By Dr. Vishaal Bhat on Monday 19 November 2007 with 0 comments

A polytrauma is a clinical unit that means a short equivalent for the term “multiple injuries with an immediate damage to a vital organ, followed by failures of vital functions”.

The term “polytrauma” has to be understood as an accidental injury of several anatomic systems of an organism, the general state of organism, not a simple addition of individual wounds of various seriousness and extent. The course of an illness depends not only on the degree of damage to individual organs, but also on significant participation of systems, whose anatomical damages would be totally diminutive. Moreover, the injury influences pathologically also systems that are not directly affected by a trauma. The prototypes of polytraumas have become road accidents. By their nature, polytraumas do not allow for an immediate treatment of all injured parts. The dominant nature of injuries to vital organs require other wounds to wait for attention. Statistical analyses show occurrence of serious injuries of maxillo-facial area with a consequent affection of the middle facial third, in cases of polytraumas. Such injuries are combined with brain damages of various degree (88%), defects of lower (25%) and upper limbs (24%). Chest injuries occur at 15% of cases, damages of the spinal chord, abdomen and pelvis happen less frequently.

The treatment strategy is based on a five-step therapeutic plan:

  1. reanimation

  2. the first surgical phase (life-saving activities)

  3. phase of an active awaiting - to stabilize a patient’s condition

  4. the second surgical phase (final treatment)

  5. recovery and rehabilitation phase

Treatment of combined injuries of the facial area should assure the following:

At first, all attention has to be paid to making the airways free (releasing of stuck tongue, foreign object inside the mouth, mucous scraps and coagula). If the airways cannot be freed, breathing has to be enabled by tracheotomy or by a long-term intubation.

The second phase consists of treatments directed towards bleeding control and suturing situationally soft tissues. In cases of defective wounds, these are sutured by “enwreathing”. No long-term actions may be undertaken (such as osteosynthesis), bone fragments are fixed temporarily mainly by fixtures and dental splints.

The phase of stabilization of the general patient’s condition does not mean a period of a physician’s inactivity. A definite therapy and further treatments should be planned. An inter-disciplinary collaboration helps to specify a diagnosis and get all technical tools ready. A sufficient fixation of bone fragments has to be provided during the awaiting phase. Care should be also taken about the oral cavity, damaged soft tissues and patient’s diet.

A rigid inter-maxillary fixation with the aid of dental splints belongs among the basic methods of treatment of maxillo-facial injuries. In cases of polytraumas is the firm intermaxillary fixation undesirable for the following reasons: it does not allow for intubation by mouth, draining from airways is difficult, lung ventilation is worsened, food intake, introduction of a stomach probe and the oral hygiene are troublesome. During the final treatment of fractures of jawbones, it is necessary to use such methods of osteosynthesis that do not require intermaxillary fixation (such as minisplints). Besides taking care of injuries at the last phase of therapy, a complex stomatological treatment should be done. An active rehabilitation is very important as well. Secondary surgeries take place during this phase, as well as necessary corrections in order to achieve optimal results of the treatment and to minimize permanent consequences of an injury.

Category: Oro-Maxillo Facial Surgery Notes



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