FRAKTUR MANDIBULA
Identitas Pasien
Nama
: Tn. A. S
Umur
: 40 th
Jenis Kelamin: Laki-laki
Alamat
: Jln. Ligar Utara 2 No.
181
Agama
: Islam
Pekerjaan : Wiraswasta
No. RM
: 15020479
MRS : 19-01-2015
Anamnesis
KU : Sulit mengunyah
AK :
Pasien datang dengan keluhan utama sulit
mengunyah sejak 3 minggu SMRS. Pasien memiliki
riwayat kecelakaan saat mengendarai sepeda motor
kecepatan sedang, helm (+), riwayat pingsan (-),
perdarahan telinga kiri (+), perdarahan dari hidung
dan mulut (+).
Pasien kemudian dibawa ke RSHS dan menjalani
perawatan selama 1 minggu di bagian Bedah Saraf.
Pasien pulang untuk mengurus BPJS kemudian kontrol
ke Poli Bedah Plastik untuk masalah mengunyah,
Pemeriksaan Fisik
Status Generalis
KU : Tampak Sakit Sedang, Kes : Compos Mentis
T : 110/80 mmHg, N : 88 x/menit, R : 20 x/menit, S : 36,9 C
Status Lokalis
Ar : rima orbita dx : asimetri (+), step off (+), distopia (+),
diplopia (-)
Ar : ZMC dx : tampak deformitas dan asimetry, edema (-),
step
off (+), hipoestesi ()
Ar Mandibula dx : tampak deformitas (+), asimetri, edema
(-),
step off (+), maloklusi (+), hipoestesi ()
floating maxila (-)
Foto Klinis
Foto Klinis
Scheidel Xray
Waters Xray
Panoramic Xray
Laboratorium
PT/APTT/INR
: 12.4/29,8/0,90
Hb/Ht/L/E/T
:
11,6/35/7.300/3,83/264.000
AST/ALT : 13/23
Ur/Kr
: 32/0,89
GDS
: 110
Na/K
: 137/4,3
Diagnosis Kerja
Panfacial
fracture
(unfavourable-comminutive)
Rencana
Maxilomandibular
Refracture
& ORIF
28 Januari 2015
fixation
Fractures sites
Most fractures
occur:
in the body (29%)
condyle (26%)
angle (25%)
symphysis (17%)
ramus (4%)
coronoid process
(1%)
Facial fractures
associated with
mandibular fractures
70% had mandible
fracture alone.
15% had another facial
bone fracture along
Anatomy
14
Muscles
Diagnosis of Mandibular
Fractures
Clinical Examination The sign and
symptoms of mandibular fractures are as
follows :
1.
2.
3.
4.
5.
Principles of treatment
18
Treatment by Types of
Fracture
Class I
Teeth on each side of fracture
MMF (4-6 weeks)
ORIF (--if lefort)
Class II
Teeth are pesent only one side of the fractures site
Type of late neede to control nontoohtbearing
fragment
Larger inferior border plate & smaller superior
border plate
Treatment by Types of
Fracture
Class
III
border)
Instruments
Instruments:
EXTRAORAL APPROACH
24
Rigid fixation
Intraosseous
wiring
Plates and
screws
25
Wire cutters
Wire twisters
Clamps
Retractor
Wire fixation
Wire fixation
Wire fixation
intraoral
(submucose)
Incision
Reduction, get proper occlusion
Fixation
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
TERIMA KASIH