Oral Trauma

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CLINICAL DESCRIPTION

Facial trauma may involve injuries to the soft tissue of the face to the mandible or maxilla, the cheekbones or the zygomatic arch, the nose, eye sockets or the teeth. Oral and maxillofacial trauma may result in the following:

  • Fractures of the teeth and alveolar bone
  • Fractures of the maxilla, mandible orbit and nose
  • Contusions, lacerations, and cuts of soft tissues in general, the trauma varies in severity and may be associated with a variety of complications
    • Severe hemorrhage, Airway obstruction, Trauma to the eye, Injury to intracranial structures, Injuries to the cervical spine, Contamination and/or infection of tissues
    • Varying degrees of deformity and interference with the function(s) of the injured structure/organ.

CLINICAL FEATURESSIGNS AND SYMPTOMS

  • Pain on opening the mouth, bruising, swelling, or tenderness
  • Difficulty in chewing, speaking, or breathing Loose, broken, or missing teeth
  • Change in the biting of teeth
  • Bleeding from the mouth

INVESTIGATIONS

  • FBC
  • CT Scan
  • Skull views (PA ,LO,TL, OMV ,SMV, OPG)

TreatmentNON-PHARMACOLOGICAL 

  • Maintain patent airway
  • Clean the area with NSS
  • Check for fractures and break in the skin or mucosa, treat accordingly
  • Control bleeding without damaging tissue, by suturing or gauze packs
  • Always suture the facial skin with fine nylon 4/o or 5/o
  • Ensure proper apposition of skin edges
  • Sutures and simple fractures can be treated under local anesthesia
  • Complex and complicated fractures may be treated under LA and pre-medicated with Pethidine 100mg IM for 18 years and above
  • Fractures not suited under local anesthesia must be treated under general anesthesia
  • Remove stitches on the 7-10th day

PHARMACOLOGICAL 

  • Give Penicillin orally when able to swallow or parenteral if they cannot swallow
  • Give Tetanus toxoid – tetanus antitoxin prophylaxis 1500 IU SC/IM if actively immunized plus
    • If not actively immunized give the above plus first dose vaccine 0.5 ml, then Second dose vaccine 0.5 ml after 1 to 2 months, then third dose vaccine 0.5 ml after 6 to 12 months
  • Give analgesics e.g., Paracetamol 1 gm 8 hourly for 3 days. When in severe pain give Pethidine 50−100 mg IM STAT

Admit If

  • In severe pain
  • Blood loss is severe
  • Injuries are extensive
  • Airway is compromised