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Tổng hợp các tai nạn ở vùng răng hàm mặt thường gặp

Tai nạn là một việc không hề ai mong muốn. Thế nhưng, đôi khi trong đời sống đôi khi chúng ta lại gặp phải. Hãy cùng tìm hiểu xem đâu là những tai nạn ở vùng răng hàm mặt mà bệnh nhân thường gặp nhé!

Tai nạn ở vùng răng hàm mặt thường gặp

Tai nạn ở vùng răng hàm mặt trong giao thông

Đây là tai nạn ở vùng răng hàm mặt thường gặp nhất, tai nạn giao thông chiếm tỷ lệ 60-70% trong tổng số các tai nạn vùng răng miệng, còn lại là tai nạn sinh hoạt và tai nạn lao động.

Tai nạn ở vùng răng hàm mặt trong sinh hoạt

Bị té ngã, va đập vào vật cứng, bị đánh vào vùng mặt, bị hung khí chém vào mặt, bị chó cắn, tự tử…

Tai nạn ở vùng răng hàm mặt thường gặp khi lao động

Trong lúc làm việc, người lao động gặp tai nạn như dụng cụ cầm tay, mảnh vở văng vào mặt.

Tai nạn ở vùng răng hàm mặt thường gặp trong thể thao

Trong bóng đá, bị té ngã, bị đá vào vùng mặt, bị quả banh tennis đập trúng vào mặt.

Ngoài ra còn có tai nạn do hỏa khí, bị phỏng do lửa, do bị tạt axít… Ở vùng mặt cổ thường để lại sẹo xấu, sẹo dính gây thiếu hổng trên da mặt. Những trường hợp bị phỏng nặng làm hư hại da mặt phải ghép da, lấy da ở vùng đùi hay ở vùng bụng để vá ở phần da bị thiếu. Pháp và Trung quốc là những nước đầu tiên đã thành công khi cấy ghép toàn bộ da mặt của người cho (mới chết) sang người nhận bị thiếu hổng và biến dạng.

Lĩnh vực cấp cứu về tai nạn ở vùng răng hàm mặt

– Vết thương phần mềm thuộc lãnh vực răng hàm mặt là tất cả phần da, phần mềm bên ngoài của vùng đầu, phần bên trong miệng, niêm mạc nướu, má, lưỡi, răng và xương hàm.

– Đối với mắt, phần bên ngoài thuộc khoa hàm mặt, bên trong mắt và nhỡn cầu thuộc về khoa mắt

– Đối với tai – mũi – họng: phần bên ngoài vành tai và mũi thuộc khoa răng hàm mặt, bên trong mũi và tai thuộc khoa tai – mũi – họng (E.N.T). Trong miệng thì từ yết hầu trở vào trong thuộc khoa T.M.H

Những tai nạn ở vùng răng hàm mặt thường gặp và cách xử lí

Những tai nạn ở vùng răng hàm mặt – Gãy xương hàm trên

Xương hàm trên gãy (maxillary bone fracture) sẽ ảnh hưởng đến xoang hàm, hốc mắt và nền sọ. Khi gãy xương gò má, đường gãy Le Fort 1: chấn thương làm nứt xương hàm trên làm cho xương gò má bị sụp vào nhưng chưa ảnh hưởng đến xương hốc mắt .

Đường gãy Le Fort 2 có rạn nứt xương hốc mắt, bệnh nhân thị lực giảm, nhìn thấy 2 hình (Song thị): hiện tượng đeo kính râm do có xung huyết phần mềm quang mắt. Đường gãy Le Fort 3 nặng hơn vì vết nứt đi vào sâu nền sọ, làm biến dạng mặt, khớp cắn bị lệch do xương hàm trên bị kéo xuống phía dưới. Đường gãy Le Fort 3 cần phải theo dõi não vì có thể làm chấn thương sọ não, diễn tíến nặng có thể đi đến tử vong.

Điều trị: Những trường hợp gẫy xương hàm trên thường phải phẫu thuật nắn chỉnh lại xương, bệnh nhân phải nhập viện để điều trị.

Những tai nạn ở vùng răng hàm mặt thường gặp – Gãy xương hàm dưới

Khi gãy xương hàm dưới thường khớp cắn bị lệch, tùy theo vết gãy trên xương hàm dưới (mandibular bone), khớp cắn sẽ bị lệch lạc nhiều hay ít, và việc cố định xương hàm sẽ khó hay dễ.

Vùng cổ lổi cầu (neck of condylar), nơi mang lồi cầu tiếp giáp với xương thái dương tạo thành khớp thái dương hàm, T.M.J) là nơi dễ bi gãy nhất khi bị chấn thương ở góc hàm dưới, nếu lực đập bên góc hàm phải sẽ làm cổ lồi cầu bên trái bị chấn động và bị ga4y. Cổ lồi cầu rất nhỏ nên khi gãy , xương khó lành thương hơn các nơi khác.

Điều trị

Bệnh nhân phải nằm điều trị nội trú thời gian khoảng 3 tuần lễ, ăn thức ăn lỏng để chờ thời gian cho xương kết hợp tốt. Ngày trước việc cố định xương hàm dưới lâu và gây nhiều trở ngại cho việc ăn uống của bệnh nhân, ngày nay việc kết hợp xương gãy bằng các nẹp và ốc vít platinum giúp cho sự lành thương nhanh chóng và dễ dàng thoải mái cho bệnh nhân hơn

Những tai nạn ở vùng răng hàm mặt thường gặp – Chấn thương răng

Nguyên nhân khiến răng bị chấn thương

+ Do bị té gẫy răng
+ Do bị va đập bởi vật lạ bên ngoài như: trong xô xát, bị đánh bằng tay hay bằng vật cứng, do súng đạn gây nên.

Cách xử lí những tai nạn ở vùng răng hàm mặt do răng bị chấn thương

Răng bị văng ra ngoài xương ổ do bị va chạm mạnh, nếu răng vẫn còn nguyên có thể cắm lại (Làm implant lại tại chỗ) nếu răng chưa bị để ra ngoài quá lâu. Răng sẽ được cố định lại trong xương ổ răng, nhưng gốc răng phải còn tốt và được chữa nội nha tốt (trám bít ống tuỷ răng cẩn thận).

Nếu răng cửa bị gãy ngang vùng cổ răng, sau khi chữa nội nha (endodontics, root canal filling), răng sẽ được đóng chốt (Pivot hay core) làm cùi giả và chụp mão sứ lên trên để phục hình răng.

Trường hợp răng bị gãy quá sâu, chân răng chỉ còn 1/3 thì không thể đóng chốt được, gốc răng còn lại phải được nhổ và sau đó sẽ làm phục hình bằng cầu răng hay implant.

Một số trường hợp tai nạn ở vùng răng hàm mặt đặc biệt

Khi bị vật cứng va chạm vào vùng răng cửa, các răng cửa trên có thể bị chết do chùm mạch máu và dây thần kinh đi vào răng bị đứt. Răng chết sẽ bị đổi màu dần dần, có khi bệnh nhân không biết vì không thấy đau. Răng bị chết do va đập vào có thể bị nhiễm trùng làm viêm khớp, hoặc thành kinh niên, chóp góc răng có thể bị u hạt (granuloma) hay nang răng (root cyst, traumatic cyst). nếu để lâu việc điều trị sẽ khó khăn hơn phải làm nội nha và phẩu thuật cắt chóp răng.

Một số trường hợp răng bị chết khô (Dry gangrene), không bị nhiễm trùng nhưng màu răng dần dần bị đổi thành xám đen hay nâu mất thẫm mỹ. Việc tái tạo màu sắc và hình dáng cho răng bằng phục hình răng sứ (Porcelain hay ceramic crowns, jackets) là tốt nhất.

Những tai nạn ở vùng răng hàm mặt thường gặp – Vết thương phần mềm

Các vết thương phần mềm ở ngoài mặt thuộc lãnh vực Khoa RHM như: Bên ngoài mắt , bên ngoài tai, vành tai, bên ngoài mũi, cánh mũi. Khi có vết thương ở mặt, bệnh nhân có thể đến cấp cứu ở BV RHM trung ương hoặc BV RHM TP HCM.

Các vết thương phần mềm thường không khó và không mất nhiều thời gian điều trị như vết thương ở xương. Tuy nhiên các thiếu hổng ở mặt khó tạo hình thẫm mỹ hơn các vùng khác. Thí dụ như vết thương phỏng do hỏa khí, do bị tạt axít để lại những sẹo xấu rất khó cho tạo hình. Thế giới hiện nay đã thành công trong việc ghép toàn bộ da mặt của người mới chết để thay cho da mặt của bệnh nhân bị biến dạng vì các tai nạn ở vùng mặt.

Những lưu ý khi chăm sóc tai nạn ở vùng răng hàm mặt ở vết thương phần mềm

Vết thương nông ở vùng mặt khâu không khó nhưng muốn cho thẩm mỹ và không bị sẹo xấu, bác sỹ phải khâu với chỉ nhỏ bằng nylon (6.0) thay vì chỉ silk 3.0 bình thường. Nếu bệnh nhân có chấn thương vùng mặt, nên vào các BV lớn có chuyên khoa RHM để được khâu thẩm mỹ vì các cơ sở tuyến dưới chỉ khâu cầm máu, và thường không có loại chỉ khâu thẩm mỹ cũng như các y, bác sỹ của tuyến dưới không được đào tạo chuyên môn để có những đường chỉ khâu đẹp.

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In the past year, there have been two very public deaths as a result of disallowed terminations in Ireland. Savita Halappanavar, an Indian dentist who died in October after being denied an abortion despite a miscarriage, and an unnamed Irish resident who died in a taxi in London after traveling to the UK for a termination.

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