Emergency War Surgery NATO Handbook: Part IV: Regional Wounds
and Injuries: Chapter XXIII: Maxillofacial Wounds and Injuries
Introduction
United States Department of Defense
Peer Review Status: Internally Peer
Reviewed
The management of maxillofacial injuries is divided into
immediate, primary, and reconstructive phases.
- In the immediate phase the establishment and maintenance of
the airway and control of hemorrhage have the highest priority.
Appropriate protective dressings are applied and hydration is
maintained. The institution of antimicrobial therapy in this phase
contributes to minimizing the incidence of subsequent infection.
Penicillin is the drug of choice. If there is a question of
penicillin allergy, clindamycin is an excellent alternative.
- The primary phase consists of early definitive surgical repair
of the wound and is accomplished at the first primary care
facility to which the casualty is evacuated. Treatment performed
during this phase of management significantly influences the
subsequent requirement for or the magnitude of bony as well as
soft tissue reconstruction and, therefore, the ultimate long-term.
functional and cosmetic outcome. Generally, both hard and soft
tissues are conservatively debrided. Repair begins with
reapproximation and fixation immobilization of fractured bones,
application of intraoral devices, reestablishment of dental
occlusion or intermaxillary ridge relationships, and finally,
primary closure of intraoral mucosa and overlying soft tissues
wherever possible.
- In the third or reconstructive phase, the tertiary care center
attempts to correct deformities, such as malocclusion, and to
obliterate defects with grafts or prosthetic devices. Ideally,
treatment is carried out in specialized units staffed by dental,
oral, and plastic surgeons who work in close cooperation with
specialists in otolaryngology, ophthalmology, and neurosurgery. At
least 25% of casualties with maxillofacial injuries also have
injuries of the head and neck. In addition, dental laboratories
should be available for the fabrication of dental appliances.
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