Trauma

maksilofasial
Dr Dewi Haryanti K, SpBP-RE
Sub bagian bedah plastik FK UNS/RSUD Dr
Muwardi Surakarta

Definisi
Suatu kelainan yang timbul akibat trauma dan

menyebabkan fraktur pada maksilofacial :

Fraktur Nasal
Fraktur Zygoma
Fraktur Mandibula
Fraktur Maxilla :

Lefort I : Transversal
Lefort II : Pyramidal
Lefort III : Craniofacial disjunction

Anatomi
MaksiloFacial

Vaskularisasi muka

Vaskularisasi muka

Vascular patterns of the

face

N Fasialis

N. Fasialis

N.Fasialis

N.Trigeminalis

N. Trigerminalis

Pemeriksaan Klinis
Anamnesis
Pemeriksaan fisik
Pemeriksaan Foto Rontgen

Pemeriksaan Klinis
Anamnesis : adanya riwayat trauma muka
Pemeriksaan fisik :
Umum
Lokal :

Gejala yang timbul : luka /jejas di muka,udem,

deformitas, echymosis,maloklusi,
anestesia/hipoestesia, pendarahan hidung atau
mulut, diplopia, enoftalmus

Pemeriksaan Foto
Rontgen
Foto kepala AP dan Lateral
Foto Waters
Gambaran yang didapat :ada perkabutan pada
sinus maksilaris dan ada garis fraktur pada
tulang muka
Biasanya fraktur maksilofacial disertai cedera

kepala

Foto (AP/Lat/Waters)

History
Alteration in the way the teeth meet.
Pain site(s), aggravating, relieving

factors,severity.
Numbness of skin, mucosa and teeth.
Alteration in ability to speak, swallow,chew
open mouth.
Disturbances of vision : blurring,double vision.

Reduced patency of oral and nasal airway.

Hearing disturbance.
Abnormal sounds from the jaw joints.
Neck problems.

Examination
Scalp, frontal bones and supraorbital

ridges.
Orbits and nasoethmoidal region
(traumatic telecanthus and saddle nose
deformity)
External auditory meati, zygomatic arches
and infraorbital margins.
Zygomatic buttreses, alar regions and
upper teeth.
TMJ, mandible and lower teeth.

Asymmetry
Step defects
Discontinuity
Crepitus
Tenderness
Neurological deficits (sensory and motoric)
Missing and mobile teeth.
Mobility of the mid face.

Indikasi Operasi
Bila terjadi gangguan fungsi
Bila terjadi gangguan estetik
Prinsip Terapi : Tindakan dilakukan

secepatnya,tetapi bila kondisi tidak

memungkinkan sebaiknya tindakan dilakukan
sebelum hari ke 14 pasca trauma.

Orbita
Visual acuity,diplopia.
Exophthalmus/Enophthalmus (retrobulbar

hematom,blow out fracture)

Telecanthus.
Corneal abrasions, conjungtival tears and
eyelid laceration.

Penanganan
Fr
Orbita
A B C
Eksplorasi
Reposisi
Fiksasi dengan :
Wire atau Miniplate inter fragmen
Apabila ada diplopia dilakukan penanganan

untuk muscle entrapment

Eksplorasi dan pembebasan dapat dilakukan
5-7 hari proses trauma (saat edema sudah
hilang)

Nasal
Asymmetry
Deformity in all three dimensions
Bilateral or unilateral epistaxis
Possible leak of cerebrospinal fluid (bethadine

test)
Septal haematoma or disruption
Anosmia or paranosmia
Crepitus

Penanganan
Fr
Nasal

ABC
Reposisi dengan forceps Walsham, forceps
Asch atau Salinger
Pasang tampon cavum nasi
Pasan gips kupu-kupu
Sangat dianjurkan tindakan ini dilakukan
dalam narkose umum
Tampon dicabut hari 3-5 hari
Gips dipertahankan 10-15 hari

Midface (zygomaticomaxillary)
Malocclusion
Maxilla moving
Malar flattening
Downsloping palpebral fissure
Infraorbital nerve paresthesis

Penanganan Fraktur
Zygoma

ABC
Eksplorasi
Reposisi
Fiksasi dengan : miniplate dan screw atau
dengan wire
Aprroach :
Semi open : Fr Arkus Zygoma dgn Gilliscs

Procedure
Open : ekstra oral,subcilier,infraorbita,
subconjungtiva,intraoral

Mandibula
Malocclusion
Tenderness and step-offs (palpation)
Swelling and bruising
Lower lip paresthesias (infra alveolar nerve)
Hematomas in the floor of the mouth
Open bite, trismus (mandibular condyle)

Penanganan Fr Mandibula
Tujuan: mengembalikan Oklusi seperti

keadaan semula
A B C
Inter Dental Wiring-Inter maxilary Wiring
(IDW-IWR)
Arch Barr
Miniplate dan screw
Fiksasi dengan wire atau arch barr

dipertahankan 4-6 minggu

Maxilla
Anterior open bite, malocclusion
Mobility of maxilla(floating)
Epistaxis
Elongation of the face.
Lefort I :pyriform rim
Lefort II : nasal root (nasofrontal suture)
Lefort III (craniofacial disarticulation)

:zygomatocofrontal suture

Penanganan
Fr
Maksilla
A B C
Lefort I : transversal
Lefort II : Pyramidal
Reposisi dengan Rowe Forleps,Heaton Williams
Fiksasi :
IDW+IMW/Arch Barr+ suspensi ((zygomatico
Circumferential wiring)
Miniplate dan screw
Fiksasi wire atau arcbar dipertahankan selama 5-6
minggu

Lefort III Open Reduction Internal Fixation

Fiksasi dengan : miniplate,suspensi (fronto
circumferential wiring)

Nasoorbital ethmoidal
(NOE)
Saddle nose deformity
Traumatic telecanthus
Avulsion of medial canthal ligaments

Radiologic examinations
Skull X-rays (AP/Lateral)
Waters/reverse Waters
Submentovertex view
Panoramic radiographs (Panorex)
CT-Scann
Three Dimension CT-Scann.

Management
Depends on : organised,teamwork.
Maintain airway + secure cervical spine.
Bilateral parasymphyseal fracture (immediate

stabilization/pulling the tongue anterior)

Closed reduction
Gillies procedure
MMF (IDW-ivy loop,arch bar)
Circumferential wiring.
Barton bandages.

Open reduction
Approach :

bicoronair.infracilliar,ginggivobuccal.
Delayed untill patient has been stabilized.
Bony repair (10 days to 2 weeks)
IMF/plate and screw with or without MMF.

Soft tissue abrasions and

laceration
High-priced real estate
Anatomic landmarks ( white skin roll,

vermilion border,brow eyes)

Cleanse the wound with normal saline
Explore the injury to its full depth
Beware facial nerve and parotid gland and
duct injury!!
Layered closure

Soft tissue as soon as possible.

Lacrimal duct :Dacryocystorhinostomy/repair

of Stensen duct.
Retrobulbar hematoma: emergency
evacuation

Stensons duct rupture

Scalp loss

Soft tissue laceration

Windshield injury

Questions?

Thankyou