mice

- c!municări &uc!-na4ale 5i &uc!-inuale- dipl!pia

- tul&urări repirat!rii

- tul&urări neur!l!gice 2 6ip!ete4ie* anete4ie*ne#ralgii

- &l!carea dec6iderii gurii

- c!ntricţia 5i anc6il!4a temp!r!-mandi&ulară

TR*T*#E%T

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Constituie urgenţă chirurgicală:

.,  tratament de urgenţă 0pr!#i4!rie1

,  tratament primar 0de"initi#1

+,  tratament ecundar 0de ntreţinere1

,  tratament tardi# 0al c!mplicaţiil!r tardi#e1

1. Tratamentul de urgenţă 

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- de e3tremă urgenţă 0al c!mplicaţiil!r #itale1- urgenţa #itală am7nată 2 A,%,C,

  - aigurarea permea&ilităţii căil!r aeriene 5i

menţinerea l!r   - aigurarea circulaţiei$ - c!m&aterea t!pului

cardiac 5i reluarea unui ritm p!ntan

  - !prirea 6em!ragiei

  - re"acerea maei anguine

52 Tratamentul specific în „urgenţa imediată”:

- reducerea 5i im!&ili4area pr!#i4!rie a "racturil!r 

- antialgic

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- anti&i!pr!"ila3ia

- er!terapia antitetanică

  'mobilizarea proizorie:  - mi,loace inter-cranio-maxilare  - &anda8 ment!ce"alic

  - "r!ndă ment!nieră  - dip!4iti#ul n "!rmă de 4ă&ală

- mi,loace interdentare intermaxilare 2 ligaturile de 7rmă

- mi,loacele interdentare monomaxilare

  - ligatura n '  - ligatura n punte

  - ligatura n cară D!nr!G

  - atele #eti&ulare

 

62 Tratamentul definiti primar 

Ideal 2 c7t mai prec!ce 5i mai c!mplet

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@e !&icei n <urgenţă am7nată> 2 la -'6* une!rila -' 4ile

Se "ace prin$ - reducerea anat!mică a"ragmentel!r !!ae

  - im!&ili4are

  - rec!ntrucţia părţil!r m!i  - reta&ilirea tării generale

(regătirea traumatizatului

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 - l!c!-regi!nală

 - generală

 - anete4ia

 - anti&i!terapia - medicaţia antiedemat!aă

Reducerea fragmentelor 

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- manuală

- !rt!pedică - tracţiuni elatice interma3ilare

  - tracţiuni elatice inter-crani!-ma3ilare

- intrumentală  - c6irurgicală 0dec6iă1

'mobilizarea fragmentelor de fractură:

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#etode ortopedice: - m!n!ma3ilare - atele

  - &raHet-uri

  - plăcuţa palatinală

 - iteme inter-ma3il!-mandi&ulare

 - iteme inter-crani!-ma3ilare

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#etode c!irurgicale- upenia internă

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  - la arcada 4ig!matică

  - la ap!"i4a malară a "r!ntalului

  - la !ul parietal

  - la re&!rdul !r&itar in"eri!r 

  - la arcada 4ig!mat!-al#e!lară

  - la pina na4ală

  - "i3at!ri e3terni

- met!de intra"!cale = !te!inte4ă - cu "ir metalic- cu plăcuţe metalice au re4!r&a&ile

 

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'%D'C*7'' TER*(E3T'CE 8% F3%C7'E DE F)R#*DE FR*CT3R9

Fracturile ocluzo-faciale

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- reducere 5i im!&ili4are - !rt!pedic* prin tracţiunielatice inter-ma3il!-mandi&ulare

  - !te!inte4ă

  - upenie internă

 

Fracturile centro-faciale

- e reduc 5i im!&ili4ea4ă c6irurgical

Fracturile latero-faciale

d 6i i l i l il d l

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- e reduc c6irurgical 2 n primele - 4ile de laaccident pe cale anteri!ară

- pe cale temp!rală 2 Killie-@an Te!d!recu

- pe cale inuală 5i rin!l!gică

- pe cale end!&ucală- !te!inte4a cu "ir metalic au plăcuţe

metalice

 

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'ndicaţiile osteosintezei$

"racturi #ec6i cu tendinţă la ren"undare

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- "racturi #ec6i cu tendinţă la ren"undare

- "racturi cu diata4i mare

- "racturi cu interpunere de alte ţeuturi n "!carulde "ractură

 )steosinteza se face la nielul:

- ap!"i4ei "r!nt!-malare- re&!rdului !r&itar in"eri!r 

-  8!ncţiunii ma3il!-malare

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Tratamentul sec!elelor:

- !te!t!mii ale "ragmentel!r #ici!c!n!lidate* rep!4iţi!nare 5i "i3are prin

!te!inte4ă

- platii de adiţie,

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  Cazuri clinice

Fracturi de masivfacial

 

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