Case presentation

1
?????? ??????? ??? ????? ??????

• ?. ????1, ?. ????1, ?. ??-?????2, ?.???1
• 1????? ??"? ??????? ???-?????,
• 2???"? ?????,
• ???? ????? ?"? ?. ???????, ?????

??? ???? ?? ????? ???????? ??????? ??????
2005
2
?????

• ????? ???? ????"? (?????/???????) ??? ????? ???,
  ???? ???? ??? ?????? ????? ?????? (?????, ?????)
• ???????? 119,529 ????? ????"? ???? 2002, 15
  ????? ??? ??????? 0-14, ????? ????"? ?????.
  ????? ???? ?-37 ???? ?????? ?????.
• (??????? ????? ??? ???"?, ????? ???? ???????)
• ?????? ????? ????"? ????? ??????? ??????
  01-07/05, ??? 38 ????? ?? ????? ?? ?????? ???
  ?????.

3
Upon arrival

• ?? ?????? ??????? ????? /????? ?????/ ???????
  ????/????? ??"?/??????/ ??? ??/ ??? ?-ABUSE
• ??? ????? ???? ??"?? ????? ?????? ??? ???????
  ??? blood dyscrasia? ??????? ?? ????? ?? ?????
  ????????
• ????? ????? ??????, ??????
• ?????? ?????? ?????? ???????/???????
  ???????/???????, ???????/???????, ?????
  ??????/?????, ????? ?????

4
???? ??????

• Contusion
• Abrasion
• Laceration
• Burn
• Penetrating injury

5
Contusion

• ????? ????? ???, ?? ??????/????? ???? ????
• ????? ????
• ??? ???? ???????/?????? ?????, ?????
• ??????? ????, ????????
• ?? ????? ??? ???? ????? ?????
• ????? ????? ?????
• ????? ????

6
Abrasion

• ????? ????? ??? ?? ?????? ?? ??????? ????
• ?????? ????? ????? ??? ????? ???? ???? (???)
• ???? ?"??? ?????"
• ????? ?????, ????? ????? ???? ??????? ???? ?????
  ?? ?????, ???? ?????????? ????
• ????? ????? (????? ???????????)

7
Laceration

• ??? ?? ???? ??? ??? ??????, ???? ?????? ??????
  ?????? ?? ??? ?????, through and through
• ????? ???????? ????? ??? ???? ???? ?? ???? ????
• ????? ?????? ??? ???? ????? ????, ????? ?????
• ???? ??? ????? ?????? ?????,
• ????? ??? ??????????? PO
• ???? ??? ????? ????? ??
• ????? Stenson ?? ?????
• ???????

8
Burn

• ?????? ???????/??????/?????? (????????, ??????,
  ?????? ???????? ..)
• ?????? ???? ????? ???????? ??? ?????? ???? ????
  (???? ?????) ?????? ????? ??????? ????????
• ?????? ????? ??? ????, ???, ??????? ?????, ????
  ???? ??????
• ???? ????? ????? ????? ...
• ?? ????? ??????? ??? ?????
• ?????? ????? ????? ??????

9
Penetrating Injury

• ??"? ??????
• ???? ????? ?????/??/????? ???? ??? ????
• ??? ?????? ??? ?? !!
• ????? ??? ???? ?????
• ??/?????? ???? ??? ???
• ??????? ??????? ???
• ?????, ????? ??????? ??
• ???????

10
????? ??????? ??????? ??????
11
Labial frenulum tear

• V-shape
• ??"? ??? ???? ????
• ???? ?????? ??? ????? (??????? ?????)
• ???? ????? ?????? ???????
• ????? ????? ??? ???? ??"?

12
Tongue laceration

• ?????- ???? ?????, ???? ???? ??, ????? ?????? ??
  ???????, ????? ?????
• ??? ??????? ?? ???? ???????, ?? ??? ??"?
• ???? ????? ???? ?? AW

13
Tongue laceration

• ?????? ?? ????? ?? ??- ??????, ??????? ??????
  ???????? ???????
• ???, ????????? ????- ????? ?????? ?????? ???? ??
  ??? ???????
• ????, ?????? ???????- ????? ???? ?????? ??????
  ?????? ???? ?????

14
Tongue Laceration

• ??????? ?????? ????
• ??? ???? (gt 1 ?"?) ????? ?? ????? ?? ???? ???
  ????
• ????? ?????? ??? ?????? ?? ?????
• ?????/ ????? ??????
• ????? ?? ????? ???????
• ????? ??? ????? ?????? ??????? ?? ?? ?????? ?????
  ????? (anterior split tongue) ?? "?????"

15
Lip Anatomy

• ??????? ?????? ??????? ??????? ??? ?????? ?? ????
  ????? ???, ???? ???? ??????
• ????? ?? ????? ??? labial arteries

16
Lip laceration

• ???? ???? ??????
• ?????? ?????? ?? ?? ???? ????????-??? ?? ??????
  ??? ????? ????? (???? ??? ??????)
• ????? labial artery ?? ????
• ????? ??? ??? ??? ?? ??? ?? ??? ??? monocryl 6/0

17
Upper lip laceration extending superiorly

• ????? ??? ???? ????? ????? ?????? ??????
• Barnett ???? ?????? ?????, ???? ????? ???? ?????
  ?????? ???? ???, ?? ???? ????? ?? dehisence

18
Missing tooth, labial laceration

• ??? ???? ???? ????? ?? ???? ????? ??????, ???
  ?????? ???

19
Gingival trauma

• ??? ???? ???? ?? ???? ????? ?? ????? ???????? ???
  ???? ?????????- ?? ???? ???? ?????
• ??"? ??' ????? ???????
• ??? ???? ??????? ??
• ???????/????????
• ?? ???? ????? ????
• ?????????? ??????
• ?????? ???? ?????
• (??? ????? ?????)

20
Oral traumatic ulceration

• ????? ????? "???" ???? ??? ??????
• ??? ?????? ???"? ??????? ?????? ??????????????
  (??????!!) ?????? pseudoaneurysm
• ????? ????? ????? ?????? CT-angio
• ????? ?? ?????? ?????? ????? ?? ?????, ????
• ?-deep neck infection

21
Palatine hematoma (d/t FB)

• ?????? ???? ???? ?? ???? ??????, ?????? ?? ??
  ?????
• ?? ??????? ?????? ?? ?? ???????? ?"?????" ??????

22
Dentoalveolar trauma

• ???? ???? ??????? ?????
• ???/?????????/avulsion ?? ???????
• ??? ?-alveolar process ?? ???? ?????????
  ???????????? ????
• ?????? ????? ??????/ ?????? ?? ????

23
Dog bite

• ????? ??? ?????? ?????
• ??"? ????? ?? ????? ??? ?????
• ?? ???? ????? ?????
• ????? ?? ????
• ?? ???? ?????? ?????

24
?????

• ????? ??? ????? ?? Midazolam / ????? ????? ????
  ????? (????? ??????? ????? ????)
• ???? ????? ????? ?? ???? ????? ????????
• ????? ?????? ????? ??????- Vicryl 4/0
• ?????? ????? ????- ????? ??????
• ????? ????? ?? silk 3/0, ??? ?? ????
• ????? ?????? monocryl 5/0-6/0

25
Upon discharge

• ??? ???? ?????? ??????
• ??? ???? ?????? ??????
• ?????? ?? (?? ???/???????????)
• ?????? ?????? ???? ????? ?????? ???? ?????
• ????? ???? ??????/??? 7-10 ???? ???? ?????
• ????? ????? ??????, ?????, ?????, ???

26
????????

• 38 ???????, ?-3 ?????? ???????
• 27/38- ?????? ???????, ???? ????? ??????, ?????
  ????? ?????? 2 ????? ?????? ?????? ?-7 ?????
• 4/38 - ?????? ?????????, ?? ???? ??? ????
  (??????)
• 4/38 - ????? ?????, ????? ????? (???? ??? ??????
  ?????)
• 5/38 ?????? ?????? ???, ????? ??????
• 1/38 ???? ????????????, ????? ??????

27
?????

• ????? ???? ??"? ?? ??? ????? ?? ???? ??????
  ?????? ????
• ?? ???? ?????? ?????? ???????, ????????
  ??????????????? ?? ????????? ??????