Soft tissue response and healing in omfs
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Transcript of Soft tissue response and healing in omfs
Page 1
GOOD MORNING
SOFT TISSUE REACTIONS AND
HEALING IN MAXILLOFACIAL
TRAUMA
MODERATOR – DR. RAJASEKHAR G.
PRESENTED BY- DR. SHEETAL
KAPSE
INCLUSIONS • Introduction
• Soft tissue layers in maxillofacial region
• Soft tissue reactions to trauma
• Healing of soft tissues
• Consequences of improper healing
• Factors affecting wound healing
• Conclusion
• References
SkinMuscle
CartilageNerve
Mucosa
INTRODUCTION
• The capacity for self-repair is crucial for the survival
of any organism, because without it the organism
would likely perish after minimal injury.
• A wound is a disruption in the normal anatomic
structure and function of tissue and is accompanied by
cellular damage.
INTRODUCTION
• Wound healing is an intricately coordinated series of
processes that involve cellular and subcellular
responses to tissue injury, leading to the release of
cytokines and growth factors, cell activation, and
resultant tissue regeneration.
INTRODUCTION
• The understanding of the remarkable cascade of events
involved in wound repair and healing is advancing
exponentially with the ongoing discoveries of the roles of
growth factors and signaling pathways.
• There is growing interest in stem cell research,
regenerative medicine applications, and bioactive wound
healing products.
Soft tissue layers in
maxillofacial region
Five layers of critical anatomy:1. Skin 2. Superficial fat compartments3. Superficial
musculoaponeurotic system (SMAS)
4. Retaining ligaments5. Mimetic muscles Deep plane, including the deep fat compartments
M.A. Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI 10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin Heidelberg 2012
J Ästhet Chir 2015 · 8:157–163 DOI 10.1007/s12631-015-0021-4© Springer-Verlag Berlin Heidelberg 2015
Superficial fat compartments of the face
Superficial musculoaponeurotic system (SMAS)
J Ästhet Chir 2015 · 8:157–163 DOI 10.1007/s12631-015-0021-4© Springer-Verlag Berlin Heidelberg 2015
Ligaments and septa between fat compartments of the face
P. M. Prendergast. Anatomy of the Face and Neck. M.A. Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI 10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin Heidelberg 2012
Mimetic muscles
Deep fat compartments
The buccal fat padand its extensions
The prezygomatic space. This space extends anteriorly to the infraorbital area.
Michael Miloro, Scott Redlinger, Diane M. Pennington, Tommy Kolodge, In Situ Location of the Temporal Branch of the Facial Nerve. Journal of Oral and Maxillofacial Surgery. 2007; 65(12):2466–2469
Soft tissue reactions to trauma
Cellular responses to cell injury
autolysis, necrosis & apoptosis
gangrene & pathologic calcificationHarsh Mohan. Textbook of Pathology. India; Jaypee Brothers Medical Publishers (P) Ltd; 2015.
Biosynthesis of prostaglandins (PG) and leukotrienes(LT)
Tripathi KD. E,ssentials of Medical Pharmacology. India; Jaypee Brothers Medical Publishers (P) Ltd; 2008.
Fonseca Raymond J, Walker Robert V, Barber H Dexter,
Powers, Michael P, Frost David E. oral and maxillofacial trauma. China: Saunders; 2013.
Healing of soft tissues
Fonseca Raymond J, Walker Robert V, Barber H Dexter, Powers, Michael P, Frost David E. oral and maxillofacial trauma. China: Saunders; 2013.
Wound_Healing_1.flv
Types of wound healing
Healing by primary intension / primary wound closure
Healing by secondary intension
Delayed primary closure / wound repair
Wound healing of SKIN
Epidermal wound healing. Injury to the epidermal layer induces epidermal keratinocytes to undergo a process of migration, mitosis, and maturation to reconstitute the epidermis and restorebarrier function.
Overview of the wound healing response. The panels show progressive phases of wound healing.
A, The early wound (day 2) exhibits many migratory responses.
B, As healing progresses (day 4), there is evidence of mitosis in the several compartments.
C, In the later stages of healing (day 14), the wound is maturing to establish a new homeostasis.
Wound healing of MUSCLE• Stages – 31. Inflammation – 5 days2. Proliferation – 2-6
weeks3. Remodeling - months
• RICE protocol• Role of NSAIDs• Role of steroids• Ideal therapeutic agents• Growth factors – IGF-1, • Gene therapy• Stem cell therapy• Antifibrosis therapy – decortin, suramin,
interferon – Y• Bionic replacement
Wound healing of CARTILAGE• Physiologically cartilage is considered as an isolated tissue
which is devoid of blood, lymphatic channels and free nerve endings.
• Inflammatory phase is absent in healing process
• Superficial injury – defects remain unchanged for 2 years• Penetrating injuries – repair by hyaline cartilage like
tissues.• Blunt impact – rapid degeneration & osteoarthitic lesions.
• Future trend – tissue engineering & growth factors.
Wound healing of NERVE
CLINICAL ASSESSMENT OF HEALING NERVE INJURY• An assessment of the status of the sensory nerve can be done in a relatively
short time in everyday clinical setting.
score responseS0 no recovery
S1 recovery of deep cutaneous pain
S1+ recovery of superficial pain
S2 same as S11 with addition of some touch Sensation
S2+ same as S2 but with hyperesthesia
S3 same as S2 but without hyperesthesia and with 2-point discrimination greater than 15 mm,
S3+ same as S3 with good localization of stimulus and 2-point discrimination of about 7 to 15 mm
S4 complete recovery (2-point discrimination is now 2 to 6 mm)
Thomas G. Auyong, Anh Le. DentoalveolarNerve Injury. Oral
Maxillofacial Surg Clin N Am 23 (2011) 395–400
Wound healing of MUCOSA
Dressings and topical agents 1. Dressings
2. Negative pressure wound therapy3. Topical agents4. Growth factors
Open v/s closed Dry v/s moist
Consequences of improper healing
1. Dehiscence2. Evisceration 3. Hemorrhage 4. Adhesion5. Herniation6. Sinus tract and
Fistula formation7. Suture
complications8. Hypertrophic scar9. Keloid
Factors affecting wound healing
Local Systemic Foreign bodies Aging
Venous insufficiency Smoking
Pressure, trauma Diabetes
Ischemia, hypoxia Corticosteroids
Radiation Immunocompromised state
Salivary contamination Malnutrition
Scarring Cytotoxic chemotherapy
Hematoma Vitamin deficiency
Chronic illness
Peripheral artery disease
Conclusion
• When treating facial injuries, knowledge of the wound healing process is crucial to maximize healing and minimize adverse outcomes such as infection, malunion and disfiguring scarring.
• In the trauma arena, oral and maxillofacial surgeons must not only treat acute traumatic wounds appropriately, but must also do everything possible to optimize the wound healing conditions.
• Knowledge of the technologic advances in wound care, regenerative medicine, and tissue engineering will allow the surgeon treating maxillofacial trauma to achieve the best possible outcome in these potentially devastating facial injuries.
References 1. Fonseca Raymond J, Walker Robert V, Barber H Dexter,
Powers, Michael P, Frost David E. oral and maxillofacial trauma. China: Saunders; 2013.
2. Harsh Mohan. Textbook of Pathology. India; Jaypee Brothers Medical Publishers (P) Ltd; 2015.
3. Tripathi KD. E,ssentials of Medical Pharmacology. India; Jaypee Brothers Medical Publishers (P) Ltd; 2008.
4. Hom, Hebda, Gosain, Friedman. Essential tissue healing of the face and neck. India. Peoples medical publishing house.
5. M.A. Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI 10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin Heidelberg 2012
References 6. J Ästhet Chir 2015 · 8:157–163 DOI 10.1007/s12631-
015-0021-4 © Springer-Verlag Berlin Heidelberg 2015
7. Michael Miloro, Scott Redlinger, Diane M. Pennington, Tommy Kolodge, In Situ Location of the Temporal Branch of the Facial Nerve. Journal of Oral and Maxillofacial Surgery. 2007; 65(12):2466–2469.
8. Thomas G. Auyong, Anh Le. Dentoalveolar Nerve Injury. Oral Maxillofacial Surg Clin N Am 23 (2011) 395–400
9. P. M. Prendergast. Anatomy of the Face and Neck. M.A. Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI 10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin Heidelberg 2012
“ God heals, and the doctor
takes the fees ”
Benjamin Franklin(American Statesman, scientist, Philosopher)