Chapter 11. Non-fire and firearm injuries of the face. Thermal and radiation lesions of the maxillofacial region (V.V. Afanasyev)
17 topics with brief breakdowns: definitions, key facts, and class questions.
The chapter covers mechanical, thermal, and radiation injuries of the maxillofacial region. It reviews all types of trauma: from domestic non-firearm soft tissue injuries and mandibular dislocations to severe gunshot wounds and polytrauma.
The material covers the clinical presentation and treatment of facial bone fractures (upper and lower jaws, zygomatic bone and arch, nasal bones), rules for transport and therapeutic jaw immobilization, and principles of primary surgical wound debridement (PSD). Special attention is paid to the specifics of burns, frostbite, radiation injuries, and the prevention of post-traumatic complications.
Exams and clinical duty shifts most frequently focus on the biomechanics of mandibular fractures, immobilization methods, the PSD algorithm taking into account the blood supply and innervation features of the face, and the management strategy for patients with combined maxillofacial trauma.
Why is the pulp not removed immediately in case of subluxation?
The absence of electrical excitability (according to pulp testing) in the first weeks does not always mean irreversible pulp death. The tooth is monitored dynamically, as recovery of values may take several months.
What is the advantage of MRI over X-ray in TMJ examination?
MRI allows detailed visualization of not only the bones, but also soft tissue structures: the capsule, ligaments, articular disc, and surrounding muscles, including dynamically during jaw movement.
Why are fractures within the dental arch always open?
The mucosa of the alveolar part is fixed and tears together with the periosteum during bone dislocation. If the line passes through the socket, the wound communicates with the oral cavity through the torn periodontal ligament of the tooth.
What is the difference between one-stage and gradual reposition?
One-stage reposition implies returning fragments to their place immediately in a single procedure. Gradual reposition is used when the rapid option is impossible, utilizing elastic traction that aligns the bones over several days.
Why is delayed tooth extraction from the fracture line performed precisely on days 12–14?
By this time, a primary callus forms, stabilizing the bone fragment. Simultaneously, traumatic periodontitis develops, which reduces the retention strength of the root, facilitating its luxation.
What is the essence of Kazanjian's method?
Surgical passage of a wire loop through the infraorbital margin of the zygomatic bone, followed by fixation of the externally led hook to a rod on a plaster cap.
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