Shuker Sabri T
Department of Oral and Maxillofacial Surgery, Baghdad Medical City, Baghdad, Iraq.
J Oral Maxillofac Surg. 2010 Jan;68(1):93-100. doi: 10.1016/j.joms.2009.07.077.
Distinctive mechanisms of primary blast effects have produced a transitional era of facial trauma. Implosion mechanism damage is one of these. Implosion mechanism damage results in injury limited to the gas-containing structures of the auditory canal, paranasal sinuses, gastrointestinal tract, and lungs. Worldwide, the victims of explosive detonations have increased and advanced dramatically. The outcome is greater mortality and morbidity and new types of injuries, especially in the maxillofacial region. Thus, the knowledge of, and experience with, their management should be shared globally by colleagues through publications.
The implosion and mini re-explosion of compressed air sinuses leads to skeletal crush injury to the nasal-orbital-ethmoidal, maxillary sinuses, and nasal bones. A variety of surgical approaches were used successfully under conditions of war. The assessment of the associated injuries to the lung and/or brain is the initial priority to any life-threatening blast injury. This article describes the biophysical results of blast injuries to the middle third facial skeleton and associated injuries and details the management and protection of crushed air containing paranasal spaces.
Easy, simple, and fast treatment and management were used successfully on the pulverized, fragmented skeletal architecture of the facial middle part without increasing morbidity and with the avoidance of unnecessary surgical trauma.
Injuries in one of the most difficult esthetic, physiologic, and anatomic regions of the body is best treated with an understanding of the biophysical effects of the implosion mechanism on air-containing spaces in the maxillofacial region. The introduction of new methods for the management of severe destruction of hard and soft tissue will decrease the incidence of complications and the operative time.
原发性爆炸效应的独特机制造就了面部创伤的过渡时代。内爆机制损伤就是其中之一。内爆机制损伤导致的损伤仅限于耳道、鼻窦、胃肠道和肺部等含气结构。在全球范围内，爆炸事件的受害者数量大幅增加且伤情更为严重。其结果是死亡率和发病率更高，以及出现了新型损伤，尤其是在颌面区域。因此，同事们应通过出版物在全球范围内分享对这些损伤的认识和处理经验。
压缩空气鼻窦的内爆和微二次爆炸会导致鼻眶筛、上颌窦和鼻骨的骨骼挤压伤。在战争条件下成功采用了多种手术方法。对肺和/或脑的相关损伤进行评估是任何危及生命的爆炸伤的首要任务。本文描述了面部中三分之一骨骼爆炸伤的生物物理结果及相关损伤，并详细介绍了对含气鼻窦挤压伤的处理和防护。
对面部中部粉碎、破碎的骨骼结构成功采用了简便快捷的治疗和处理方法，未增加发病率，且避免了不必要的手术创伤。
对于身体最具美学、生理和解剖学挑战性的区域之一的损伤，最好在了解内爆机制对颌面区域含气间隙的生物物理效应的基础上进行治疗。引入新的软硬组织严重破坏处理方法将降低并发症发生率和手术时间。
