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Resident Manual of Trauma to the Face, Head, and Neck
2
III. Principles of Soft Tissue Wound Management
...........................36
A. Initial Wound Management...........................................................36
1. Cleansing.....................................................................................36
2. Debridement..............................................................................36
3. Passive Drains............................................................................36
4. IV Antibiotics and Tetanus Toxoid........................................36
5. Inspection and Documentation.............................................36
B. Primary versus Delayed Closure.................................................36
C. Laceration Care after Repair.........................................................36
1. Closing Clean Wounds Primarily. .........................................36
2. Avoiding Additional Incisions................................................ 37
3. Reconstructing the Facial Framework Early........................ 37
D. Bite Wounds..................................................................................... 37
IV. Principles of Plating
.............................................................................38
A. Reconstructive Goals.....................................................................38
B. Technical Objectives......................................................................38
1. Stability at Each Fracture Site.................................................38
2. Three-Point Fixation of Mobile Segments..........................38
3. Bone Fragment Contact...........................................................38
C Plating Systems ..............................................................................38
1. Metal Plating..............................................................................39
2. Resorbable Plating....................................................................39
V. References and Resources
................................................................39
Chapter 3: Upper Facial Trauma
I.
Frontal Sinus and Anterior Skull Base Trauma
.............................41
A. Introduction.......................................................................................41
B. Classification....................................................................................42
C. Presentation......................................................................................43
1. Anterior Wall Fractures...........................................................43
2. Posterior Wall Fractures..........................................................43
3. Frontonasal Duct Fractures.................................................... 44
4. Corner Fractures ...................................................................... 44
5. Through-and-Through Fractures.......................................... 44
D. Management ...................................................................................45
1. Anterior Wall Fractures...........................................................45
2. Posterior Wall Fractures ........................................................ 46
3. Frontonasal Duct Fractures ....................................................47
4. Through-and-Through Fractures.......................................... 48
II. Naso-orbital-ethmoid Fractures
........................................................51
A. Anatomic Structures of the NOE Complex..............................52
B. Indications of Injury to the NOE Complex Structures...........53