顎顔面外傷の診断と治療

抄録

Facial injury should be considered separately as soft tissue and hard tissue injuries. Diagnosis between them is very important to obtain good results for appropriate treatment. Soft tissue includes facial nerve branches in the cheek, a parotid duct in the cheek injury, and lacrimal draining system in the medial canthal region. Basic planning of the treatment is respective primary repair of the injured tissue. Rarely reconstruction using autogenous ductal tissue such as a vein should be considered for the tissue defect. Topical management of the scar on the face is challenging for the proper plastic surgical suturing technique. Layer to layer suture is also fundamental technique for general sugery. W shaped scar plasty for the visible scar is important procedure for facial aesthetics.

Conversely, facial bone injury is of particular importance in precise diagnosis and its prognosis for the treatment. Basic diagnosis includes pulpation, inspection, and roetogenographic and CT scans. Treatment protocol consists of precise reduction and repositioning as much as possible with rigid osteosynthesis. Delayed treatment of the facial bone injury becomes more difficult, because of consequent atrophy and shrinkage of the soft tissue around the injured bone. Malunited fracture induces unpredictable deformity, which requires definitive plastic surgical reconstruction using basic autogenous bone and or cartilage as well as soft tissue, such as fat, fascia, or muscle tissue. Functional as well as aesthetic reconstruction are required for the treatment of old fractures. Fundamental diagnostic procedure and proper treatment is described in this report.