Base knowledge, skills, the skills necessary for studying of the theme (interdisciplinary integration).

Names of the previous disciplines	The got skills
1. Topographical anatomy.	To define the damaged anatomic region.
2. General surgery.	Arrest of bleeding. Temporal method.
3. Internal illnesses.	To make the diagnosis of a faint, a collapse, a shock.
4. Pharmacology.	To appoint the scheme of medicaments treatment to the victim.
5. Рентгенология.	To define a method of inspection necessary for the patient.

TASKs FOR INDividual WORK DURING PREPARATION TO Lesson.

4.1. List of basic terms, parameters, characteristic, which a student must master at preparation to lesson:

The term	Definition
1. Raposition.	Comparison of fragments.
2.Immobilization.	Exception of function, immobilization.

4.2. Theoretical questions to lesson: 1. What is the trauma? 2. Classification of damages of maxillofacial area in a peace time. 3. Methods of examination of patients with a trauma of maxillofacial area. 4. Volume and the order of rendering of medical aid by the wounded at stages of evacuation. 5. Classification of dislocations of teeth. 6. A clinical picture of a dislocation of teeth. 7. Classification of fractures of teeth. 8. A clinical picture of fractures of teeth. 9. Methods of treatment of fractures of teeth. 10. Methods of treatment of dislocations of teeth. 11. Classification of bleedings. 12. Temporal methods how to stop bleeding. 13. Methods of a constant (permanent) how to stop of a bleeding. 14. Definition of concept " primary surgical processing of wounds ". 15.How to make primary surgical processing wounds of the face. 16. Kinds of surgical processing. 17. Kinds of seams. 18. A general characteristic of bullet wounds. 19. Ballistic features of damages of soft tissues in maxillofacial area. 20. Clinical features of the picture of blind wounds of soft tissues of maxillofacial area. 21. Scoping and rendering of medical aid by the maxillofacial wounded with damages of soft tissues at a stage of the first medical aid. 22. Concept of traumatic illness, clinic, diagnostics, treatment. 23. Early and late complications of traumatic damages of maxillofacial area.

4.3. Practical works (task) which are executed on lesson: 1. To make the methods of inspection of the patient with traumatic damages of maxillofacial area. 2. Additional methods of inspection of the patient with traumatic damages of maxillofacial area. 3. To examine the patient with a fracture of maxilla or mandible. 4. To write a medical card of out-patient with traumatic damages of maxillofacial area. 5. To make the plan of treatment of the patient with traumatic damage of maxillofacial area. 6. Rehabilitation of the patient after fractures of the jaws.

5. TABLE OF CONTENTS OF THEME:

Wounds (vulnus) are the mechanical damage of the organism, which occur from destroying the integrity of the covered tissues - skin or mucous membrane. During this damage there can be destroyed more deep tissues, inner organs (damage of the brain, liver, stomach, kidneys and others). The injury of the covered tissues separates the wound from other kinds of damage. For example the injury of the liver, which is caused by the dull trauma of the abdomen without destroying the skin, is the rupture and the damage during the stroke by a knife in the abdominal region-wound of the liver, because we observe the destroying of the skin.

The main clinical features of the wounds are pain, bleeding and hiatus. Their devel­opment depends on the localization of the wounds, mechanism of the damage, volume and deepness of the injury, and common condition of the patient.

I. Pain (dolor)

It caused by direct damage of the nerves in the wounds region, and in result if it's freezing during the development of the swelling. The pain can be localized not only in the place of damage but also it can be spread over the whole region of innervation.

The intensivity of pain syndrome in case of the wound by the next features is deter­mined:

1. Localization of the wound.

2. Injuries of the big nerves trunks are present.

3. The character of the weapon and the frequency of causing and wound - the weapon is sharp and the damage of the receptor is less, and the pain is less.

4. Nerves - psychological condition of the organism. Pain feeling can be decreased when the patient is in the condition of effect, shock, alcohol or narcotic influence. Pain is not present during the operation with anesthesia, and during such a disease, like syringomyelia (the damage of the gray instances of the spinal cord).

Pain is the protective reaction of the organism, but long and intense pain causes exhaustion of the central nervous system.

II. Bleeding (haemorrhagia)

Bleeding - the constant feature of the wound because of the damage of the tissue starts from skin and mucous tissues and it is accompanied by the disturbance of the integrity of vessels. The intensity of the bleeding can be different - from capillary to arterial bleeding.

It is determined by:

1. The presence of damage of big (or middle) vessels: arterial or vein ones. Localization of the wound. The most intensive bleeding is in injuring of the face, head, neck, manus -the tissue of these parts of the body has more blood than others.

2. The character of the weapon.

3. The condition of local and common hemodynamics. When the arterial pressure is decreasing or squeezing of the magistral vessel the intensity of the bleeding de­creases.

4. The condition of the coagulation system.

III. Cleft (Hiatus)

The hiatus of the wound is caused by the contraction of the elastic fibers of the skin. Expressivities divergention of the skin's borders of a wound first of all is deter­mined by correlation of its axis to the Langergan's lines. These lines shoe the main direction of the rough skin structures situation. For example, for decreasing of the hia­tus during the operation of the extremities the surgeons choose the longitudinal direc­tions of the incisions. The special means of direction of the incision is in cosmetic and plastic surgery during closed skin defects. For big hiatus of the wound (incisions of the festering) the incision is made perpendicularly to the Langergan's line.

Classification of the wound

1. Classification according to the origin

All the wounds are divided into two groups: operative and accidental.

Operative wounds are caused deliberately, with treatment or diagnostic aim, in spe­cial aseptic conditions, with minimal damage of the tissues, during the anesthesia, with athorough hemostasis and by joining with stitches of the incisive anatomical structures. In such condition the pain is not present in case of the operative wounds, the possibility of the bleeding is minimal, and the hiatus of the wound is removed at the end of the operation by applying stitches, it means that the main wound features are removed arti­ficially.

The operative wounds heal by the primary tension.

All other kinds of wounds are accidental. The common thing of the wounds is that they are caused contrary to the will.

2. Classification according to character of tissue injure:

1. cut or incised wound (vulnus incisum);

2. stub or pierced wound (vulnus punctum);

3. contused wound (vulnus contusum);

4. lacerated wound (vulnus laceratum);

5. crushed wound (vulnus conqvassatum);

6. sabre or slash wound (vulnus caesum);

7. bite wound (vulnus morsum);

8. mixed wound (vulnus mixtum);

9. gunshot wound (vulnus sclopetarium).

Cut wound (Vulnus incisum)

A sharp object causes these wounds. During the influence of the tissues the effort is concentrated on the concrete area, and this area has the high pressure, and this influence divides the tissue in the direction of sharp objects action. The surrounding tissues dam­age is not substantial. But the sharp object goes down to the internal organs and tissues. These wounds lead to a faint pain syndrome, big bleeding, and the hiatus depends on the correlation of the axis to the Langergon's lines. Cut wound is dangerous with the ves­sels damage; nervous damage if this trauma does not have such complications the wound is going to heal by primary tension.

Stab wound (Vulnus punctum)

Stab wound is caused by narrow and pointed object. The anatomical peculiarities are large depth and small area of the injured skin and mucous tissue.

The pain syndrome is slight, hiatus is absent, the external bleeding is absent, but hematoma can develop. Its special feature is damage of the inner vessels, nerves and organs. That's why this kind of wound has the difficult diagnostics. During the stab wound the injure can be simple or with serious complications of the liver, stomach and others - this condition can lead to death. This wound can lead to spreading of infection.