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    Traumatismeleregiunii

    OMF

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    TRAUMATISMELE ORO-MAXILO-FACIALE

    Traumatismele partilor moi

    Fracturi de mandibula

    Fracturile etajului mijlociu al fetei

    Fracturile complexului zigomatico-maxilar

    Traumatismele priamidei nazale

    Traumatismele dento-parodontale

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    I.Traumatisme de parti moi

    Caracteristici :

    Derm elastic

    Strat grasos sarac eceptie ge!ia!"maseteri! #asculari$atie %ogata &re$e!ta di!tilor Mucoasa adere!ta Raporturi cu caile aero-digesti'e"!eurocra!iu Risc mare de i!(ectie &ot duce la des)gurari * importa!ta asupra

    psi+icului pac ,

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    Etiopatoge!ie/ le$iu!i traumatice0-1/ traumatisme ce(alice

    2/ %ar%ati3-4 a!i3/ accide!te rutiereAgresiu!i uma!e

    Accide!te de mu!ca5sporti'e5 muscaturiIatroge!ii stomatologiceArme de (oc * rar 6pe timp de pace7Automuscare

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    Forme a!atomo-cli!ice

    Clasi)care 8 - i!c+ise 9 co!tu$ii 8 ec+imo$e5+ematoame5etc - desc+ise 9 plagile 8

    - ecoriatii - li!iare - $dro%ite - muscate5s(asiate5smulse - asociate cu (racturi - mutila!te Arsurile * 'eci!atatea cu caile aero-digesti'e

    superioare ,

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    SimptomatologieDurereaSolutia de co!ti!uitate 8 (orma margi!ilor

    plagii5 particularitatile plagilor pri! arme de(oc

    A!este$ia locala&arali$ia localaFistule sali'are:ipersialieTul%urari (u!ctio!ale

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    Tul%urari asociate:emoragiaSoc traumatic 8

    I!su)cie!ta resp. ac. 8 o%structia CAS5edem CAS

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    Complicatiile Secundare :

    . I!(ectii

    3. :emoragii secu!dare

    ;. Fistule sali'are

    0. Complicatii septice4. Complicatii !er'oase 8

    a!este$ie5+ipo

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    Tratame!t de urge!ta al

    complicatiilor:emoragia 8

    - +emosta$a de urge!ta

    - ligaturi i! masa 6dispo$iti' =a$a!>ia!7 - compresiu!e digitala 6ACE5ramuri7

    - repletie 'olemica

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    Tratame!tul de urge!ta al

    plagilorFara eci$ii largi

    Se 'a (ace imo%ili$area (racturilor

    Lam%ouri )ate cat mai asema!ator cu!ormalul

    Fragme!te adere!te de periost se pastrea$a

    Se etrag doar di!tii (oarte mo%ili

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    Tratame!tul plagilorTimpii 8

    - curatarea

    - imo%ili$area (ragme!telor osoase - sutura 8 per prima5 de po$itie5 primara

    i!tar$iata5 secu!dara

    - com%aterea i!(ectiilor 8 dre!a>5 pa!same!t5

    igie!a - alime!tatie

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    Tratame!t asociat

    A% Seropro)laie teta!ica

    #acci!are a!tira%ica

    Tratame!t reparator tardi'

    Sec+ele plagilor 8 cicatrici c+eloide5etc

    Supuratii sti!se

    &laga complet cicatri$ata

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    TRAUMATISMELE ORO-MAXILO-

    FACIALEI. Traumatismele partilor moi

    I.3 Fracturi de ma!di%ula

    I.; Fracturile eta>ului mi>lociu al (eteiI.0 Fracturile compleului $igomatico-mailar

    I.4 Traumatismele priamidei !a$ale

    I.1 Traumatismele de!to-parodo!tale

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    I.3 Fracturi de ma!di%ulaEtiologie 8 agresiu!i5accide!te.

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    Meca!isme de producereSediul este co!ditio!at de Locul de aplicare a F Directia I!te!sit age!tului Re$iste!ta osului data de8 - (orma

    - grosime - co!)guratia osului - 'arsta - %oli ge!erale

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    Deplasarea (ragme!telor&rimara 8 soc traumaticSecu!dara 8

    - co!tractia musculara - directia " !r li!ilor de (ractuta

    - statusul de!tar

    Deplasari 8

    - 'ertical9decala> - ori$o!tal9i!calecare

    - sagital9rastur!are #

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    Forme a!atomo-cli!iceFu!ctie de sediu5grad de i!teresare5!r li!ii

    (ract.

    Simple

    Li!iare

    Comi!uti'e

    Complete < i!complete

    Totale 8 media!e5paramedia!e5laterale5 deu!g+i5 de ram5 de co!dil5 de apo)$acoro!oida.

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    Fracturi media!e

    I!c+iderea

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    Fracturi paramedia!eIC-C

    454/ (racturi ma!d

    Deplasari secu!dare (ragme!tul mare * postero-i!(erior

    (ragme!tul mic - a!tero-superior

    R!-OT

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    Fracturi laterale

    C-M;@-;/ (racturi ma!di%ulaDeplasari primare si secu!dare

    I!teresarea ca!alului ma!di%ularClinic8- tume(actie ge!ia!a si su%ma!d

    - ec+imo$e i! pla!seu %ucal

    - dis(agie - deplasare ori$o!tal 8 scurtari dema!d5de'ieri de me!to!Mandibula de"lata#panoramica# axiale

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    Fracturi de u!g+i

    Cur%ura osului " eruptia M;

    -34/ (ract de ma!dDirect " i!direct 6%ar%ie 7Deplasari (u!ctie de i!teresarea i!sertiilor

    musculare pterigoid"maseterClinic

    - tume(actie marcata a reg parotideo-maseteri!e

    - trismus - dis(agie - durere la apasare pe u!g+i sau me!to! - daca apar deplasari 8 tume(actii

    marii5+ematoame de pla!seu

    Mandibula de"lata

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    Fracturi de ram

    3-4/#erticale 8 marg %a$-i!ci$ura sigm (ara deplasari

    Ori$o!tale 8 lociuO%lice 8 i!ci$ sigm * marg post ramScurtari ale ramului * de'ierea li!iei

    media!eClinic

    - tume(actie parotideo-maseteri!a - durere - i!oclu$ie (ro!tala

    - oclu$ie i! 3 timpi-

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    Fracturi de co!dil

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    Fracturi de co!dil

    @5-;1/Fractura intracapsulara - $dro%irea capului co!dilia! - i!teresarea co!ductului auditi' - limitarea misc ma!d5dureri5otoragie

    - ma!di%ula de)lata5&arma5BealFractura extracapsulara - su%co!dilia!a i!alta - me!to! de'iat de partea (racturata

    - palparea co!ductului 8 a%se!tamiscarilor - oclu$ie i! 3 timpiFractura subcondiliana joasa 8 li!ie postero-

    i!(erioara

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    Fracturile apo)$ei

    coro!oideI!(u!darea arcadei temporo-$igomaticeDirectie o%lica pri! i!ci$ura sigmoida i! >os si

    a!terior

    Limitare dureroasa a desc+iderii gurii

    Fara deplasare 8 e'ide!tiere strict RX6ma!di%ula de)lata5 aiala :irt$7

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    Fracturi multipleDeplasari mari ale (ragme!telor&aramedia!e " laterale sau u!g+i

    Laterale du%le

    Media!e

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    Fracturi comi!uti'eLocali$ari multiple#arietate (oarte mare a li!ilor de (ractura

    Le$iu!i marcate ale partilor moi

    Age!t puter!ic 8 metal5eplo$ii5proiectile

    De(ecte osoase

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    Fracturi partialeCo!ti!uitate pastrataFracturi de creasta5 (ro!taleSimptome 8

    - impote!ta (u!ctio!ala

    - durere 'ie

    - sialoree

    - de(ormare a co!turului (acial

    - tume(actie5ec+imo$e

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    Fracturi partialealpare8 - mo%ilitate a!ormala - a%se!ta tra!smiterii miscarilor

    - +ipoeste$ie5a!este$ie5pareste$ie$iagnostic 8

    - de(ormatii osoase - crepitattii osoase - lipsa tra!smiterii miscarilor - tul%urari oclu$ieOT #tomogra"e#arma#%eal&

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    E'olutia (racturilor. Calus )%ri!oproteic 9 posttraumatic 4-$

    3. Calus )%ri!os pro'i$oriu 0-1$

    ;. Calus osos primiti' 9 em%rio!ar

    0. Calus osos de)!iti' 9 propriu-$is ;-0$

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    Complicatiile

    . Complicatii imediate

    3. Complicatii secu!dare

    ;. Complicatii tardi'e

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    Complicatiile imediateComotia cere%rala:emoragia

    Tul%urari respiratorii acute

    Soc traumatic

    Tul%urari de a!este$ie a %u$ei i!(erioare

    - sem!ul #i!ce!t dAlger

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    Complicatiile secu!dareI!(ectii

    Supuratii 8 a%cese sau osteite5osteomieliteRar a%cese pulmo!are

    Complicatiile tardi'e 9

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    Complicatiile tardi'e 9SEC:ELE

    I!atar$ierea i! co!solidare * dupa 2 s

    &seudoartro$a * dupa 1-2 lu!i

    - stra!sa5laa5%ala!ta

    - cli!ic 8 de(ormare5tul% (u!ctio!ale5mo%ilita!ormala5 oclu$ie patologica

    - tratame!t c+irurgical

    Co!solidare 'icioasa * de(ormare5tul% deoclu$ie

    Co!strictie de ma!di%ula * %ride cicatriciale

    A!c+ilo$a ATM * (racturi i!tracapsualre copii

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    Tratame!tul (racturilorDe urge!ta 8 tul%urari ge!erale gra'eUrge!ta al plagilor

    De)!ti' al le$iu!ilor osoase si de parti moi

    Reparator tardi'

    ,, Atitudi!ea (ata de di!tii di! (ocarele de

    (ractura

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    Tratame!tul de urge!ta al (racturilor

    Ba!da> me!toce(alicFro!da me!to!ieraImo%ili$are ma!di%ulo-mailara

    - elastica 8 atele #esti%ulare5)re de sarma5i!elecauciuc

    - rigida 8 - Le%la!c 8 ligat colet %ima

    - I' 8 3dd ma la a!tago!istii

    - Stout 8 colet ultimul M5%uclei!terde!tare

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    Imo%ili$area de)!iti'aCo!te!tieMe!a>area parodo!tiuluiIgie!a %u!a5 alime!tatie adec'ata

    Metode 8 - mo!omailare 8 atele metalice #5 si!e L5

    si!e du%le #-L6=ersti!g75 prote$e5 gutiere acrilice

    - %imailare 8 elastica 8 atele metalice

    :auptmaer rigida 8 ligaturi

    - dispo$iti'e preco!(ectio!ate 8i!estet5Darcisac

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    Tratame!tul c+irurgical al

    (racturilor I!dicatii 8

    - (racturi comi!uti'e5 cu deplasari

    - (racturi asociate (aciale

    - (racturi pri! arme de (oc

    Co!trai!dicatii 8

    - iradiere

    - tesuturi co!tami!ate - a!omalii

    - plagi !ei!c+ise si i!ti!se

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    Tratame!tul c+irurgical al

    (racturilor&roceduri 8

    - osteosi!te$a

    - )atori eter!i

    - sercla> perima!di%ular

    - suspe!dari la dista!ta

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    Fracturi media!e si

    paramedia!e (ro!de

    atele

    dc lipsesc (ragme!te 8 imo%ili$are i!termailara

    Fracturi laterale

    imo%ili$are i!termailara cu atele # cu %uto!i si!a L pt asce!sio!ari

    imo%ili$ rigida a!tirotatio!ala

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    Fracturi de u!g+iAtele #

    Tractiu!e elastica

    Tractiu!e rigidaOsteosi!te$a cu )r metalic

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    Fracturi de ramFara deplasare 8 ap me!toce(alic

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    Fracturi la copii

    anestezie generalagutiere acrilice

    Fracturi la varstnici

    proteze sau sabloane de ocluzie

    osteosinteza

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    Cazuriclinice

    Fracturi demandibula

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    FRACTURI ALE ETAJULUI

    MIJLOCIU AL FEEI= ALE MASIVULUI FACIAL

    FRACTURI ALE ETAJULUI

    MIJLOCIU AL FEEI= ALE MASIVULUI FACIAL

    Etiologie

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    accidente de circulaieaccidente de muncaccidente prin agreiuniaccidente de p!rt

    accidente pr!due de animaleaccidente prin arme de "!c

    Frec#en$%r&ai '()*de + !ri mai puine "a de mandi&ul,

    Aciunea traumatimului- ./+ medie 0agital1 2 "racturi liniare tran#erale

    l t l " t i l i t &it

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    - lateral 2 "racturi c!mple3 4ig!mat!-!r&itar

    Traumatim #i!lent 0accident de circulaie1 2 "racturipan"aciale

    Le4iuni traumatice - prile m!i - muc!aa ca#itil!r

    - pielea 5i mu5c6ii

    - #aele

    - peri!tul

    - dinii 5i par!d!niul marginal

    - c6eletul !!Liniile de "ractur - perpendiculare pe t7lpii de

    re4iten

    - la ni#elul plat"!rmel!r !ri4!ntale

    Clasificare

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    Fracturi pariale:de pr!ce al#e!lartu&er!4itate

    &!lt palatin

    ap!"i4 acendentperete anteri!r al inuului

    arcad 4ig!matic

    ! malar

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    Fracturi t!tale $

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    - "racturile !ri4!ntale - in"eri!are 2 Le "!rt I

    - mi8l!cii 2 Le F!rt II - uperi!are 2 Le F!rt III

    - "racturi #erticale 5i !&lice - "ractura medi! agital - "ractura lateral

    - "racturi c!m&inate

    - "racturi multiple 5i c!minuti#e

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    II, Fracturi centr!-"aciale

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    Fracturi t!tale"racturi ale !ael!r na4ale$

    - unilateral 5i &ilateral

    "ractura c!mple3ului na4!-etm!id!-ma3ilar 0C,9,E,M1

    Fracturi pariale

    ap!"i4a acendent a ma3ilarului

    eptului na4al&!lii palatine

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    Fracturi latero-faciale.,Fracturi ale c!mple3ului 4ig!matic 0=!r&it!-4ig!matice1

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    Fracturi anterioare

    t!tale$ - inc!mplet - di8uncie ma3il!-malar

    - c!minuti#

    pariale$ - a re&!rdului !r&itar in"eri!r

    - a re&!rdului !r&itar lateral - a plan5eului !r&itar 0&l!:-!ut1

    Fracturi posterioare"ractura arcadei 4ig!matice

    Fracturi anterioare i posterioare

    3.Fractura peretelui anter!-lateral al inuului ma3ilar

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    Fracturi asociate$

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    Fracturi asociate$

    - pan"aciale 0; ! "r!ntal* mandi&ul1- crani!-"aciale 0; cal!ta 5i &a4a craniului1-medi!-crani!-"aciale0C,9,E,F,M,1

    - later!-crani!-"acial$- "r!nt!-ma3il!-malar-"r!nt!-"en!-temp!r!- ma3il!-malar-4ig!mat!-"en!-temp!ral

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    Deplasarea fragmentelor osoase

    primar 0&l!cul "acial ete retrudat* c!&!r7t* r!tat1secundar 0prin traciunea mu5c6il!r1

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    Examenul clinic exo-bucalSemne clinice$edemul 2

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    Examenul clinic exo-bucalSemne clinice$Deplasrile osoase -inpecie 0nc6ide* dec6ide gura1

    -palpare - de"!rmare

    - dic!ntinuitate - m!&ilitate !!aEmfizemul subcutanatTulburrile de sensibilitate$ - 6ip!ete4ii

    - anete4ii

    - durere

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    Examenul clinic exo-bucalSemne clinice$EpistaxisulRinolicoreea 0lic6id ce"al!ra6idian n "!a na4al1

    Tulburri oculare: -dipl!pie - midria4 - de#ierea a3ului gl!&il!r !culari

    - cderea acuitii #i4uale

    - cecitateEpifora

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    Examenul clinic endo-bucalSemne clinice$

    Ec!imoze " plgiDeformarea arcadelor dentareTulburri de ocluzie#obilitate osoas anormal

    $imitarea desc!iderii gurii

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    Examenul clinicTulburri funcionale:Repiraie

    MaticatieF!natie

    @eglutiie

    iperali#aie

    SE#%E &' S'#(T)#E DE $)C*$'+*RE

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    Fracturile ocluzo-faciale

    Fracturile transersale ,oase $e Fort '.:

    'c(imoze:n 5anurile na4! 5i la&i!geniene*

    n muc!aa #eti&ular 0n p!tc!a#1*

    n &!lta 5i #lul palatin

    Tulburri de ocluzie uncte dureroase /n 0anul estibular1 retrotuberozitar

    Rx-)(T

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    Fracturile transersale mi,locii $e Fort ''.:

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    tume"ierea "eei* edem* ec6im!4e palpe&rale* c6em!4i*ec6im!4e n "undul de ac #eti&ular

    de"!rmarea "eei 2 na turtit epita3i 2 epi"!ra

    tul&urri de !clu4ie em"i4em u&cutanat dic!ntinuitate !!a m!&ilitate an!rmal a !ael!r na4ale 5i ap!"i4el!r

    acendente ale ma3ilarel!r* a &l!cului al#e!l!-palatin parete4ii* 6ip!ete4ii* anete4ii pe ner#ul in"ra!r&itar,

    Fracturile transersale mi,locii $e Fort ''.:

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    Fracturile transersale mi,locii $e Fort ''.:

    Rx: - semiaxial antero-posterioar - S2*2F2

    - de profil a masiului facial - C2T2 - R2#2%

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    Fracturile transersale /nalte $e Fort '''.:

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    - de"!rmaia "eei 2 n"undare mare 0deplaare p!teri!r 5in 8!1

    - "al pr!genie - ec6im!4e palpe&rale &ilaterale

    - c6em!4i c!n8uncti#!-&ul&ar - epi"!ra 2 epita3i - curgere de lic6id ce"al!-ra6idian - 6emat!ame retr!&ul&are

    - tul&urri !culare$ - e3!"talmie - dipl!pie

    - tra&im

    - cecitate

    m!&ilitate an!rmal 2 mai#ul "acial e ridic 5i e

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    c!&!ar la nc6iderea 2 dec6iderea gurii

    tul&urri de !clu4ie - !clu4ie dec6i

    - !clu4ie ncruci5at

    tul&urri "unci!nale

    Rx: - semiaxial

    - S2*2F2 - C2T2

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    Fracturile erticale:

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    #ediane:

    tume"iere 5i ec6im!4 a &u4ei uperi!are

    !luie de c!ntinuitate ntre I,C, a "i&r!muc!aei tul&urri de !clu4ie 2 n en lateral m!&ilitate !!a an!rmal

    Fracturile erticale:

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    - (aramediane !luie de c!ntinuitate la&ial* gingi#al* pe &!lt deplaare pre na"ar* n 8! tul&urri de !clu4ie

    m!&ilitate !!a 6em!ragii intrainuale* na4ale re"luarea alimentel!r pe na

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    Fracturile complexe:

    deplari* de"!rmri mari

    6em!ragii

    di"iculti repirat!rii tul&urri de !clu4ie

    Rx: - C2T2 0i R2#2%2

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    Fracturile pariale$-

    De rebord aleolar

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    De rebord aleolar

    - "ragmentul "i3at la peri!t au deprin

    - le4iuni dent!-par!d!ntale - dec6iderea inuului ma3ilar - c!municri - ec6im!4e - tul&urri de !clu4ie

    - epita3i

    De tuberozitate - deprinderea "ragmentului !! - dec6iderea inuului - 6em!ragii - 6emat!ame - tul&urri de !clu4ie - epita3i - c!municri &uc!-inuale

    Fracturile posterioare (ale arcadei zigomatice):

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    p ( g )

    - ec6im!4e - ec!riaii

    - puncte durer!ae

    - n"undare

    - limitarea dec6iderii gurii

    - edem 2 tume"acie

    Rx: - incidena axial 0i semiaxial

    Fracturile pariale:- de re&!rd !r&itar lateral au in"eri!r - treapt* 5an

    ec6im!

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    - ec6im!4

    - 6emat!m - e3c!riaie - plag

    - de"!rmare

    - durere

    - de plan5eu !r&itar - edem - ec6im!4 palpe&ral

    - c6em!4i

    - en!"talmie

    - dipl!pie

    - tra&im

    - epita3i

    Fracturi asociate (cranio-faciale)

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    - le4iuni ence"alice - c!m!ia cere&ral - c!ntu4ia cere&ral

    - dilacerare cere&ral

    - edemul cere&ral

    - le4iuni meningeale

    - le4iuni neur!l!gice

    - tul&urri !l"acti#e

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    EVOLUBIE

    C!n!lidare rapid - calu "i&r! 2 '-.( 4ile - calu !! 2 (-+( 4ile

    COMDLICABII

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    I, [email protected]

    . 'nsuficiena respiratorie acut prin$- retrudarea mai#ului "acial

    - c!rpii trini

    - ali# - 7nge - 6emat!m peri"aringian

    - edemul na4al 5i "aringian

    - cderea lim&ii

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    3. !cul 6em!ragic- 6em!ragii mai#e

    ;. !cul traumatic2 prin timularea recept!ril!r ner#!5i,

    , Edemul cere&ral

    ''2 SEC3%D*RE2 in"eciile

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    '''2 T*RD'4E:- c!n!lidare #ici!a - tul&urri de !clu4ie

    - tul&urri "i4i!n!mice

    - c!municri &uc!-na4ale 5i &uc!-inuale- dipl!pia

    - tul&urri repirat!rii

    - tul&urri neur!l!gice 2 6ip!ete4ie* anete4ie*ne#ralgii

    - &l!carea dec6iderii gurii

    - c!ntricia 5i anc6il!4a temp!r!-mandi&ular

    TR*T*#E%T

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    Constituie urgen chirurgical:

    ., tratament de urgen 0pr!#i4!rie1

    , tratament primar 0de"initi#1

    +, tratament ecundar 0de ntreinere1

    , tratament tardi# 0al c!mplicaiil!r tardi#e1

    1. Tratamentul de urgen

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    - de e3trem urgen 0al c!mplicaiil!r #itale1- urgena #ital am7nat 2 A,%,C,

    - aigurarea permea&ilitii cil!r aeriene 5i

    meninerea l!r - aigurarea circulaiei$ - c!m&aterea t!pului

    cardiac 5i reluarea unui ritm p!ntan

    - !prirea 6em!ragiei

    - re"acerea maei anguine

    52 Tratamentul specific n urgena imediat:- reducerea 5i im!&ili4area pr!#i4!rie a "racturil!r

    - antialgic

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    - anti&i!pr!"ila3ia

    - er!terapia antitetanic

    'mobilizarea proizorie: - mi,loace inter-cranio-maxilare - &anda8 ment!ce"alic

    - "r!nd ment!nier - dip!4iti#ul n "!rm de 4&al

    - mi,loace interdentare intermaxilare2 ligaturile de 7rm- mi,loacele interdentare monomaxilare

    - ligatura n ' - ligatura n punte

    - ligatura n car D!nr!G

    - atele #eti&ulare

    62 Tratamentul definiti primarIdeal 2 c7t mai prec!ce 5i mai c!mplet

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    @e !&icei n 2 la -'6* une!rila -' 4ile

    Se "ace prin$ - reducerea anat!mic a"ragmentel!r !!ae

    - im!&ili4are

    - rec!ntrucia pril!r m!i - reta&ilirea trii generale

    (regtirea traumatizatului

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    - l!c!-regi!nal

    - general

    - anete4ia

    - anti&i!terapia- medicaia antiedemat!a

    Reducerea fragmentelor

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    - manual

    - !rt!pedic - traciuni elatice interma3ilare

    - traciuni elatice inter-crani!-ma3ilare

    - intrumental - c6irurgical 0dec6i1

    'mobilizarea fragmentelor de fractur:

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    #etode ortopedice:- m!n!ma3ilare - atele - &raHet-uri

    - plcua palatinal

    - iteme inter-ma3il!-mandi&ulare

    - iteme inter-crani!-ma3ilare

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    #etode c!irurgicale- upenia intern

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    - la arcada 4ig!matic

    - la ap!"i4a malar a "r!ntalului

    - la !ul parietal

    - la re&!rdul !r&itar in"eri!r

    - la arcada 4ig!mat!-al#e!lar

    - la pina na4al

    - "i3at!ri e3terni

    - met!de intra"!cale = !te!inte4 - cu "ir metalic- cu plcue metalice au re4!r&a&ile

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    '%D'C*7'' TER*(E3T'CE 8% F3%C7'E DE F)R#*DE FR*CT3R9

    Fracturile ocluzo-faciale

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    - reducere 5i im!&ili4are - !rt!pedic* prin traciunielatice inter-ma3il!-mandi&ulare

    - !te!inte4

    - upenie intern

    Fracturile centro-faciale

    - e reduc 5i im!&ili4ea4 c6irurgical

    Fracturile latero-faciale

    d 6i i l i l il d l

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    - e reduc c6irurgical 2 n primele - 4ile de laaccident pe cale anteri!ar

    - pe cale temp!ral 2 [email protected] Te!d!recu

    - pe cale inual 5i rin!l!gic

    - pe cale end!&ucal- !te!inte4a cu "ir metalic au plcue

    metalice

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    'ndicaiile osteosintezei$

    "racturi #ec6i cu tendin la ren"undare

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    - "racturi #ec6i cu tendin la ren"undare

    - "racturi cu diata4i mare

    - "racturi cu interpunere de alte euturi n "!carulde "ractur

    )steosinteza se face la nielul:

    - ap!"i4ei "r!nt!-malare- re&!rdului !r&itar in"eri!r

    - 8!nciunii ma3il!-malare

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    Tratamentul sec!elelor:

    - !te!t!mii ale "ragmentel!r #ici!c!n!lidate* rep!4ii!nare 5i "i3are prin

    !te!inte4

    - platii de adiie,

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    Cazuri clinice

    Fracturi de masivfacial

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