TRAUMA WAJAH

M. Rizqy Setyarto
Bedah Plastik RS Dr. Kariadi
cedera pada jaringan lunak maupun
jaringan keras dari wajah (termasuk
telinga).
 Latar Belakang
• Insiden meningkat
• Cedera multipel
• Memerlukan penanganan multidisiplin
dokter bedah plastik, bedah syaraf, ortodonsi dan
dokter mata
• Face is a mirror of the human, need balance
and harmony to restore
berdampak pd interaksi kepribadian dan sosial
 satu kesatuan yang terintegrasi.
Struktur tulang wajah
Pembuluh arteri wajah
A) Arteri Facialis
 Perjalanan arteri berkelok-
kelok
 Dicabangkan dari sisi anterior
A. carotis eksterna
 Awalnya berjalan di medial
mandibula, lalu kearah anterior
mandibula

Cabang-cabang:
• A. labialis superior et inferior –
upper and lower lips
• A. angularis - nose, angle
(corner)of eye
 Pembuluh arteri wajah
a. Temporalis Superficial TRANS. FACIAL. A.
b) a. Temporalis Superficial
- Cabang terminal dari a.
carotis eksterna
- muncul dari anterior meatus
auditori eksternus (opening
to ear), disebalah dalam kel.
parotis
- Beberapa cabangnya menuju
scalp (kulit kepala)
Cabang yg menuju wajah:
1) a. facialis transv –
Diatas ductus parotis
Pembuluh arteri wajah
a. supra trochlearis Cabang dari a. carotis
interna yang
mensuplai wajah:
• a. supra trochlearis
• a. supra orbitalis

a. supra orbitalis
Nervus Trigeminus – Persarafan sensoris pada
regio wajah
Persarafan Motoris otot-otot ekspresi wajah
Nervus Facialis (CRANIAL NERVE VII)
Kelenjar Parotis
Kelenjar Lacrimales & Duktus
Nasolakrimales
PENATALAKSANAAN
TRAUMA WAJAH
 Primary Survey
• A irway & Cervical Spine control
• B reathing & ventilation
• C irculation & hemmorrhage control
• D isability
• E xposure
 Secondary Survey
• Patient History
– Mechanism of Injury
– Loss of consciousness
– Pre-morbid history
– Medication and allergy
– Tetanus status
– Associated injury
• Specific Questions:
- How is your vision?
- Hearing problems?
- Nasal obstruction?
- Are there areas of numbness or tingling on
your face?
- Is the patient able to bite down without any
pain?
- Is there pain with moving the jaw?
Physical Examination
Basic Full Face Proportion
Inspection
• Deformity :
– Asymmetry
– Elongation
– Flat
• Discharge :
– Nose
– Ear
– Mouth
• Injury mark :
– Bruise
– Swollen
– Laceration
• Occlusion
Evaluation of globes
Forced duction test
Evaluation of zygoma and nasal
Intra-oral evaluation
Palpation of orbits
Palpation of nose
Palpation of zygoma
Palpation of maxilla
Palpation of mandible
 Physical Examination

Discontinuity of left lateral orbital rim

Bilateral orbits swollen Good orbits movement, diplopia (-)

Nasal bone
discontinuity
Deformity of 2/3
lower face

Laceration injury mark

Laceration injury mark on upper lip Left malar depressed

 Imaging Studies

– Plain radiograph AP, lateral view

– Water’s or Reversed Water’s view
– Panoramic
– TM Joint view
– Nasal soft tissue view
– CT Scan coronal or axial, 3D
AP and Lateral view
Water’s
Panoramic view
Nasal (soft tissue) lateral view
Temporomandibular joint view
Ct Scan 2D
CT Scan 3D
TERIMA KASIH