PENANGANAN KASUS- KASUS

BEDAH MULUT

Departemen Bedah Mulut dan Maksilofasial.

Fakultas Kedokteran Gigi Universitas Airlangga.
 Pendahuluan
 Sebagai kasus-kasus Dentoalveolar
Surgery Cabut Gigi sampai
Odontektomi.
 Kasus-kasus berikutnya adalah infeksi
odontogen
 Kasus-kasus Trauma Regio Maksilofasial
 Kasus-kasus Kista neoplasia Di Rongga
Mulut
 Kasus Kelainan congenitalLabio-
palatoschisis.
 Indikasi Pencabutan Gigi
 Periodontitis apikalis gangren pulpa.
 Periodontitis marginalis dgn kegoyangan
gigi yang parah/diatas derajad
duakurangnya tulang penyangga gigi.
 Fraktur sagital mahkota gigi.
 Gigi penyebab fokus infeksi.
 Dll
Teknik Surgical Extraction
Akar tunggal
Akar ganda
 Odontektomi
 Gigi impaksi  molar ketiga bawah/atas,
kaninus dan supernumemery tooth.
 Molar ketiga bawah sering pericoronitis
 Banyak macam-macam kasus ditentukan
oleh klasifikasinya.
 Tingkat kesulitan ditentukan oleh
klasifikasi gigi yang bersangkutan.
 Diperlukan latihan-latihan.
TIPE I-A
CATATAN PROSEDUR ODONTEKTOMI
TIPE I-A

1. DIBUAT CELAH HORIZONTAL UNTUK TEMPAT TUMPUAN

UNGKIT ELEVATOR
2. GIGI DIGERAKKAN SEDIKIT KE ARAH DISTAL
3. GIGI DIUNGKIT DENGAN ARAH UNGKIT VERTIKAL  KE
ARAH KORONAL
 Abses Submukosa
Kasus
 Abses submukus oleh karena Pericoronitis
Gigi 38,infeksi masuk melewati marginalis.
 Penyebab juga banyak ok infeksi
odontogen gigi yang masuk lewat jaringan
pulpo-periapikal.
 Pembengkakan fluktuatif pd bukal
fold/terangkat,batas jelas.
 Dilakukan incisi intra oral dan diberikan
 Abses Sublingualis/Submentalis
Kasus.
 Ekstra oraltampak pembengkakan
kearah submentalis.
 Intra Oral bengkak pd
sublingual,kemerahan,fluktuatif,gigi insisif
bawah goyang, banyak kalkulus.
 Penyebab periodontal disease.
 Dalam foto panoramik tidak ada gigi yang
karies
 Abses Subcutan
Kasus.
 Pembengkakan berbatas jelas pada kulit
dagu, fluktuatif, kemerahan, agak terasa
sakit.
 Disebabkan oleh gigi gangren molar
bawah.
 Terapi insisi extra oral, drainase dan
pemasangan drain serta ekstraksi gigi
penyebab, setelah diberikan antibiotik
secukupnya.
 Maxillofacial Injuries
 Penanganannya mengikuti pembagian
phase
 Emergency or initial care ( primary survey)
 Early care(secondary survey)
 Definitive care( setelah penderita stabil
sepenuhnya)
 Secondary care or revision
 PINCIPLE OF MANAGEMENT
OROMAXILLOFACIAL FRACTURE
 Emergency care( ABC
dievaluasi, airway bebas)
 Reduction
 Fixation
 Immobilization
 Rehabilitation
 Evaluation
Diagnosis of Maxillofacial Injuries

 Inspection
 Palpation
 Diagnostic Imaging
 Plain films
 CT
Diagnosis of Maxillofacial Injuries

 INSPECTION
 Hemorrhage
 Otorrhea
 Rhinorrhea
 Contour deformity
 Ecchymosis
 Edema
 Continuity defects
 Malocclusion
CLINICAL SIGN AND DIAGNOSE

 Clinical sign
 Deformities, swelling
 Long face
 premature Contact
 Open bite
 Periorbital edema
 Echimosis
 Parestesi
 Trismus,
 Disturbing of chewing
 Gingival laceration
 Displacement of occlusal plane
 Inspection

Sublingual ecchymosis Step defects, ridge

discontinuity, malocclusion
 Diagnosis of Maxillofacial Injuries

 PALPATION
 “Step” Defect
 Mobility: false movement,
floating maxilla, unstable
mandibula
 Crepitus
 Bony segments
 Subcutaneous emphysema
 Mobility: false movement,
floating maxilla, unstable
mandibula.
 Diagnosis of Maxillofacial Injuries

 DIAGNOSTIC IMAGING
 Panorex
 Plain films
 CT
 Stereolithography
Stereolithography
 DEFINITVE TREATMENT
 Fixation & immobilization maxilla
fracture
 intra and intermaksila fixation
 external fixation
 internal fixation
MAXILLA FIKSATION & IMMOBILIZATION

Intramaxilla & intermaxilla

Jelenko splint

Winter, jelenko or erich

External fixation (Craniomandibula
appliance)
External fixation (Mallar Mandibula fixation)
 Perawatan definitif

Fixation & immobilization

mandibular fracture
 Indirect dental fixation
 Direct dental fixation
 Indirect skeletal fixation
 Direct
skeletal fixation (open
reduction)
 Fixation & immobilization
mandibular fracture
Indirect dental fixation

Stout multiple loop

GILMER

Kazanjian
Eyelet (Ivy)
Direct dental fixation(Cast cap silver
splint)
Indirect skeletal
fixation (Circumferential
wiring)
 Direct skeletal
fixation (Intra osseous
wiring)
Direct skeletal fixation(Bone plate fixation)
 Mandibular Fractures
 Mandible is second
most common
fractured facial bone
 50% of mandibular
fractures are multiple
 Examine patient and
radiographs closely and
suspect additional
fractures
 Mandibular Fractures
 Clinical Signs and
Symptoms
 Tenderness & pain
 Malocclusion
 Ecchymosis in floor of
mouth
 Mucosal lacerations
 Step defects inferior
border
 CN V3 Disturbances
 Mandibular Fractures
 Treatment depends on fracture site and
amount of segment displacement
 Closed reduction
 Application of arch bars
 Placement into intermaxillary fixation (IMF)
 Open Reduction
 Internal wire fixation
 Bone plates
 Stabilitas Fraktur Mandibula

Stabil Tidak stabil Stabil Tidak stabil

Garis Trayektori Pada Mandibula
Champy plate untuk mandibula
Closed Reduction with IMF
Open Reduction
 Midface Fractures
 LeFort I Transverse Maxillary
 Lefort II Pyramidal
 Lefort III Craniofacial Dysjunction
 Zygomatic Complex
 Orbital Floor
 Nasal Fractures
 Naso-orbital/Ethmoid
 Midface Fractures

 Three buttresses allow

face to absorb force
 Nasomaxillary (medial)
buttress
 Zymaticomaxillary
(lateral) buttress
 Pyterigomaxillary
(posterior) buttress
 Diagnosis of Lefort I Fractures

 Direction of force
 Maxilla displaced posteriorly
and inferiorly
 Open bite deformity
 Hypoesthesia of infraorbital
nerve
 Malocclusion
 Mobility of maxilla
 Noted by grasping maxillary
incisors
 Treatment of Lefort I Fractures

 Direct exposure of all

involved fractures
 Reduction and anatomic
realignment of the maxillary
buttresses to reestablish
 Anterior projection
 Transverse width
 Occlusion
 Restoration of occlusion
using IMF
 Internal fixation using
miniplate fixation
 Le Fort
Le Fort 1 Fracture I Fracture
Treatment Treatment
 Diagnosis Lefort II and III

 Bilateral periorbital
edema & ecchymosis
 Step deformity palpated
infraorbital &
nasofrontal area
 CSF rhinorrhea
 Epistaxis
 Treatment of Lefort II and III

 Fractures should be treated as early as

the general condition of the patient
allows
 Team approach to treatment
 Neurosurgery
 Ophthamology
 ENT
 Plastic
surgery
 Oral/Maxillofacial surgery
 Treatment of Lefort II and III

 Intubation must not interfere with ability to

use IMF
 Exposure & visualization of all fractures
 Approaches to inferior rim
 Infraorbital
 Subciliary
 Transconjunctival

 Coronal approach
 Gingivobuccal incision
Treatment of Lefort II and III

 Severely comminuted fractures preliminary

approximation may be performed with wire
 Establishment of the correct occlusion
 Correct reconstruction of the outer facial
frame for proper facial dimensions
 Correct position for nasoethmoidal complex
Treatment of Lefort II and III

 Reestablishment of the correct intercanthal

distance
 Infraorbital rim fixated
 Orbit is reconstructed
 Occlusion unit with IMF is fixated
Lefort II & III
Reconstruction
 Le Fort II/III Fracture
Le Fort 2 Fracture Treatment
Treatment
 Nasal-Orbital-Ethmoid Fractures
Nasal Fractures

 Treatment
 Restoration of form and
function
 Proper reduction of nasal
fractures
 Correction of medial
canthal ligament
disruption
 Correction of lacrimal
system injuries
 Nasal-Orbital-Ethmoid Fractures

 Surgical considerations
 Definitive surgery as soon
as possible after:
 Appropriate consultations
 Definitive radiographic
imaging
 Significant edema allowed to
resolve
 CONCLUSION

 Manage the emergency first

 Principle management of fracture are
reduction, fixation & immobilization
 Immobilization can be done by wiring,
splinting
 Kasus-Kasus Lain
 NAMA :
 KELAMIN:
 UMUR :
 Epulis Granulomatosa
 Massa yang tumbuh pada gingiva.
 Penyebab gigi gangren.
 Suatu massa yang bertangkai.
 Massa mudah berdarah.
 Papiloma
 Massa/lesi berada di mukosa pipi.
 Lesi bertangkai.
 Warna relatif sesuai dengan mukosa
sekitar.
 Ditimbulkan suatu sebab iritan.
 NAMA : NY. HENY K
 KELAMIN : WANITA
 UMUR : 26 TH
 NAMA :
 KELAMIN : LAKI -
LAKI
 UMUR : 41 TH
 NAMA : TN.JUNAEDI
 KELAMIN :LAKI - LAKI
 UMUR : 44 TH
 NAMA : TN.
SUDARMONO
 KELAMIN:LAKI -LAKI
 UMUR :56 TH
 NAMA : TN. SEFTIAN
 KELAMIN : LAKI -LAKI
 UMUR : 26 TH
TAMPAKGAMBARAN RADIOLUSEN UNILOKULER PADA
DAERAH APIKAL SISA AKAR GIGI 46
 NAMA : MEGI
 KELAMIN : LAKI -
LAKI
 UMUR : 19 TH
 TAMPAK GAMBARAN RADULUSEN
UNILOKULER KESAN TERLETAK DIDALAM SINUS MAKSILARIS KIRI
RONGGA POST ENUKLEASI KAPSUL KISTA POST
KISTA ENUKLEASI
 Mucocele
 Kista kelenjar saliva minor.
 Sering terjadi di bibir bawah.
 Mudah pecah dan timbul lagi/rekuren.
 Biasanya berukuran kecil sampai sedang.
 Sering penyebabnya oleh karena sering
tergigit.
 Teraqapinya harus diexterpasi/eksisional
biopsi.
 Labioschizis
 Etiologi mutasi genetik
 Bayi sejak lahir.
 Bisa unilateral maupun bilateral
 Bisa incomplete maupun complete.
 Bisa disertai atau tanpa palatoschizis.
 Terapi dilakukan operasi
Operasi Penutupan Celah Bibir
 Ameloblastoma
 Merupakan tumor jinak rongga mulut.
 Penyebab tidak diketahui
 Terapi dilakukan dredging bahkan
direseksi rahang dan rekonstruksi.
 Reseksi Tumor mandibula +
Rekonstruksi dengan graf crista iliaca