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Fronto-facial injuries
05-09-2009
Fronto-facial injuries are among the most severe cranio-facial injuries. In fracture of the upper jaw, it causes fracture of the frontal bone, the anterior cranial fossa, ethmoid bone, nasal bones. Possible contusion of the frontal lobes.
Clinical features of fronto-facial injuries has several features, among them - expressed not only swelling of facial tissues, but the head. Because edema is sometimes impossible to inspect the eye, which is important to identify their trauma, as well as the destruction of the optic, oculomotor nerves. With such injuries can be compression of the optic nerve in its canal, damage to the area intersection, as well as bruising to the retrobulbarno area. Patients immediately after trauma may be expressed by bleeding from the nose, which is difficult to stop. This occurs at the turn of the maxilla, ethmoid bone, nasal bones. It is often noted liquorrhea, including difficult to diagnose - «hidden liquorrhea». All patients with fronto-facial fractures should be treated as patients with liquorrhea. Stop the bleeding from the nose, including at the turn of the upper jaw, the skull base, can sometimes posterior nasal tamponade. Such patients often impose traheostomu as intubation through the glottis rather difficult. At the same time, they have often been observed aspiration of vomit, blood, mucus, making it necessary to reorganize the first tracheobronchial tree through traheostomu.
The defeat of the frontal lobes of the brain affects the behavior of the patient and determines the identity of the clinical picture. Patients disoriented in their own identity, place and time. Expressed negativism, resisting inspection, uncritical attitude toward his condition, stereotyped in speech behavior. They expressed bulimia, thirst, untidiness. Perhaps psychomotor agitation.
Providing first aid, it is necessary to normalize the breath of the victim, stop the bleeding and begin to fulfill protivoshokovym event.
Before removing the patient from shock to primary surgical treatment of wounds of the head and face is contraindicated.
Surgeries are taking just to survive. Required viewing ophthalmologist, neurologist, if indicated - a neurosurgeon. There should be an x-ray study of the skull and face bones in two projections. Appears intracranial hematoma is removed as soon as possible. Therapeutic immobilization exercise no sooner than 4-7 days after removing the patient from serious condition.
Permanent (medical) immobilization broken upper jaw injuries when the brain is possible only after stabilization of vital functions (blood pressure, respiration, cardiac activity). It is possible to achieve at 2-4-th day since the injury.
From a practical point of view, cranio-cerebral trauma associated with fractures of the face (including the upper jaw), divided into four groups [YE Gelman, 1977]:
▲ I - severe head injury (contusion of the brain of severe and moderate severity, intracranial hematoma) and severe bone fracture face (fracture of the upper jaw of Le Fort II, Le Fort I, fracture of the upper jaw and lower at the same time, etc.). In half of these patients developed traumatic shock. Temporary immobilization is possible immediately after removing from the shock. Medical immobilization: conservative methods - to 2-5-th day; osteosynthesis - no earlier than the 7-th day;
▲ II - severe head injury and non-severe trauma face bones (fracture of the upper jaw of Le Fort III, unilateral fractures of the upper and lower jaw, cheekbones, etc.). Therapeutic immobilization can be carried out in 1-3rd day;
▲ III - non-severe head injury (concussion, contusion of the brain mild) and severe damage to the bones of the face. Severity of the condition is mainly due to injury of the facial skeleton. Therapeutic immobilization, including the fixation, it is possible in the first day after injury;
▲ IV - non-severe head injury and not heavy damage to the bones of the face. Immobilization of bone fragments can be carried out within the first hours after injury.
Treatment of patients with CoN ™. Our clinical experience and literature data indicate that early specialist treatment not only aggravates the patient's condition, but also contributes to an earlier termination liquorrhea, reduces the risk of intracranial inflammatory complications.
Patients with head injury and fractures of the facial skeleton usually come in poor condition due to possible fracture of the vault and base of the skull, contusion of the frontal and temporal lobes of the brain, massive bone fractures faces. In addition, fractures of the upper jaw is very shokogenny. Patients are often found in a coma. Their condition is aggravated by external respiratory disorder due to excessive bleeding and cerebrospinal fluid with aspiration of blood, cerebrospinal fluid and vomit.
Treatment of patients with CoN ™ consists of three tasks:
▲ fighting threaten to disrupt vital functions of the body, bleeding, shock, compression and swelling of the brain;
▲ local treatment of cranial and extracranial lesions, which begin immediately after diagnosis and early prevention of possible complications. Treatment may include radical surgery at different times after injury, depending on the overall condition of the patient, severity of brain damage. When kraniofastsialnoy trauma most rational and recognized kraniomaksillyarnaya kraniomandibulyarnaya fixation, which allows for sealing of the cerebral skull. Eliminate the cause of compression of the brain and provide a reliable immobilization of bone fragments jaw (jaws). .
▲ medical, social and labor rehabilitation of the affected [Likhterman LB, Fraerman AP, 1994].
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Articles for theme "face":
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03-09-2009
Aging, «return of youth» and prolong life, interested person from the time of antiquity. Nature has endowed man short-lived, but its physiological resources, its reserves, margin, calculated for more. Such facts are known: in Iran, lived an old man, who has worked for 195 years without glasses, and in Bolivia, a woman retained the ability to work in 203 years. In 1925, in Hungary, died on the couple when he was 172 years, and she - 164. Many examples of longevity and the Caucasus, but that life expectancy remains low: 60-70 years, and in some countries up to 40 years.
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03-09-2009
While studying sculpture and painting portraits of the natural person or people who can distinguish the set of distinctive features that define the individuality of appearance, on the one hand, and the condition of the person (alive or portrait) - on the other. It's head and, accordingly, a person is part of the body, to a greater degree of personally identifiable individual. Externally, the person can be broadly defined physical and mental condition. It suffices to recall the expression of individuals in a state of agony in the religious ( «Crucifixion», «Sv.
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03-09-2009
Approximately 18 years of age the skin of a human face looks fresh, smooth and elastic. In adolescence, the external shape of the face changes in volumetric and proportional relationships, and by 30-35 years, it is formed completely, that is, in the dawn of life.
At maturity (after 40 years), there is a trend gaining weight, even in lean people. Undoubtedly, a role played by biological type, health and «modus vivendi», ie the image of human life. Fatty tissue on the face alters the familiar face.
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03-09-2009
In living nature, as in the material world in general, there is no completely symmetric or completely asymmetric objects. This principle of the structure of matter affects all its components: space, energy, physics, chemistry, biology, cells, atoms, electrons and quanta. In any object there is always the unity of symmetry and asymmetry.
Man, like vertebrates, bilateral symmetry of the body in the form of pairing organs or the presence of left and right halves of the individual parts and organs.
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03-09-2009
1. The pleasure (joy, happiness, laughter, smile, satisfaction, sympathy).
The intensity of expression of these emotions to a greater extent determined by the degree of displacement sideways commissure of the lips, the degree of opening of the mouth and the number of exposed teeth, and the degree of closure century.
With a smile:
closed-mouth or just slightly open, lower jaw slightly shifted downwards;
-commissure lip shifted to the side and upwards, the lips become thinner, more closely pressed to the teeth (reduced zygomaticus major muscle and muscle of the angle of the mouth).
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