Management of Maxillofacial Fracture: Experience of Emergency and Trauma Acute Care Surgery Department of Sanglah General Hospital Denpasar Bali

Abstract

BACKGROUND: Maxillofacial fracture is one of the major trauma; the cases were increasing because of the high number of motorcycles in Bali. The goal of the treatment is proper positioning of the occlusion, and it depends on rapid diagnosis and proper treatment.
 AIM: This study aims to know the characteristics of the maxillofacial fracture patients in Sanglah General Hospital Denpasar Bali.
 METHODS: A retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January to June 2015. Total recorded patient were 35 patients. The data obtained include age, gender, type of the fractures, and operation management.
 RESULTS: The injury was more common in male compared to female (80% vs 20%). Age 20 to 40 years old were more common (48.57%), followed by the child to adolescent (aged 0 to 20 years old) were 31.43%, and adult to elderly (aged 40 to 60 years old) was 20%. The mandibular fracture was most common (51.43%), other fractures such as a zygomatic fracture (31.43%) and maxillary fracture (17.14%). Internal fixation was the gold standard of the treatment (65.71%), and the other was an arch bar (34.29%).
 CONCLUSION: Diagnosing the right injury to the facial bone is a key step in determining a treatment plan. Rapid diagnosis and proper treatment lead to good occlusion, both internal fixation and arch bar were an effective treatment. The importance of dealing with almost all maxillofacial fracture problems in the first surgery.

Management of Multiple Maxillofacial Fracture With Mild Head Injury

“…In multiple facial trauma, anatomic reference points may be more difficult to expose and may be comminuted and therefore unable to provide proper reduction, so open reduction and internal fixation in this patients was initiated from the mandible to restore the anatomical position and supporting structures which are the key to fracture reduction. 1,6,17 The open reduction internal fixation (ORIF) procedure in this case was performed one week after the trauma, there were problems with the left maxillary comminuted fragment. Reduction of zygmoatic complex fractures becomes more difficult with time, and surgery may be delayed up to 10 days if necessary to wait for the edema to subside, making it easier to manipulate the fracture area and soft tissue.…”

“…Direct trauma usually occurs in the occipital, mastoid, supraorbital area, while indirect trauma usually occurs on the face, where then the force is transmitted through the bones of the face or lower jaw. 3,6,9 Based on history taking, physical examination, and investigations, this case was diagnosed with a mild head injury. Head injury is one of the main causes of death and disability in the productive age group and mostly occurs due to traffic accidents.…”

“…Plates and screws have been used over the past few decades to facilitate stability of bone fragments in the maxillofacial region, and are currently the most frequently used technique. 6,7,9 The open reduction technique with internal fixation or known as open reduction and internal fixation (ORIF) in facial trauma was introduced in 1975. This technique applies the principle of orthopedic materials to the facial bones using plates and screws.…”

“…Radiographic examination is very essential in studying and evaluating a fracture. 2,5,6 Anatomically, the head is divided into the skull (cranium) and the facial bones. The skull bones consist of the calvary bones and the skull base bones, while the facial bones consist of the maxilla, zygoma, lacrimal, nasal, and vomer bone.…”

“…Among the patients who arrived at the hospital, 80% were classified as mild head injuries, 10% were categorized to moderate injuries, and 10% were included as severe head injuries. 3,5,6 Head injury is a series of pathophysiological events that occur after head trauma which can involve the scalp, bone and brain tissue or a combination thereof. Head injuries were classified according to the Glasgow Coma Scale (GCS) score.…”