Jabaut Joshua M, Kotora Joseph, Ambrosio Art
Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
Department of Emergency Medicine, Naval Hospital Camp Lejeune, Jacksonville, North Carolina.
J Emerg Med. 2017 Aug;53(2):262-264. doi: 10.1016/j.jemermed.2017.03.022. Epub 2017 May 3.
Degloving injuries of the extremities are well documented; however, there are few reports of degloving injuries to the mandible. A literature review demonstrates several cases of mandibular degloving in pediatric patients. However, no isolated mandibular degloving injuries have been reported in adults.
We report a case of a 21-year-old male who presented to the emergency department with facial trauma after a motorcycle accident. Initial examination of the head and neck showed ecchymosis and edema overlying the left periorbital area, eye closure secondary to periorbital edema, upper eyelid and lower eyelid superficial lacerations, as well as a left oral commissural and lower intraoral lacerations. Following completion of maxillofacial computed tomography after primary and secondary survey, the intraoral lesion was found to be a degloving injury of the mandible. This injury was irrigated with bacitracin and betadine before closure. It was ultimately closed in a layered fashion with deep layers reconstructing the sheared attachments of the overlying tissue to the periosteum, followed by gingivobuccal mucosal apposition superficially. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Facial trauma is a common presentation in the emergency department. It is important that the emergency physician complete a thorough head and neck evaluation, including the oral mucosa and gingivobuccal sulcus, as mandibular degloving injuries may be occult. Without a high level of suspicion, such lesions may be missed, increasing the risk of subsequent infection and obligate healing by secondary intention leading to increased morbidity.
四肢脱套伤已有充分的文献记载；然而，下颌骨脱套伤的报道却很少。文献综述显示了几例儿科患者下颌骨脱套的病例。然而，尚未有成人孤立性下颌骨脱套伤的报道。
我们报告一例21岁男性，在摩托车事故后面部受伤，被送往急诊科。头颈部初步检查显示左眶周区域有瘀斑和水肿，因眶周水肿导致眼睑闭合，上睑和下睑浅表裂伤，以及左侧口角和口腔内下部裂伤。在进行初级和次级检查后完成颌面计算机断层扫描，发现口腔内病变为下颌骨脱套伤。在缝合前，用杆菌肽和碘伏冲洗该损伤。最终分层缝合，深层重建覆盖组织与骨膜的剪切附着处，随后浅表进行牙龈颊黏膜对位。
急诊医生为何应了解此事？：面部创伤是急诊科常见的病症。急诊医生全面彻底地评估头颈部，包括口腔黏膜和牙龈颊沟很重要，因为下颌骨脱套伤可能隐匿。如果怀疑程度不高，此类损伤可能会被漏诊，增加后续感染风险，并不得不通过二期愈合，导致发病率增加。
