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:

Term	Definition
1. Regeneration	Restoration of structural elements instead of dead tissue
2. Combustiology	This branch of medicine that studies severe burn injury and tied them with pathological conditions, including burn shock, and treatment of these conditions.

4.2. Theoretical questions to lesson: 1. What is trauma? 2. Statistics of traumatic injures of maxillofacial area. 3. Classification of injures of bones of maxillofacial area. 4. Classification of injures of soft tissues of maxillofacial area. 5. Basic methods of examination of patients at policlinic. 6. Additional methods of victim’s examination.

4.3. Practical works (task) which are executed on lesson:

1. Conduct palpation of maxillofacial region of a patient with a suspected fracture of the upper jaw. 2. Conduct a test of indirect loads in a patient with a suspected fracture of the lower jaw.

5. TABLE OF CONTENTS OF THEME:

The facial skeleton can be roughly divided into three areas: the lower third or mandible, the upper third, which is formed by the frontal bone, and the middle third, an area extending downwards from the frontal bone to the level of the upper teeth or, if the patient is edentulous, the upper alveolus.

Fractures of the middleface have also been called «upper jaw fractures» or «fractures of the maxilla», but in view of the fact that bones adjacent to the upper jaw are almost invariably involved in such injuries, these terms are not strictly accurate. It is better to use the term «mid-facial». Fractures of the facial skeleton are one component of a spectrum of «maxillofacial injuries» and they are associated with varying degrees of involvement of the overlying soft tissues and such neighbouring structures as the eyes, nasal airways, paranasal sinuses and tongue. They can vary in severity from a simple crack in the upper alveolus to a major disruption of the entire facial skeleton.

Fracture of the mandible worldwide occurs more frequently than any other fracture of the facial skeleton apart from the nose. Fractures of the zygomatic complex are also common and are often associated with facial lacerations. Therefore all doctors working in Accident and Emergency departments should be able to recognize these injuries and be familiar with the basic management. Fractures of the lower jaw or alveolus may present to a dental surgeon in his practice or, albeit rarely, be a complication of a difficult tooth extraction. Therefore the study of the management of facial bone fractures has a real practical application which is not merely relevant to those studying for higher qualifications or pursuing a career in oral and maxillofacial surgery.

There are three types of regeneration: physiological, pathological and reparative. Physiological regeneration of bone occurs throughout life and is characterized by constant renewal of cells and intercellular organic matter.

Reparative or reconstructive, regeneration occurs when the damaged bone and aimed at restoring tsilesnosti and function of bone. On pathological regeneration say in cases where as a result of various causes distortion occurs regenerative process violation variable proliferation and differentiation.

The result is a wound healing bone callus. There are the following types of callus: periosteal (outer) corn, which is mainly formed by periosteum; endosteal (inner) callus formed in the direction of the endosteum; intermediarna corn fills the gap between the compact substance of bone fragments; paraossalna callus formed as a jumper between fragments of bone on hotels fracture.

Burns (combustiones) - lesion of skin thermal, electrical, radiation factors. Burns mainly affects the skin, much less - mucous membranes, subcutaneous fat, others are deeper anatomical lesions (fascia, muscles, tendons, joints). When a tissues of the head and neck wound process proceeds according to the general laws of tissue damage. The most frequently occurring thermal burns due to high temperatures.

Effect of heat, chemicals and radiation energy leads to pathological changes in the tissues - burns. In peacetime burns occur as a result of violations of safety regulations on business or in life. Burns faces and heads up from 12.4% to 24.5%

Burns, depending on the origin, divided into 4 groups: thermal, chemical, electrical, radiation.

The nature of damage to the skin and deeper tissues located examine four degrees of burns:

1 - characterized by intense redness and slight swelling;

2 - create different skin blisters of different sizes with transparent serous fluid;

3a - part of the dermis with epithelial formations sweat, sebaceous glands and hair follicles are not damaged;

3b - total skin necrosis.

4 - necrosis of tissue (tissue charring)

To severe burns include burns III b and IV degree, leaving deforming scars on the face and neck, deep defects and deformities eyebrows, eyelids, ears, nose, lips, chin and second parts of the face.

Characteristics of thermal burns.

Postburns changes of facial tissue, usually lead to serious view of the lower jaw and the second functional and cosmetic defects. Most of all damaged protruding part of the face - nose, ears, lips, eyebrows, zygomatic part of the chin. Thermal burns of all degrees causing the patient a sense of unbearable pitch and a sharp pain that is worse when touching the damaged surface.

After one degree of burns of face skin varies little, sometimes remains pigmentation. Burns faces have 2 degrees of aseptic downstream end at the end of the second week of treatment epithelialization of the skin which is very sensitive when touched and easily injured. In cases of infected blisters or injured with burns surface face have 2 degrees on the spot granulations are always hypertrophic scars. Burns 3a and 3b degrees accompanied by infection. The process of healing is accompanied by the formation of scars after burn injuries, which often turn into keloid. They are usually formed ulcers, cracks. When defeat ever possible complications in the form of conjunctivitis. When burn injuries face time with injuries the second parts of the body, accompanied by changes in the body necessary observations relevant professionals.

Dimensions of surface burn determine the percentage in relation to the entire body surface through "nine rules" and "rules of the palm." "Rule of Nine" should be used with considerable damage to the surface of the body. The calculation to determine the following: the surface of the head and neck - 9%, lower limb - 18%, upper limbs - 9%, front surface of the body 18% of the rear surface of the body - 18%, intermediate and genitals - 1% of the total area body. More accurate results are obtained using methods of Postnikov. Square custody measure applying to the surface of sterile burn

Characterization of chemical burns

Chemical burns caused by the action of inorganic acids (sulfuric, hydrochloric, nitric), meadow (slaked lime, potassium hydroxide and sodium) salts of heavy metals (silver nitrate) on exposed areas of the body or the mucous membranes of the oral cavity, oropharynx, esophagus. The depth of the burn depends on the concentration and temperature of the substance, duration of exposure. The mechanism of acid burns lies in the fact that acid alter biological fluids - colloids cells is dehydration and coagulation of tissue necrosis develops dry. Mechanism of care meadows lies in the fact that alkali form of tissue alkaline albuminaty, saponified fats, wet necrosis develops.

Chemical burns are further classified into four sequential classification. When chemical burns do not form blisters. Burn disease occurs rarely, but is absorption into the bloodstream chemicals and intoxication them and their metabolites.

Frostbite

Frostbitten arise because of the low temperature. On the face of frostbite are most often the nose, ears, fabric zygomatic region cheeks. From the low temperature cartilage suffer even with small skin lesions. May develop to occurred long and lead to deformity of ears or nose. The bones of the facial skeleton when frostbite affected rarely. There frostbite tongue and lips (usually in children) as a consequence of exposure of these tissues with metal in the cold (attempt to lick a metal object).

In case of violation of natural and artificial thermoregulation possible freezing of tissues under conditions of high humidity at moderate temperatures. In the low temperature damage spreads into the tissue rather than on the surface. Frostbitten facial tissue is rarely an indication for hospitalization. W. policlinic practice they are found in half of patients with frostbite. During WWII single face frostbite were 0.69% among those treated for frostbite in hospitals. Severe frostbite face are rare as a result of prolonged contact of the low temperature on the tissues.

6. MATERIALS FOR SELF-CONTROL: