重型口腔颌面部创伤的临床救治

Clinial management of severe oral and maxillofacial injuries

目的 通过 52 0例口腔颌面部创伤病例的回顾性临床分析 ,探讨特殊类型重型颌面部损伤的救治方法。 方法 选取我科近 2 1年口腔颌面部创伤住院患者病例资料 ,分析损伤类型、相应救治方法和临床疗效。通过 4例典型病例 ,探讨颈部血管损伤、颅面多发伤、中面部骨折和面神经损伤的救治要点。 结果 全部患者无一例死亡 ,均获得良好疗效。 结论 颈动脉损伤应即刻修复 ,恢复大脑血供 ;颅面多发伤应在颅脑伤情稳定后 ,于伤后 7～ 14d行颌面部骨损伤的确定性治疗 ;中面部骨折采用骨折开放复位、坚固内固定的手术方法可获更好的治疗效果 ;面神经损伤应尽可能在伤后 3

Objective To investigate the treatment of severe oral an d maxillofacial injuries through a retrospective clinical analysis of 520 cases of oral and maxillofacial injuries. Methods The full data of 520 cases admitted in our department from January 1982 to December 2002 were an alyzed retrospectively so as to study the injury types, the corresponding treatm ent measures and the clinical curative effect. Based on four typical cases, we d iscussed the key management points for carotid artery injuries, multiple craniof acial injuries, midfacial fractures and facial nerve injuries. Results All cases gained good clinical recovery with no death occurred. Conclusions For carotid artery injuries, immediate repair should be done in order to resume blood supply. For multiple craniofacial injuries, spe cialized management should not be performed 7-14 days after injury until cranio cerebral injuries are under control. Open reduction and rigid internal fixation can get better clinical outcome for midfacial fractures. Facial nerve injuries s hould be repaired as soon as possible within 30 days after trauma.