Ministry of Health of Ukraine

Danylo Halytsky Lviv National Medical University

“Approwed”
on the meeting of the Department
of Surgical Dentistry
and Maxillofacial Surgery

Head of the Department:

professor Ya. E. Vares

METHODICAL GIUDE FOR PRACTICAL LESSONS

Educational discipline FUNDAMENTALS OF DENTISTRY

Тopic 4. Traumatic injuries of hard and soft
tissues of the maxillo-facial area. Peculiarities of
Topic of the lesson surgical treatment, general principles of
treatment, prevention of early and late
complications.
Course 3rd
Faculty Medical

Lviv – 2019

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 Actuality of the topic. According to statistical data, the frequency of traumatic injuries of the
maxillofacial area reaches up to 8% of all traumatic injuries of the human body in peacetime. Like
any injury, damage to the maxillofacial area requires emergency medical care. Anatomic-functional
features, particularly, the immediate proximity of vital organs, makes significant specifics in
providing of this care and requires the necessary knowledge and skills of doctors of all specialties..
The purpose of the lesson is: to study the features of traumatic damage to the maxillofacial
area. Know the clinical flow and methods of treatment of traumatic injuries of soft tissues, teeth and
bones of the maxillofacial area. Learn to provide emergency and first medical aid for injured
patients.
Learning objectives:
• Professional competence:
1. Collection of medical information on the patient's condition.
2. Evaluation of the results of laboratory and instrumental research.
3. Establishment of a clinical diagnosis of dental disease.
4. Planning and conducting preventive measures for dental diseases.
5. Execution of medical and dental manipulations.
6. Organization and conducting of dental medical examination of persons subject to dispensary
supervision.
7. Assessment of the environmental impact on the health of the population (individual, family,
population).
8. Maintaining medical records.
9. Processing of state, social and medical information.
• General competence:
1. The ability to abstract thinking, analysis and synthesis; the ability to learn and be trained today.
2. Knowledge and understanding of the subject area and understanding of the profession.
3. Ability to apply knowledge in practical situations.
4. Ability to communicate in the state language both verbally and in writing; Ability to
communicate in a second language.
5. Skills in the use of information and communication technologies.
6. Ability to search, process and analyze information from various sources.
7. Ability to adapt and act in a new situation; ability to work autonomously.
8. Ability to identify, put and solve problems.
9. Ability to choose a communication strategy.
10. Ability to work in a team.
11. Interpersonal skills.
12. Ability to act on the basis of ethical considerations (motives).
13. Ability to act in a socially responsible and civic conscious manner.

Methods of training:
Preparatory stage - Frontal oral interview.
The main stage - practical training, role-playing game.
The final stage is brainstorming.
Interdisciplinary integration
Disciplines Student should know Student should be able to
Попередні:
Normal anatomy Know the anatomical and To be able to explain the
physiological features of the structure of systems and organs
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 maxillofacial area: of maxillo-facial area (MFA)
- structure of the upper and lower
jaws;
Normal physiology - innervation and vascularization of
these sites;
- structure of the lymphatic system
of the head and neck;
- structure of the muscles of the head
and neck;
- structure of the head and neck
areas.
Pathologic anatomy To know the appearance and flow of To be able to explain the
the pathological processes in the appearance and flow of the
Pathologic physiology tissues and organd of MFA pathological processes in the
tissues and organd of MFA
Topographical anatomy To know the topography of the To be able to explain the
organs of MFA topography of the organs of
MFA
Hystology To know histological structure of To be able to explain the stages
soft and hard tissues of MFA of manufacturing of
cytological, histological
preparations
Mycrobiology To know the species identification of To be able to explain the stages
microorganisms in the oral cavity of manufacturing of
microbiological preparations
and the essence of
bacteriological examination
Radiation diagnostics. To know the methods of radiological To be able to explain the
examination used in MFA principles on which these or
other methods are based (X-
ray, CT, MRI, ultrasound)
General traumatology and To know the basic principles of To be able to create a plan of
ortopedics treatment of the fractures of human’s treatment of the patient with
body bones or soft tissue wounds bone fracture or with a wound
of soft tissues
Pharmacology To know the groups of medicaments To be able to create a plan of
which can be used in medicament medicament treatment of
treatment of patients with maxillo- patients with maxillo-facial
facial traumatic injuries, their main traumatic injuries
representatives and their properties

Plan and organizational structure of practical lesson of the discipline

Duration of the practical lesson is 2 academical hours – 1 hour 30 minutes

№ The main stages of the lesson, their Time Methods of Materials of methodical
functions and content period eductation support
and control
1. Preparatory stage 20 min.
1.1 Organizational measures
1 min.

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1.2 Setting up of educational goals and 4 min.
motivation.
1.3 Control of the initial level of 15 min. Individual Question Tables,
knowledge (standardized control theoretical for an phantoms,
methods). evaluation. individual collapsible jaws,
Solving oral and textbooks,
typical written manuals,
tasks.Test evaluation. reference books,
control.Writt Typical atlas,
en interwiev. situational methodical
tasks and recommendation
tests. s, video films.
2. Main Stage 50 min.
Formation of professional skills and Formation of Patients with inflammatory
abilities: professional diseases of maxillofacial
1. To collect anamnesis and to skills: Work area. The history of the
conduct a review of the patients with with patients disease.Selection of results of
the traumatic injuries of soft and with additional survey methods.
hard tissues of MFA. inflammatory Situational
2. Set up a patient survey plan. pathology of tasks.Algorithms.Phantoms,
3. Make a plan for additional the MFA. surgical
research methods. Work out the instruments.Thematic videos.
4. Complete the relevant medical results of
documentation. additional
5. To work out a method of methods of
examination and palpation of the examination
maxillofacial area during the of patients
examination. with
6. To work out the method of inflammatory
examination of the patients with the diseases of
traumatic injuries of soft and hard the MFA.
tissues of MFA. Solving of
7. To work out typical
with prescription of additional situational
methods of radiological diagnostics. tasks. Oral
8. Learn about etiology and and written
pathogenesis of the traumatic injuries evaluation on
of soft and hard tissues of MFA. standardized
9. Learn to diagnose injuries of soft list of
tossues of MFA. issues.Work
10. Learn to diagnose injuries of the with
teeth. phantoms,
11. Learn to diagnose traumatic view
injuries of bones of MFA. thematic
12. To work out clinical flow and videos.
possible complications of the
traumatic injuries of soft and hard
tissues of MFA.
13. Learn to carry out differential
diagnostics between different types
of the traumatic injuries of soft and
hard tissues of MFA.
14. Learn the stages and variants of
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 surgical treatment of the traumatic
injuries of soft tissues of MFA.
15. Learn the stages and variants of
surgical treatment of the traumatic
injuries of bones of MFA.
16. Learn the stages and variants of
treatmen of the patients with facial
burns and frosting of the face
16. Learn the medicaments and their
combinations which can be used in
medicament treatment of the patients
with the traumatic injuries of soft
and hard tissues of MFA.
3. Final stage 20 min.
3.1 Control and correction of the level of Individual Phantoms, surgical
professional skills and abilities skills instruments.The history of
control.Contr the disease.Selection of
ol of skills by results of additional methods
solving non- of examination of thematic
typical patients.Unusual situational
situational tasks.
problems
with
illustrative
material.
3.2 Control and correction of the level of Final
professional skills and abilities. evaluation of
the students
3.3 Homework. Informing students Recommended literature
about the topic of the next lesson.

Methodology of organization of educational process in practical lesson.

STRUCTURE OF PRACTICAL LESSON
Preparation stage (20 min.)
To substantiate the significance of the subject for further study of the discipline and
professional activity of the doctor in order to formulate motivation and purposeful educational
activity. Get acquainted with students with specific goals and lesson plans. Conduct standardized
control of the initial level of student training, discussion and student answers.
• Organizational part of the lesson: presence check, evaluation of the uniform.
• Informing about of the topic and the purpose of the lesson.
Topic of the lesson: «Traumatic injuries of hard and soft tissues of the maxillo-facial area.
Peculiarities of surgical treatment, general principles of treatment, prevention of early and late
complications.»
The purpose of the lesson is: to study the features of traumatic damage to the maxillofacial
area. Know the clinical flow and methods of treatment of traumatic injuries of soft tissues, teeth and
bones of the maxillofacial area. Learn to provide emergency and first medical aid for injured
patients.
• Motivation for learning activities.
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 Traumatic injuries of the hard and soft tissues of the maxillofacial area may sometimes be
accompanied by dangerous conditions for the patient's health and life (bleeding, dislocation
asphyxia, brain damage, etc.). Correct organization of surgical dental care promotes qualitative
treatment of patients, provides conditions for preventive measures. In the practice of a surgeon-
dentist, an important place is the examination of patients, which is the basis for establishing the
correct diagnosis and the appointment of effective treatment.

Materials of the methodical provision of the preparatory stage of the class:

Questions to the front-line evaluation:
1.Classification of traumatic injuries of MFA.
2. Clinical features of wounds of soft tissues of MFA. Primary surgical treatment of wounds MFA.
Stages of conducting.
3. Local complications in wounds of soft tissues of MFA.
4. First aid for injury of the facial bones. First premedical, first medical, qualified and specialized
treatment.
5. Dislocation of the lower jaw.
6. Classification, clinic and treatment of jaw fractures.
7. Burns of the face – classification, clinic, diagnosis and treatment.
8. Frosting of the face - features of clinical manifestations, diagnostics and treatment.
9. Traumatic disease: pathogenesis, clinic, principles of treatment, complications. Complication of
injuries of MFA.
The main stage: the formation of professional skills and abilities (50 min.)
Providing of professional training
Causes of injury, its prevention, statistics of damages of maxillofacial area of peaceful and
military time, their classification. General characteristics and features of facial injuries. Traumatic
disease: pathogenesis, clinic, treatment principles, complications. Basic organizational principles of
tacing care of injured person with damage to soft tissues and bones of the face. First premedical,
first medical, qualified and specialized treatment.
Causes and mechanism of non-fatal injury of the person, its features. Methods of
investigation of injured persons. General immediate complications, damage to the jawbone area.
(shock, asphyxia, bleeding, etc.). Classification, clinic, treatment.
Fractures of the bones of the facial skull: lower and upper jaw, zygomatic bones, nasal bones,
adjoining bones. Frequency, causes, localization and character of bone fractures depending on the
causes and mechanism of injury. Types and typical locations of fractures. Biomechanics of
fractures, mechanism and the nature of the displacement of fragments. Clinical examination,
manifestations of fractures of the facial bones: anatomic and functional disorders, bite changes etc.
The fate of the teeth that are in the fracture lines. Indications for removing these teeth. Intraarticular
fractures, fractures with dislocation of the condyle’s head.
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 Principles of treatment of fractures of the bones of the facial skull - repositioning and fixation
of fragments, jaw immobilization, medication and physiotherapy, orthopedic and functional
treatment, complications, their prevention.
Treatment of fractures of the lower jaw. Provision of first medical aid. Ways of repositioning
of the fragments. Biomechanical bases of fixation of the fragments. Temporary (transport)
immobilization of the jaw, indications, means. Treatment immobilization. Application of individual
and standard arch bars and splints. Osteosynthesis of mandible: indications and contraindications,
osteosynthesis with bone sutures; application of metal vires, plates and frames, miniplates with
screws. Compression osteosynthesis of the mandible.
Treatment of fractures of the upper jaw, middle face area. Temporary and transport
immobilization of the upper jaw. Ways of repositioning and fixing fragments of the. Osteosynthesis
and compression osteosynthesis. Terms of healing, consequences.
Fractures of zygomatic bone and arc, zygomatic complex. Classification, diagnosis, clinical
picture. Features of treatment. Conservative, surgical methods of repositioning and fixing of the
fragments. Traumatic sinusitis. Restoration of the bottom of the orbit. Fractures of the bones and
damage to the cartilage of the nose. Diagnostics, clinic, treatment. Front and back tamponade of the
nasal passages.
Combined injuries of the maxillofacial area. Cranio-maxillo-facial trauma. Fractures of the
bones of the skull base. Diagnosis, treatment. Features of providing medical care in combination of
facial damage with concussion and brain sneezing, liquor, damage to other organs. The role of
neurosurgeons, specialists of intensive care and ophthalmologists.
Thermal damage to the face. Classification. Features, causes, severity and depth of damage,
possible complications. Treatment of face burns. Burns caused by Napalm. Electric trauma. Cold
trauma, frostbite. Clinic, treatment. Chemical damage: acids, alkalis, fighting poisonous substances.
Damage of facial tissues as a result of penetrating radiation and radioactive contamination. Clinical
flow, diagnostics, treatment of these injuries.
Combined radiation damage to the face. Peculiarities of the course of the wound process
depending on the stage of the radiation sickness. Syndrome of mutual encumbrance. The term and
features of surgical treatment of wounds and features of treatment of fractures and defects of jaws in
combined injuries. Combined chemical, bacteriological and mechanical lesions of the maxillofacial
area: clinical course, treatment at the stages of medical evacuation, features of wound treatment,
hemostasis, wound healing.
• Algorithms for the formation of professional skills and abilities.
1. To be able to conduct a survey and examination of patients with traumatic injuries MFA.
2. To be able to conduct medical care to patients with traumatic injuries of MFA.

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3. To be able to conduct interpretation of data of X-rays, CT data, MRI skulls attraumatic lesions of
MFA.
4. To be able to conduct temporary ligature viring of mandibular or maxillary fragments.
5. To be able to create a plan of debridement of the wound of soft tissues.
6. To be able to conduct stopping of the bleeding from tissues of MFA.
7. To be able to create a plan of treatment of the patient with fracture of the facial bones.
8. To be able to create a plan of treatment of the patient with facial burn.
9. To be able to create a plan of treatment of the patient with combined injury of MFA.

Final stage (20 min.)

Summing up of the lesson
Materials of methodological support of the final stage of the lesson:
• Brain storm.Students demonstrate an exhaustive description of the unusual clinical situation
and offer to offer the most rational diagnostic methods.After recording all the proposed
diagnostic methods during the discussion, students choose the most rational.
• Tasks for self-employment.To work on phantoms the technique of examination and
palpation of maxillofacial area, oral cavity under conditions of phantom class.
• Evaluation.
Conduct standardized final control using individual test tasks and questions (15 min.), Work
check (5 min.). Evaluate the student's current activities during the classroom, taking into account
standardized final control, analyze the student's progress, announce the evaluation of each student's
activity, and display it in the student attendance and student log book.An adult group at the same
time makes assessments in the record of the record of success and attendance of classes by students,
the teacher certifies them with his signature.
Brief informing the students about the topic of the next lesson and the methodical measures
for preparing for it.
Basic knowledge level:
1. Anatomical and topographic features of maxillofacial area, structure of the facialskeleton.
2. Additional methods of examination in dentistry.
3. Stages of providing of medical care for injured patients.
List of questions to be studied by the student:
1. Characteristic features of traumatic injuries of MFA.
2. Classification of traumatic injuries of MFA.
3. Clinical features of wounds of soft tissues of MFA. Primary surgical treatment of wounds MFA.
Stages of conduction.
4. Local complications of wounds of soft tissues of MFA.
5. First aid for injured. First premedical, first medical, qualified and specialized treatment.
6. Classification, clinic, treatment of fractures of the jaws, zygomatic bone and arc. Clinical
examination, manifestations, types, typical fracture sites.Biomechanics of fractures, mechanism of
the displacement of fragments.
7. Dislocations of the lower jaw.
8. Facial burns – classification, clinic, diagnosis, treatment.
9. Frostbite of the face – features of clinical manifestations, diagnostics, treatment.

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10. Traumatic disease: pathogenesis, clinic, principles of treatment, complications.Complications of
damage to the maxillofacial area (shock, asphyxia, bleeding, etc.).
11. Nutrition and care for patients with MFA trauma.
List of practical skills to be learned by the student:
1. To be able to conduct a survey and examination of patients with traumatic injuries MFA.
2. To be able to conduct medical care to patients with traumatic injuries of MFA.
3. To be able to conduct interpretation of data of X-rays, CT data, MRI skulls attraumatic lesions of
MFA.
4. To be able to conduct temporary ligature viring of mandibular or maxillary fragments.
5. To be able to create a plan of debridement of the wound of soft tissues.
6. To be able to conduct stopping of the bleeding from tissues of MFA.
7. To be able to create a plan of treatment of the patient with fracture of the facial bones.
8. To be able to create a plan of treatment of the patient with facial burn.
9. To be able to create a plan of treatment of the patient with combined injury of MFA.

Situational test tasks:

1. Patient P., 22 years old, with a bilateral mental fracture of the mandiblethere has a typical
dislocation of fragments. Which causes the displacement of the central fragment down?
A. Tension of the muscles of the supragioid group.
B. Tension of the pterygoid muscles.
C. Tension of masseter and temporal muscles.
D. Tension of mimic muscles.
E. The proper weight of the mandible.
2. The dentist of the village medical clinic has diagnosed the traumatic open fracture of the
angle of the lower jaw on the left with the displacement of the fragments. Which of the following
methods should be used for temporary (transport) immobilization of fragments.
A. Standard splint.
B. Individual arch bars.
C. Standard arch bars.
D. Weber’s splint.
E. Ligature viring.
3. The cause of traumatic disease:
A. Firearm or household injury.
B. Effect of ionizing radiation.
C. Effect of high temperature.
D. Interaction of a mechanical agent with body tissues.
E. Low temperature action.
4. In the patient from a work injury a wound of the right parotid region with uneven edges and
a significant area of damage arose. What kind of wound has arisen?
A. Contused.
B. Cut.
C. Stab.
D. Chopped.
E. Smashed.

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 5. Contusion is:
A. Closed mechanical damage of soft tissues without a visible injury of their anatomical integrity
B. Mechanical damage of the surface layers of the skin (epidermis) or the mucous membrane.
C. Injury of the integrity of the skin or mucous membrane over their entire thickness, caused by
mechanical influence.
D. Hemorrhage in the thickness of the skin or mucous membrane.
E. No correct ansver.
6. A 20 year old patient got a trauma in the area of his upper jaw. He applied to a dentist and
complained about mobility of his frontal upper teeth, pain during cutting and joining of teeth.
Objectively: the 11 and 21 teeth have II-III degree mobility. Tooth crowns are intact but have oral
position. Complete joining of teeth is impossible because the teeth are situated beyond the dental
arch. X-ray picture shows a slight broadening of periodontal fissure of the 11 tooth up to 0,5-2 mm.
The roots are intact. Make a correct diagnosis:
A. Traumatic subluxation of the 11, 21 teeth
B. Traumatic periodontitis of the 11, 21 teeth
C. Traumatic complete dislocation of the 11, 21 teeth
D. Fracture of alveolar process in the area of the 11, 21 teeth
E. Traumatic extraction of the 11, 21 teeth
7. During the transport of a patient aged 32 years with a traumatic unilateral fracture of the
body of the mandible to the department of maxillofacial surgery, the dental surgeon applied
imaxillo-mandibular fixation by Ivy. For what time it is indicaated to hold Ivy’s fixation:
A. For the entire duration of treatment.
B. Up to 5-6 days.
C. No value.
D. Up to 8 days.
E. Up to 2-3 days.
8. A patient aged 27 was admitted to a clinic complaining of the presence of blisters on the
face. From the medical history we know that 25 hours ago he participated in firefighting and injured
his face. Among his childhood diseases he indicates childhood infections, colds. On examination:
presence of thin-walled blisters containing yellowish substance on the nose and lips. What is a
provisional diagnosis?
A. Thermal bum of face of the 3-A degree
B. Thermal bum of face of the 2-3 degree
C. Thermal burn of face of the 1 degree
D. Thermal burn of face of the 3-4 degree
E. Thermal burn of face of the 1 -2 degree

Literature:
Basic:
9. Bases of Dentistry: Textbook, / ed. by V.O. Malanchuk. – Vinnytsia: Nova Knyha Publishers,
2012. – 616p.
10. Oral and Maxillofacial Surgery: Textbook, Part 1, 2 / V.O. Malanchuk. – Vinnytsia: Nova
Knyha Publishers, 2011. – 453p.
11. Principles of Dental Local Anaesthesia and Teeth Removal / Ya. E. Vares, R. Z. Ogonovsky,
Ch. R. Pohranychna – LNMU, 2007. – 63p.
12. Atlas of Human Anatomy / F. Netter – 2nd ed. – New Jersey: ICON Learning Systems. – 592 p.
Additional:
3. Contemporary Oral and Maxillofacial Surgery / L. J. Peterson, E. Ellis, J. R. Hupp, M.R. Tucker
– 3rd ed. – St. Louis: Mosby – Year Book, Inc. – 1998. – 1477 p.

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