dept. tht fk usu / rshamocw.usu.ac.id/course/download/1110000130-emergency-medicine/emd… · (...
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TRAUMA MUKA DAN
HIDUNGHIDUNG
DEPT. THT FK USU /
RSHAM
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PENDAHULUANPENDAHULUANPENDAHULUANPENDAHULUAN
� Hidung � sering fraktur
� Fraktur tulang rawan septum sering tidak
diketahui / diagnosis � hematom septum
� Pemeriksaan dapat dilakukan dengan
palpasi dan inspeksi intranasal
� >> 15 – 30 tahun, ♂ > ♀
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PENDAHULUAN
� Etilogi � multifaktor, kecelakaan >>>
� Sumbatan jln nafas, shock, gangguan vertebra
atau saraf
� Penanganan : immediate atau delayed �
kondisi jaringan kondisi jaringan
� Bersihkan luka, jahit < 24 jam, fraktur + / -
� Vaksin ATS, AB, infus
� Sumbatan jalan nafas � trakeostomi
� Foto rontgen dan CT Scan
� Konsul ke bagian lain
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TRAUMA MUKA :
� Fraktur tulang hidung
� paling sering ( 40 - 50 % )
� Fraktur tulang dan arkus zigoma� Fraktur tulang dan arkus zigoma
� Fraktur tulang maksila
� Fraktur tulang orbita
� Fraktur tulang mandibula
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GEJALA KLINIS:
� Kerusakan jar. lunak : edema, kontusio, laserasi
� Ekimosis
� Epistaksis : anterior / posterior
� Deformitas : inspeksi atau palpasi� Deformitas : inspeksi atau palpasi
� Gangguan mata : penglihatan ↓ , diplopia dsb
� Gangguan saraf sensoris ( N. Trigeminus )
� Gangguan saraf motorik ( N. Fasialis )
� Trismus, emfisema, leakage CNS
� Obstruksi hidung
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FRAKTUR TULANG HIDUNG
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PEMBAGIAN TRAUMA HIDUNG
A. WAKTU : BARU ATAU LAMA →→→→PEMBENTUKAN CALLUS
(PADA AKHIR MINGGU KE-II)
B. HUB. DGN LUAR : TRAUMA →→→→ TERBUKA / TERTUTUP
C. ARAH TRAUMA : C. ARAH TRAUMA : - LATERAL : DEVIASI KERANGKA HIDUNG, SEPTUM HIDUNG
- FRONTAL : HIDUNG →→→→ RENDAH OK. FRAKTUR & SEPTUM
TERLIPAT
D. LOKASI :
- DORSUM NASI
- FRONTO – ETMOID (INTER CANTHUS)- SEPTUM & OS NASAL →→→→ DGN / TANPA DISLOKASI
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PEMERIKSAAN- OEDEM-HEMATOMA-LASERASI-ROBEK atau
PERDARAHAN ( EPISTAKSIS )- DEFORMITAS : CEKUNGAN ATAU HIDUNG BENGKOK- FRAKTUR TULANG (+) →→→→ KREPITASI ( BARU )- SETELAH 2 – 3 HARI →→→→ EDEMA- SETELAH 2 – 3 HARI →→→→ EDEMA
PEMERIKSAAN TAMBAHAN
- RADIOLOGI : - FOTO RONTGEN POSISI AP & LATERAL
- CT Scan
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TUJUAN PENANGANAN FRAKTUR HIDUNG :
� Mengembalikan penampilan secara memuaskan
� Mengembalikan patensi jalan nafas hidung
� Menempatkan kembali septum pada garis � Menempatkan kembali septum pada garis
tengah
� Menjaga keutuhan rongga hidung
� Mencegah sumbatan setelah operasi , perforasi
septum, perubahan bentuk punggung hidung
� Mencegah gangguan pertumbuhan hidung
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FRAKTUR HIDUNG SEDERHANA
� Reposisi dgn anestesi lokal / umum
� Anestesi Lokal :
- tampon kapas Lidocain 1 – 2 % dicampur dgn
adrenalin 1 : 100.000 selama 15 menitadrenalin 1 : 100.000 selama 15 menit
( masing - masing 3 buah )
���� meatus superior dibawah os nasal
���� antara konka media dan septum
���� antara konka inferior dan septum
� 1 - 2 jam post trauma ���� edema ( - )
� Paling baik < 14 hari
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ALAT – ALAT :
� Elevator tumpul yang lurus
( Boies Nasal Fracture Elevator )
� Cunam Asch� Cunam Asch
� Cunam Walsham
� Spekulum hidung
� Pinset hidung
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TEKNIK REPOSISI :
� Fraktur piramid lebih dulu
direposisi diikuti septum
nasi
� Boeis elevator �
fragmen depresi, pantau
dgn ibu jari dibagian luar
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� Bila gagal �Walsham forceps
� Satu sisi letakkan dibawah tulang dalam dibawah tulang dalam kavum nasi, sisi yang lain diletakan diluar kavum nasi
� Manipulasi tulang ke posisi semula
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Fraktur septum nasi :
� Asch forceps
� Kedua sisi
dimasukkan ke dalam
kavum nasi dgn posisi kavum nasi dgn posisi
septum ditengah
� Hematoma septum
� insisi + drain
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� Stabilisasi reduksi
dengan tampon
anterior dan external
splint
� Tampon anterior �
buka setelah 3 - 5 hari
� External splint �
buka setelah 7 hari
� Antibiotik
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FRAKTUR ZIGOMA
� Tulang zigoma :
- tulang temporal
- tulang frontal
- tulang sfenoid
- tulang maksila
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A. Zygomaticomaxillary fracture
(Tripod fracture)
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GEJALA KLINIS :
- pipi lebih rata ( bandingkan dgn kontralateral )
- diplopia dan terbatasnya gerakan bola mata
- edema periorbita dan ekimosis
- perdarahan subkonjungtiva
- enopthalmus, ptosis
- hipestesia / anestesia saraf infra orbitalis
- epistaksis
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B. Fraktur arkus zigoma
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Fraktur arkus zygoma
� Tidak sulit untuk dikenali
� Rasa nyeri waktu bicara /mengunyah.
� Trismus � perubahan letak arkus zigoma
terhadap prosessus koronoid dan otot
temporal.
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FRAKTUR MAKSILA :
� Segera lakukan tindakan ���� fungsi normal & efek
kosmetik yang baik
� Tujuan : fungsi yg normal sewaktu menutup mulut
dan kontur muka yang cocokdan kontur muka yang cocok
� Perdarahan hebat ���� ruptur arteri maksilaris interna
atau arteri etmoidalis anterior
� Reduksi dengan menggunakan kawat baja atau mini plate
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Klasifikasi fraktur maksila :
A. Le Fort I : terbatas pada alveolus
B. Le Fort II : pemisahan bagian tengah muka
dengan tulang kraniumdengan tulang kranium
C. Le Fort III : pemisahan seluruh tulang muka
dengan basis kranii
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FRAKTUR TULANG ORBITA :
� Sering bersamaan dengan fraktur maksila
� Gejala klinis :
1. Enophthalmus1. Enophthalmus
2. Exophthalmus
3. Diplopia
4. Asimetris pada muka
5. Gangguan saraf sensoris ( nervus infraorbitalis )
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FRAKTUR TULANG MANDIBULA
� Paling sering terjadi ok mandibula terpisah dari
kranium
� Reposisi ���� perhatikan otot – otot yang berinsersi
���� efek kosmetik yang baik, pertumbuhan
gigi, proses mengunyah dan menelan
yang baik
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