А . Questions for self-checking:

Gunshot splinter injury of mental area of mandible.

                               

 

 Before surgical treatment                                   After surgical treatment

                                                                               (there are lamellar sutures at wound.)

 

B. Tasks for self-checking: 1. Patient 45 years has salivary fistula at parotid area after gunshot damage. What kind of surgical treatment is useful if the scar is cuted out, at depth of wound make seam. And the wound was close layer-by-layer after it. (Answer: method of Sapozhnikov).

2. A wounded with perforated gunshot wound of soft tissues without damages of bones, big vessels and nerves was inspected by stomatologist at stage of qualified medical aid. What is the necessary treatment? (Answer: early surgical treatment of wound).

3. The wounded with tangent gunshot wound of maxillofacial area with big defect of right cheek was get to medical office of regiment. Blood pressure 95/65, mental confusion, moderate bleeding from wound. What the volume of first medical aid? (Answer: stop bleeding, compressive bandage, anti-shock therapy).

C. Matherials for test control. Test tasks with one right answer (α = II): 1. Fixation of tongue as first medical aid is used in case such asphyxia. A. Aspirational. B. Obturational. C. Dislocational. D. Stenotic. E. Valvate. (Correct answer: C).

2. Primary surgical treatment of gunshot wound is carrying out: A. Before than 4-6 hours after trauma. B. Before than 6-8 hours after trauma. C. Before than 8-12 hours after trauma. D. Before than 12-24 hours after trauma. E. Before than 48 hours after trauma. (Correct answer: D).

3. Medical sorting of wounded is become at such stage of evacuation: A. Field of hate. B. Medical office of battalion. C. Medical office of regiment. D. Detached medical battalion. E. Special surgical hospital. (Correct answer: C).

D. Educational tasks of 3 th levels (atypical tasks): 1. The patient, 23 years old, was getting to polyclinic to the surgeon-stomatologist with complaints to pain in a chin on the right, bleeding from an oral cavity, the complicated meal. Patient ago foll and hit a chin two days. He didn't lose consciousness. Objective: there is asymmetry of the face at the expense of hypostasis of soft tissues in a chin on the right. Opening of a mouth is a little limited. "Step" symptoms between 42 and 45, a rupture of a mucous membrane, pathological mobility of fragments of the mandible. Define the diagnosis, inspection volume, a type of a temporary immobilization. (Answer: fracture of the mandible in a chin on the right with shift fragments; X-ray research of the mandible; fundiform bandage).

2. The serviceman was getting to maxillofacial department of specialized hospital with a gunshot wound of maxillofacial area which is delivered more than days ago. Objectively: in a chin a wound of the wrong form of 3х5 cm in the depth of which the shattered bone is visible. Bleeding is absent, breath violation takes place. Establish the diagnosis; specify a mistake which was made at the previous stage of evacuation and a type of surgical processing which will be carried out. (Answer: gunshot fracture of the mandible in a chin; dislocation asphyxia; at the previous stage of evacuation the tongue wasn't fixated; the deferred primary surgical processing will be carried out).

3. The serviceman was getting to pecialized hospital in 42 hours after wound in a satisfactory condition. Objectively: there is a wound of the considerable sizes with defect of tissues, penentrate into an oral cavity in the left buccal area with obvious signs of an inflammation. Define a type of surgical treatment and sutures which will be imposed. (Answer: secondary surgical treatment, lamellar sutures).