Title Radiološka obrada u maksilofacijalnoj traumatologiji
Title (english) RADIOLOGICAL PROCEDURE IN MAXILLOFACIAL TRAUMATOLOGY
Author Marko Vidović
Mentor Sanja Lovrić Kojundžić (mentor)
Committee member Sanja Lovrić Kojundžić (predsjednik povjerenstva)
Committee member Maja Marinović Guić (član povjerenstva)
Committee member Ljubica Žunić (član povjerenstva)
Granter University of Split (University Department of Health Studies) Split
Defense date and country 2019-09-30, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences
Abstract Maksilofacijalna traumatologija obuhvaća vrlo široko područje, od ozljeda samo mekih tkiva pa sve do višestrukih ozljeda skeleta lica, kao i čitav spektar metoda liječenja za pojedine vrste ozljeda. Cilj svakog radiološkog pregleda kod pacijenta sa ozljedom glave i lica je definirati mjesto i ozbiljnost fraktura kao i identificirati ozljede koje bi mogle ugroziti dišni put, vid, žvakanje, suzni sustav i sinusne funkcije. Multidetektorski CT zamijenio je klasičnu radiografiju i doveo do revolucije u snimanju maksilofacijalnih trauma.
Maksilofacijalna regija u užem smislu obuhvaća područje lica, čeljusti te usne šupljine. Zbog nedjeljivosti struktura viscerokranija obuhvaća još i orbitu s orbitalnim sadržajem, strukture nosa i paranazalnih šupljina te regije vrata. Kirurška anatomija viscerokranija prepoznaje dvije razine lica koje se ponašaju kao odvojene biomehaničke jedinice, donje lice koje čini donja čeljust i srednje lice koje obuhvaća koštani sklop viscerokranija između baze lubanje i donje čeljusti.
Svrha radiografije je potvrditi sumnju na kliničku dijagnozu, isključiti prisutnost prijeloma ili stranih tijela, te dobiti informacije koje možda nisu jasne iz kliničkog pregleda kako bi se preciznije odredila dijagnoza i opseg ozljede. Rutinske projekcije koje se koriste u procjeni stanja traumatiziranog bolesnika su Caldwellova projekcija, Watersova projekcija i lateralna (profilna) projekcija. Submentovertikalna i projekcija po Townu se također koriste za prikazivanje fraktura koje se na drugim projekcijama ne uočavaju. Sa sve većom ulogom CT-a za procjenu traume, većina kliničara zagovara njegovu uporabu te se isti smatra zlatnim standardom za radiografsku procjenu pacijenta s traumom lica.
Najprihvaćenija podjela prijeloma srednje razine lica je na frakture nazoorbitoetmoidalnog i zigomatikomaksilarnog kompleksa, dentoalveolarne frakture, orbitalne frakture, te frakture kostiju srednjeg lica koje uključuju tri tipa Le Fort fraktura (I,II i III). Prijelomi donje čeljusti mogu se podijeliti prema pomaku fragmenata, tipu prijeloma, lokalizaciji prijeloma, smjeru lomne linije, stanju zubala, starosti prijeloma.
Radiološka obrada nezamjenjiva je zbog vrlo detaljnog prikaza frakturnih linija na kostima, daje informaciju o frakturnim odlomcima i stanju kostiju lica. CT kao glavna pretraga pacijenta koji je doživio traumu apsolutno je indicirana i njeno odgađanje vrlo često dovodi do stvaranja komplikacija, a terapijske mogućnosti takvih stanja nerijetko su ograničene.
Abstract (english) Maxillofacial traumatology covers a very wide area ranging from just soft tissue injuries to multiple facial skull injuries as well as whole spectrum of treatment methods for particular type of injury. The aim of each radiological examination in a patient with head and face injuries is to define the position and severity of the fracture as well as identify injuries that could endanger the airway, vision, chewing, suction and sinus functions. The multidetector CT replaced classical x-rays and led to a revolution in imaging of maxillofacial trauma.
The maxillofacial region precisely encompasses the area of the face, jaw, and oral cavity. Due to the indivisibility of the viscerocranial structure, it also includes the orbit with orbital content, the nose structure with the paranasal cavities and the cervical regions. Surgical anatomy of viscerocranium recognizes two levels of face acting as separate biomechanical units, the lower face that includes the lower jaw and middle face that includes the bone structure of the viscerocranium between the skull and lower jaw base.
The purpose of radiography is to confirm suspicious clinical diagnosis, to exclude the presence of fractures or foreign bodies, and to obtain information that is not clear from the clinical examination to more accurately determine the diagnosis and extent of injury. The routine projections used to evaluate the condition of a traumatized patient are Caldwell's projection, Waters projection and lateral (profile) projection. Submentovertex and projection by Town are also used to determine fractures that are not visible on other projections. With the increasing role of traumatic CT assessment, most clinicians advocate its use and consider CT as a gold standard for radiographic assessment of patients with facial trauma.
The most preferred classification of the middle level facial fracture is: fractures of the nazoorbitoethmoidal and zygomatic axillary complexes, dentoalveolar fractures, orbital fractures, and middle facial fractures involving three types of Le Fort fractures (I, II and III). The fractures of the lower jaw can be classified by fragment shift, fracture type, fracture localization, fracture direction, the condition of the tooth, the age of the fracture.
Radiological treatment is irreplaceable due to a very detailed representation of fracture lines on the bones, giving information of fracture fragments and bone condition. CT as the gold standard of examination of a patient experiencing trauma is absolutely indicated and its delay often leads to complications, and later therapeutic options of these injuries are often limited.
Keywords
maksilofacijalna traumatologija
ozljeda mekih tkiva
ozljeda skeleta lica
multidetektorski CT
Keywords (english)
maxillofacial traumatology
soft tissue injuries
multiple facial skull injuries
the multidetector CT
Language croatian
URN:NBN urn:nbn:hr:176:823409
Study programme Title: Radiologic Technology (university/undergraduate) Study programme type: university Study level: undergraduate Academic / professional title: sveučilišni prvostupnik/prvostupnica (baccalaureus/baccalaurea) radiološke tehnologije (sveučilišni prvostupnik/prvostupnica (baccalaureus/baccalaurea) radiološke tehnologije)
Type of resource Text
File origin Born digital
Access conditions Open access
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Created on 2020-06-23 07:23:54