h/o RTA. swelling and tenderness ryt cheek and lower jaw. Wht is the mgmnt?
Maintain airway . X- ray - to look for any associated fracture. As lacerated wound is in the danger area of face with risk of cavernous sinus thrombosis- meticulous suturing should be done in O.T under aseptic conditions with 3- 0 mersilk .If wound seems to be deep - a deeper layer with 3- 0 vicryl can be sutured. Inj Tetglob 250 units stat Oral antibiotics preferably Amoxyclav for 1 week. Tab chymoral forte × 6 hourly for 10 days . Suturing of forehead wound with 3- 0 mersilk.
The pt with RTA having multiple injury face and skull. There is haematoma of the RT maxillary region and above the Cupid, there are multiple loose teeth and scalp injury. As per CT scan at present the pt has not any sign of head injury. Picture shows she had epistaxis Remove the nasal pack and ensure air way clear and observe for any episode epistaxis or not Xray of the face to see any maxillary nasal mandilbular fracture . Now the question of repair Pt to be taken to OT for repair which should be meticulous , caution should be taken to repair the above the upper lip ,should be done in two layers( if it is a mutispeciality hospital take help of plastic surgeon particularly for the Cupid ) if not available do carefully Dipper layer by 3/0 vicryl and skin with 3/0 mersilk keeping the margins properly. Scalp to repaired with 2/0 mersilk. Watcth for head injury and airway Take care asper to x-ray report Tetglob 250 unit stat Antibiotic broad spectrum parenteral Tab chymoral forte one tab 6hrly for 7days and Analgesic The facial injury av nice the angle of the mouth is dangerous as may develop cavernous sinus thrombosis Remove the loose teeth and take opinion of dentist
Double bilateral fracture mandible Multiple soft tissue injuries Send to your plastic surgeon for meticulous repair andfixation
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First of all make sure that air way is clear,remove any loose dentures , x-ray The face for any fracture ,keep an eye for any cavernous sinus signs. Clean the wound. Stich the cuts. Start on antibiotic to prevent secondary infection. Ampiclox 500 is ideal for soft tissue injury. Admit in hospital for observation at least over night.if there are no other injury . Face has remarkable power in healing. In a wk. You won't be able recognise the pt.
Xray mandible opg clean wound if big take stitches inj tt aug625 bd enzoflam tds zintec150 mg tds c t brain normal cerebral concussion 24 hr observation
Bilateral fracture of mandible with lacerated wound Ref to oral surgeon for the management
Wash wound with normal saline Repair with fine sutures
Its mandible #Refer it to your plastic surgery colleague
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