Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIII: Maxillofacial Wounds and Injuries

Introduction

United States Department of Defense

The management of maxillofacial injuries is divided into immediate, primary, and reconstructive phases.

1. In the immediate phase the establishment and maintenance of the airway and control of hemorrhage have the highest priority. Appropriate protective dressings are applied and hydration is maintained. The institution of antimicrobial therapy in this phase contributes to minimizing the incidence of subsequent infection.

   Penicillin is the drug of choice. If there is a question of penicillin allergy, clindamycin is an excellent alternative.

2. The primary phase consists of early definitive surgical repair of the wound and is accomplished at the first primary care facility to which the casualty is evacuated. Treatment performed during this phase of management significantly influences the subsequent requirement for or the magnitude of bony as well as soft tissue reconstruction and, therefore, the ultimate long-term. functional and cosmetic outcome. Generally, both hard and soft tissues are conservatively debrided. Repair begins with reapproximation and fixation immobilization of fractured bones, application of intraoral devices, reestablishment of dental occlusion or intermaxillary ridge relationships, and finally, primary closure of intraoral mucosa and overlying soft tissues wherever possible.

3. In the third or reconstructive phase, the tertiary care center attempts to correct deformities, such as malocclusion, and to obliterate defects with grafts or prosthetic devices. Ideally, treatment is carried out in specialized units staffed by dental, oral, and plastic surgeons who work in close cooperation with specialists in otolaryngology, ophthalmology, and neurosurgery. At least 25% of casualties with maxillofacial injuries also have injuries of the head and neck. In addition, dental laboratories should be available for the fabrication of dental appliances.  

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Operational Medicine 2001

Health Care in Military Settings

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