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

Names of the previous disciplines	The got skills
1. Normal anatomy.	To be guided in the basic questions of a structure of maxillofacial area.
2. Topographical anatomy and operative surgery.	To know topographical anatomy of maxillofacial area. Principles of operative access to different departments of maxillofacial area. To define a topical diagnosis of traumatic damages of maxillofacial area.
3. Pathological physiology.	To represent the aetiology of combine traumas of maxillofacial area and traumatic illness.
4. Neurosurgery.	To know classification, clinic, diagnostics and the general principles of treatment of the brain trauma. To make the plan of examination and treatment of victims with damage of the face and skull and brain.
5. Clinical pharmacology.	To know pharmacology products which are prescribe at сombine damages of maxillofacial area.
6. General surgery.	To be able to make the plan of inspection of the patient with traumatic damage and to fill up the medical documentation.

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. Cranial - maxillofacial damages.	This simultaneous damage of the soft tissue, a facial part of skull and a brain.
2. Соmbine damage.	This action of one injuring agent on two and more areas simultaneously.
3. Traumatic illness.	Pathological process which develops as a result of traumatic damage.

4.2. Theoretical questions to the lesson: 1. To define a concept "a cranial - maxillofacial trauma". 2. A classification of combine damages of maxillofacial area. 3. Definition and a pathogenesis of a traumatic illness. 4. Clinic of combine damages of maxillofacial area. 5. Features of the urgent aid the victims with a combine trauma of maxillofacial area. 6. Features of treatment of victims with a combine trauma of maxillofacial area.7. Preventive maintenance of complications at combine damages of maxillofacial area.

4.3. Practical works (task) which are carried out on the lesson: 1. Training from rendering the urgent aid for victims with a cranial - maxillofacial damages and a соmbine trauma in maxillofacial surgery. 2. Drawing up of algorithm of treatment at соmbine traumas in maxillofacial surgery.

5. TABLE OF CONTENTS OF THEME:

Craniofacial fractures

In 1977 Matras and Kuderna pointed out that the rising number of road traffic accidents had added to the incidence of unusual combinations of facial fractures. Among these the frontomax-illary fracture as described by Pape (1969) is the most severe. Such fractures often extend from the anterior base of the skull to the mandible, thus involving the facial skeleton in the upper, lower and mid-facial regions. Cantore et al. (1979) reported that of 387 acute head injuries admitted to their neurosurgical unit during a 3-year period, 8 per cent had cranio-orbito-facial fractures.

There is both an increase in the incidence of these craniofacial fractures together with an improved chance of survival. Extensive disruption of the anterior cranial fossa, often involving the posterior wall of the frontal sinuses, means that reconstruction must be undertaken in a hospital equipped for craniofacial surgery. No maxillofacial injury can be treated in isolation from a coexistent cranial component, not only because of the need to treat the cranial injury but also because the displacement of the frontal bones, particularly the orbital roofs, prevents correct repositioning of the facial skeleton.

Fractures of the mid-face

The imaging required to obtain a detailed picture of a mid-facial fracture needs to be balanced against the benefits to actual treatment. In the tooth-bearing part of the maxillae separation at the Le Fort I level is often a clinical diagnosis. Intraoral films may, however, be most valuable in localizing alveolar fractures or a midline split of the palate, injuries which materially influence a treatment plan.

For higher level Le Fort II and III fractures, it is important to determine the overall fracture pattern and particularly the degree of cranial involvement. When there is comminution and displacement in the naso-ethmoid region or extensive damage to the orbital integrity, the clinician needs the detailed information provided by CT in order to plan the reconstruction. It is very important to obtain accurate reduction and fixation of these fractures at the acute stage when optimal results can be achieved.

The upper facial skeleton

The so-called upper third of the facial skeleton is chiefly the frontal bone making up the superior orbital margin and orbital roof. The base of the skull extends backwards and is angled downwards at approximately 45° where the frontal bone articulates with the sphenoid. The mid-facial complex articulates with this sloping plane and the cribriform plate of the ethmoid extends upwards to make contact with the meninges of the brain and transmit the olfactory nerves. The frontal bone, the body and greater and lesser wings of the sphenoid are not usually fractured. In fact, they are protected to a considerable extent by the cushioning effect achieved as the fracturing force crushes the comparatively weak bones comprising the middle third of the facial skeleton. When fractures of the cranial component of the facial skeleton do occur there are important consequences:

1. The brain may have sustained direct injury.

2. The brain may be at risk from indirect injury secondary to bleeding at the fracture site.

3. A fracture may involve the posterior wall of the frontal sinus, the orbital roof or the cribriform plate, which in turn may be associated with a breach of the dura materand leakage of cerebrospinal fluid.

4. Displacement, particularly in a caudal direction, will interfere with reduction of the facial bones as a whole.

The mid-facial skeleton

The mid-facial skeleton is defined as an area bounded superiorly by a line drawn across the skull from the frontozygomatic suture across the frontonasal and frontomaxillary sutures to the frontozygomatic suture on the opposite side, and inferiorly by the occlusal plane of the upper teeth, or, if the patient is edentulous, by the upper alveolar ridge. It extends backwards as far as the pterygoid plates of the sphenoid, which are usually involved in any severe fracture.

This area of the facial skeleton is made up of the following bones:

- two maxillae;

- two zygomatic bones;

- two zygomatic processes of the temporal bones;

- two palatine bones;

- two nasal bones;

- two lacrimal bones;

- vomer;

- ethmoid and its attached conchae;

- two inferior conchae;

- pterygoid plates of the sphenoid.