Vous êtes sur la page 1sur 250

TRAUMATIC INJURY IN CHILDREN

(Oral and Maxillofacial)

Harfindo Nismal, drg., Sp.BM

Oral and Maxillofacial Department.


1 Faculty of Dentistry - Andalas University
Learning Ooutcomes
Used with permission from Content Visionary

Upon completion of this presentation, participants will be able to:

Understanding the incidence of traumatic oral & maxillofacial injuries in


children come to dentist.

Understanding, list and describe the categories of oral & maxillofacial


injury.

Understanding and describe how to diagnose and manage traumatic oral


& maxillofacial injury in children.

2
Definition :
Injury which is limited to the teeth and supporting
structures of the alveolus, intra and extra of oral and
maxillofacial region.

N.B Boys are three times more at risk than girls.

Causes :
1- Traffic Accident.
2- Falls.
3- During Epileptic seizures.
4- Sport injuries.
Patterns and Risk Factors

The most common injury site is the maxillary (upper) central incisors,
which account for more than 50% of all dental injuries.

Oral injuries typically result from falls (most common), bike and car
accidents, sports-related injuries, and violence.

The mouth is also a common site for non-accidental trauma, and


child abuse should always be considered in a child presenting with
oral trauma.

4 www.aap.org/oralhealth/pact
Patterns and Risk Factors

Pediatricians should be aware of the following risk factors for oral


trauma:

Children with compromised protective reflexes or poor coordination


Hyperactivity
Substance abuse (by the adolescent or within the family)
Child abuse or neglect
Malocclusion with protruding front teeth
Failure to use protective face and mouth gear

5 www.aap.org/oralhealth/pact
6
7
8
9 http://www.aap.org/oralhealth/pact
OPG

10
Diagnosis

Clinical
History Radiographic
examination Vitality test
Examination
History

1. Personal history
2. Medical history
3. Previous dental history
4. History of trauma (when ,how ,where )
History of Trauma

1) When did the accident occur ?


The shorter the time between accident and
treatment the better prognosis.
2) where did the accident occur ?
If the accident occurred in dirty place prophylactic tetanus is
indicated

3) how did the injury occur ?


Direct force under the chin condylar fracture
Direct force to teeth Crown F, Root F, displacement
Clinical Examination

Extraoral Examination
Laceration ; Abrasions ; Contusions on the head and
neck can be noted visually
Any asymmetries including deviation in mouth
opening.

Intraoral Examination
Soft tissue ( tongue ; gingiva .. )
Teeth ( displacement ; mobility ; tooth fracture ;
colour change )
15
Classification of tooth fracture
Ellis classification:
Class I:
crack or fracture of E only
Class II:
fracture of E , D with out pulp exposure
Class III:
fracture of E , D with pulp exposure
Class IV:
Fracture line passes beneath the gingival margin
Class V:
Root fracture
a) vertical b) horizontal
(apical , middle , cervical)
Class I :

1- a crack of the enamel without


loss of tooth structure.
Do not require immediate treatment.

2- fracture of enamel only


smoothing the sharp edge
regular vitality test , radiograph
Class II :

Immediate treatment of the crown is


required to:
1) protect the pulp
2) restore the esthetics and function.

Cover the expose of the dentine by a


layer of calcium hydroxide to
reparative dentine formation.
A- Reattachment of tooth fragment.
B- Acid-etch composite resin
restoration
Class III :
The treatment depends on many
factors such as:
1) vitality of the exposed pulp.
2) Size of the exposure.
3) Time elapsed since the exposure.
4) Degree of root maturation.
5) Restorability of the fractured
crown.

The main objective of treatment is to


maintain the vitality of the tooth.
Class IV :

Treatment usually involve removing


the loose fragment .
1- tooth can be extruded
orthodontically
2- crown lengthening to gain
access to placement of
restoration.
Class v :
1) Horizontal Root fracture

When the fracture occur near the


apical 1/3, the prognosis is more
favourable than the middle or cervical 1/3
because :
1) more alveolar support
2) immobilization of the tooth is much easier

Treatment of root fracture depends upon :


1) Condition of the pulp
2) amount of mobility or the level of the fracture
line
(A) apical 1/3 root fracture

1) reduction , splinting the tooth

2) the tooth should be checked


periodically for vitality and
radiograph.
(B) middle 1/3 root fracture :
1) reduction , splinting the tooth

2)the patient recall 2-3 months , checked the


vitality ,radiograph

3)if the tooth non vital and no healing the


following treatment is performed:
a) R C T of both fragments
b) apical fragment removed surgically
c) intraradicular pin to stabilizeboth segments
(C) cervical 1/3 root fracture :

1)reductin , splinting the tooth


2)recall the patient periodically and checked the
vitality and radiograph
3)if there is radiolucent and pulp necrosis the
following treatment is performed
a) extraction the tooth
b) removed the apical fragment and
endo-osseous implant placed
c) orthodontic extrusion
d) if the fracture is 1-2mm infrabony
remove the coronal segment and
osteoplasty to expose the root
2) vertical root fracture :

usually the prognosis is not favorable

treatment of V R F :
1)extraction of the tooth
2)using co2 laser and ND:YAG laser beam
Types of Tooth Injury

Tooth injury can be divided into 7 main categories:

1. Concussion
2. Subluxation
3. Lateral Luxation
4. Intrusion
5. Extrusion
6. Avulsion
7. Fracture Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry,
Duke Children's Hospital

26
Concussion

Concussion involves injury to supporting structures of the


tooth, without loosening or displacement.

Tooth is tender to percussion.

Recommended Treatment:
Stick to a soft diet for 2 weeks.

Monitor for changes in tooth color.


Refer to dentist for non-urgent evaluation.

27 www.aap.org/oralhealth/pact
Subluxation

Subluxation involves injury to


supporting structures of the tooth
with loosening but no displacement.
The tooth is tender to percussion,
with bleeding at the gingival margin.

Recommended Treatment:
Stick to a soft diet for 2 weeks. Used with permission from Rebecca Slayton, DDS PhD

Dental follow-up; may splint permanent teeth.


Monitor for changes in tooth color that may indicate pulp necrosis.

28 www.aap.org/oralhealth/pact
Lateral Luxation

Lateral luxation involves injury to the


tooth and its supporting structures,
resulting in tooth displacement. The
injured tooth is at risk for pulpal necrosis
and root resorption.
Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke
Pediatric Dentistry, Duke Children's Hospital

This type of injury requires prompt referral


to a dentist for repositioning of the injured tooth/teeth.

Even primary teeth should be examined by a dentist, because the


Underlying permanent tooth may be injured.
29 www.aap.org/oralhealth/pact
Intrusion

With intrusion injuries, the tooth is


pushed into the socket and the alveolar
bone. It may appear shortened or barely
visible.

Intrusion has a poor prognosis and


high risk for complications, including Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke
Pediatric Dentistry, Duke Children's Hospital

root resorption, pulp necrosis, and


infection. May require a root canal.

Intrusion injuries may also damage underlying permanent dentition,


especially if an infection develops.
30 www.aap.org/oralhealth/pact
Intrusion, continued

With intrusion injuries, teeth may re-erupt. If a primary tooth does


NOT re-erupt, it will require extraction to not interfere with
permanent tooth eruption.

Recommended Treatment:
Do not attempt to remove intruded tooth. Instead, focus on pain
control and consider antibiotic prophylaxis.
For a primary tooth, seek dental evaluation within 1 week (or
earlier, for significant symptoms).
For a permanent tooth, refer to a dentist immediately for
repositioning and splinting.
31 www.aap.org/oralhealth/pact
Extrusion

With an extrusion injury, the tooth


is partially displaced from its socket.

This type of injury requires


re-positioning and stabilization.

Refer to a dentist promptly to


evaluate the extent of injury, as well
as any associated injury (e.g. Used with permission from Rama Oskouian

fracture).

32 www.aap.org/oralhealth/pact
Avulsion

With this type of injury, the tooth


is completely out of the socket.

Management of avulsion injuries


depends on the tooth type.
Used with permission from Rama Oskouian

33 www.aap.org/oralhealth/pact
Avulsion of a Primary Tooth

Do NOT re-implant a primary tooth, as this may damage the


underlying permanent tooth.

Instead, refer to a dentist within 24 hours.

34 www.aap.org/oralhealth/pact
Avulsion of a Permanent Tooth

This is a dental emergency!

Avulsion should be managed as follows:


1. Gently rinse off debris with saline or milk. Hold tooth by crown only.
2. Avoid touching the root. Do not clean or rub it. It is important to
preserve the periodontal ligament for tooth survival.
3. Re-implant an avulsed permanent tooth immediately, ensuring
correct orientation. The tooth should be re-implanted within 20
minutes, but the best outcome is with teeth replaced within 5
minutes.
4. Instruct patient to bite on gauze or a handkerchief or to hold the
tooth in place.
35 www.aap.org/oralhealth/pact
Avulsion of a Permanent Tooth, continued

5. Send to a dentist or maxillofacial surgeon immediately for


radiographs, splinting, and antibiotic prophylaxis.
6. If the tooth cannot be re-implanted on scene, transport it (ordered
by preference) in: a tooth storage solution, warm milk, saline, or
saliva.
7. A tooth should not be transported dry or in plain water, as this
significantly decreases the chance of ligament survival.
8. Never suggest a child hold the damaged tooth in his or her mouth
because of the risk of aspiration or bacterial contamination.

36 www.aap.org/oralhealth/pact
Fracture

There are 5 basic types of tooth fracture:

1. Infraction: incomplete fracture (crack) of the enamel without


loss of tooth structure.
2. Uncomplicated Crown fracture: an enamel fracture or an
enamel-dentin fracture that does not involve the pulp.
3. Complicated Crown fracture: an enamel-dentin fracture with
pulp exposure.
4. Crown/root fracture: an enamel, dentin, and cementum
fracture with or without pulp exposure.
5. Root Fracture: a dentin and cementum fracture involving the
pulp

37 www.aap.org/oralhealth/pact
Uncomplicated Crown Fracture

This type of fracture is a crack of the enamel


or dentin that does not involve the pulp. It
may have a sharp edge.

Recommended Treatment:
Inspect injured lips, tongue, and gingiva to
rule out presence of tooth fragments.
Provide a soft diet, avoiding temperature
extremes.
If a permanent tooth is injured, refer to a
dentist for evaluation ASAP (within 12 to 24
hours).
Recommend long-term follow-up to evaluate Used with permission from:

38 for complications, which are uncommon.


a. Rocio B. Quinonez, DMD, MS, MPH; Associate Professor Department of Pediatric
Dentistry, School of Dentistry
b. Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke
Children's Hospital
Complicated Crown Fracture

Complicated crown fracture is an enamel-


dentin fracture with pulp exposure.

Site of a complicated crown fracture has a


reddish tinge or will bleed.

This type of fracture can cause extreme


pain and may lead to pulpal necrosis, root
resorption, or infection in exposed pulp.

Refer to dentist as soon as possible


(within 12 to 24 hours) for evaluation.

39 Used with permission from:


a. Rebecca Slatyton DDS, PhD
b. Rocio B. Quinonez, DMD, MS, MPH; Associate Professor Department www.aap.org/oralhealth/pact
of Pediatric Dentistry, School of Dentistry
Crown/Root Fracture

Enamel, dentin, and cementum fracture with or without pulp


exposure.

Likely complications include root resorption and pulp necrosis.

Refer to dentist as soon as possible (within 12 to 24 hours) for


evaluation, where diagnosis will be made via radiograph.

Treatment consists of reduction and splinting or extraction.

40 www.aap.org/oralhealth/pact
Root Fracture

Excessive mobility of the tooth may indicate a


root fracture. This type of fracture includes
pulp exposure. Potential complications for a
root fracture include resorption and pulp necrosis.

Refer to a dentist ASAP (within 12-24 hours) for


evaluation, where diagnosis is made radiographically.
Used with permission from Martha Ann Keels, DDS,
PhD; Division Head of Duke Pediatric Dentistry, Duke
Children's Hospital

Treatment consists of reduction and splinting for


permanent teeth or extraction, depending on the extent of the
traumatic lesion.
41 www.aap.org/oralhealth/pact
Complications and Consequences of
Tooth Injury

There are many possible consequences of an oral injury:

Pain, which can be severe.


Infection, including abscess.
Ankylosis.
Inflammatory root resorption.
Aesthetic consequences.
Negative impact on self-esteem.
Impaired oral or phonetic function.
High cost.

For these reasons, prevention of tooth injury is paramount.


42 www.aap.org/oralhealth/pact
Vitality Test

Vitality test just following traumatic injury often given false negative response

Types of vitality test


1) Thermal pulp test
cold test

heat test

2) Electrical pulp test


3) Cavity test
Radiographic Examination

1- stage of root formation


2- presence of root fractur
3- periapical radiolucencies
4- injury of the supporting periodontal membrane
(degree of intrusion or extrusion of the tooth)
5- size of the pulp

N. B. If a jaw fracture is suspected extaoral radiographs


indicated (panoramic and lateral oblique views )
Treatment

*soft tissue injuries

1- Determination of child immunization status:-

If the child had received a primary immunization


activated with booster injection of toxoid .
Unimmunized child can be protected by tetanus
antitoxin.

2- Adequate debridment of the wound


Emergency Report
Wednesday, February 4th 2015
Reffered From Sehati Medika Clinic
Name : Nazar, an
Sex : Male
Age : 2 years old
Address : Jl. Cibaduyut no.25 rt 03/05
Cibaduyut Kota Bandung
Religion : Moeslem
Status : Single
Medical Rec No. : 1500003568
Time of arrival : 14.32 PM
PS : bleeding from the mouth
S:
A 2 y.o male patient came with bleeding from the mouth. 3
hours prior to admission, when the patient was playing in his
home in Cibaduyut area, the patient fell with mechanism his
upper jaw hit the floor first. History of unconsciousness (-),
nausea and vomiting (-), bleeding from mouth (+), bleeding
from ear and nose (-). The patient was taken to the Sehati
Medika clinic, but there was nothing done there just, cleaning
wound and there are given two types of drugs(patien forgot the
name of the drug), patients taken it one time. Then, the patient
was reffered to Hasan Sadikin ER department. History of
immunization was complete.
O:
Primary Survey
A: Clear
B: symmetrical shape and movement,
VBS R=L, RR= 30x/m
C: HR= 92 x/minutes
D: GCS15 (E4M6V5)
Pupil :Round equal RL 3/3 mm, LR +/+
Motoric: No parese

Secondary survey: within normal limit


General status :

Skin : Turgor (+)


Head : Symmetrical face
Eyes : Non anemic konjunctiva, Non icteric sclera
Neck : JVP not rising
Submandible lymph nodes : not palpable, no pain
Thorax : Symmetrical shape and movement
Pulmo : VBS R=L, Rh -/-, Wh-/-
Cor : Pure Regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Hepatic & Lien : not palpable
Extremity : Warm, CRT < 2
Local status :
Extra Oral : Symmetrical face
Intra Oral :
Gingiva : Lacerated wound at teeth 51- 62 with
2x0.5x0.5 cm in size, irreguler edge, bone
based
Lip : Within normal limit
Vestibulae : Within normal limit
Tongue : Within normal limit
Buccal mucosa : Within normal limit
Palate : Within normal limit
Floor of mouth : Within normal limit
Tonsils : T1-T1
Odontogram

intrution Avultion
UE UE
V IV III II I I II III IV V
V IV III II I I II III IV V

UE UE

Occlusion (+)
Laboratory findings :

Hematology
- PT : 10.1 (10,4-14,4) second
- INR : 0.94 (0,83-1,16) second
- APTT : 22,9 (20-40) second
Hb : 12,9 (11.5-13.5) g/dL
Ht : 38 (34- 40) %
WBC : 14.400 (6000-17.000)/mm3
RBC : 4,83 (3,96-5.32) million/uL
Platelets : 439.000 (150.000-450.000)/mm3
A:
Dentoalveolar fracture of teeth 51-62 with
intrusion of tooth 51 and avultion of teeth 61,62 +
lacerated wound at gingival of teeth 51 -62
P : Oral surgery treatment

CBC, PT-APTT
R/ Amoxycillin syr 125 mg 1 cth PO
Paracetamol syr 120 mg 1 cth PO
Diazepam supp 5 mg Supp.
Extraction of tooth 51
Alveolectomy
Debridement
Suturing at Intra oral
Suggestions :
Soft diet
Plan for panoramic x-ray
Oral hygiene instruction
R/ Amoxycillin syr 125 mg 3 x 1 cth PO
Paracetamol syr 120 mg 3 x 1 cth PO
Aplication of hyaluronic acid gel at post suturing intra oral
Control at Oral Maxillofacial Surgery Clinic on Thursday, Jan 5th 2015

Discharged

Yuli Indrawati., drg/ Prof.Dr. Harmas,drg., SpBM


Post Treatment
Emergency Report
Monday, February 16th 2014
Name : Khansa Nabiila
Sex : Female
Age : 3 year old
Address : Jln Andir no 109, Ciroyom
Kodya Bandung
Religion : Moslem
Medrec No. : 1500004779
Time of admission : 16.54 PM
Ps: Bleeding from the mouth
S:
A 3 y.o female patient, came with bleeding from his
mouth. 2 hours prior to admission, when the patient
was playing with her sister at home in andir area.
Suddenly he fell down from second floor with unknown
mechanism. History of unconsciousness (-), nausea &
vomiting (-), bleeding from mouth (+), bleeding from
ear & nose (-). The patient was taken to Kebon Jati
Hospital, but theres no treatment. Then the patient was
taken to Hasan Sadikin Hospital.
O:
Primary survey
A : Clear
B : Symmetrical shape and movement, RR: 26 x/min
C : HR: 91 x/min
D : GCS 15 (E4M6V5) round equal pupil 3mm, ODS:
LR +/+ ; Parese -/-

Secondary Survey
Oedem and hematom at left frontal and parietal
General Status
Skin : Turgor (+)
Head : Asymmetrical face, Oedem and hematom at
left frontal and parietal
Eye : Non anemic conjungtiva, non icteric sclera
Neck : JVP did not increase,
Chest : Symmetrical shape and movement
Pulmo : VBS right=left, Rh-/-, Wh -/-
Cor : Pure regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Extremity : Warm, CRT <2
Local Status

Extra Oral :
Asymmetrical head
Oedem and hematom at left frontal 2x2cm in size
Oedem and hematom at left parietal 2x2 cm in size
Intra Oral :
Tongue : Lacerated wound at dorsal tongue 1,5x0.5x0.5
cm in size, irregular edge, muscle based
Palate : Within normal limit
Vestibulae : Within normal limit
Lips : Within normal limit
Gingiva : Within normal limit
Buccal mucous : Within normal limit
Floor of mouth : Within normal limit
Tonsil : T1-T2
Odontogram

V IV III II I I II III IV V

V IV III II I I II III IV V

Occlusion (+)
Schedel AP-Lateral

Impression : within normal limit


Laboratory Findings:

PT : 10.1 8,8-12,8 second


INR : 0.94 0.84-1.16 second
APTT : 26.8 14,5-34,5 second

Hb : 11.6 F(11.5-13.5) g/dL


Ht : 36 F(34 - 40) %
RBC : 4.76 F(3.95- 5.26) juta/uL
WBC : 20100 (5500-15500) /mm3
Platelet count : 37300 (150.000-450.000) /mm3
A:
Lacerated wound at dorsal tongue
P: Treatment from Oral Surgery

Routine blood count, PT-APTT


Schedel AP-Lateral
R/ Amoxycillin syr 125mg 1 cth
Paracetamol syr 120mg 1 cth
Suturing of IO lacerated wound
Application of hyaluronic acid gel at post suturing IO
Suggestion :
Soft diet
R/ Amoxycillin syr 125mg 3x1 cth
Paracetamol syr 120mg 3x1 cth
Oral Hygene Instruction
Application of hyaluronic acid gel at post suturing IO
Control to OMFS clinic on Tuesday February 17th 2014

Discharged

Eka Marwansyah., drg./Ida Ayu A., drg., Sp.BM


Post Treatment
Emergency Report
Sunday, Desember 28th 2014
Name : M. Hanif
Sex : Male
Age : 2 year old
Address : Jln Sukahaji, Gg Buntu no 9
Sukarasa, Bandung
Religion : Islam
Medrec No. : 1400042457
Time of admission : 12.19 AM
Ps: Bleeding from the chin
S:
A 2 y.o male patient, came to RSHS with chief
complain bleedimg from his chin 2 hours prior to
admission, when the patient carried by his mother, at
store area in lembang area, suddenly he felt down with
mechanism the chin hit the floor first. History of
unconsciousness (-), nausea&vomiting (-), bleeding
from mouth (-), bleeding from ear & nose(-). History of
immunization (-). Then the patient was taken to ER
departement of RSHS.
O:
Primary survey
A : Clear
B : Symmetrical shape and movement, RR: 25 x/min
C : HR: 94 x/min
D : GCS 15 (E4M6V5) round equal pupil 3mm, ODS:
LR +/+ ; Parese -/-

Secondary Survey
Within normal limit
General Status
Skin : Turgor (+)
Head : Symmetrical face
Non anemic conjungtiva, non icteric sclera
Neck : JVP did not increase,
Chest : Symmetrical shape and movement
Pulmo : VBS right=left, Rh-/-, Wh -/-
Cor : Pure regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Extremity : Warm, CRT <2
Local Status

Extra Oral : Symmetrical face, lacerated wound at regio mentale


1cmx0.3cmx0,2cm, irreguler edge, muscle based
Intra Oral :
Tongue : Within normal limit
Palate : Within normal limit
Vestibulae : Within normal limit
Lips : Within normal limit
Gingiva : Within normal limit
Buccal mucous : Within normal limit
Floor of mouth : Within normal limit
Tonsil : T1-T1
Odontogram

V IV III II I I II III IV V

V IV III II I I II III IV V
Laboratory Results:

- BT : 100 1-3
menit
- CT : 430 3-5
menit
- Hb : 11.9 L(11.5-13.5) g/dL
- Ht : 36 L(34 - 40)
%
- RBC : 4.90 L (4.11- 5.95) juta/uL
- WBC : 11.600 (5000-14500) /mm3
- Platelet count : 434.000 (150.000-450.000) /mm3
A:
Lacerated wound at regio mentale
Treatment :

Routine blood count, BT, CT


R/ Amoxycillin syr 125mg 1 tsp
Paracetamol syr 120mg 1 tsp
Debridement
Suturing of Ekstra Oral lacerated wound
Suggestion :
Plan to perform Panoramic x-ray
R/ Amoxycillin syr 125mg 3x1 tsp
Paracetamol syr 120mg 3x1 tsp
Aplication of ikamicetin zalf for four days, and
continue with aplication of myoderm zalf at days 5
Control to OMFS clinic on Monday December 29th
2014
Removal of suturing POD VII January 4th 2015

Discharged

Imran., drg./Asri Arumsari., drg., Sp.BM


Post Treatment
Emergency Report
Monday, Oktober 12th 2014
Name : Rafly Firmansyah
Sex : Male
Age : 5 year old
Address : Kp Tarigu Kel Margahurip
Banjaran, Bandung
Religion : Islam
Medrec No. : 1400034218
Time of admission : 10.01 AM
Ps: Bleeding from the mouth
S:
A 5 y.o male patient, came with bleeding from his
mouth. 7 days prior to admission, when the patient
was playing at home, suddenly he fell down and his
tongue was bitten. History of unconsciousness (-),
nausea&vomiting (-), bleeding from mouth (+), bleeding
from ear & nose (-). The patient was taken to Al-Ikhsan
Hospital and because there was no dentist on duty, then
the patient went home. 4day prior to admission, the
patient was taken to Sartika Asih Hospital and because
no bleeding the patient only received some medicines
(the patient didnt remember the medicines). 1 day
prior to admission, tongue was bleeding again. Then the
patient was taken to ER departement of RSHS.
O:
Primary survey
A : Clear
B : Symmetrical shape and movement, RR: 29 x/min
C : HR: 94 x/min
D : GCS 15 (E4M6V5) round equal pupil 3mm, ODS:
LR +/+ ; Parese -/-

Secondary Survey
Within normal limit
General Status
Skin : Turgor (+)
Head : Symmetrical face
Non anemic conjungtiva, non icteric sclera
Neck : JVP did not increase,
Chest : Symmetrical shape and movement
Pulmo : VBS right=left, Rh-/-, Wh -/-
Cor : Pure regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Extremity : Warm, CRT <2
Local Status

Extra Oral : Symmetrical face


Intra Oral :
Tongue : Lacerated wound at dorsal tongue
1,5x0.5x0.5 cm in size, irregular edge,
muscle based
Palate : Within normal limit
Vestibulae : Within normal limit
Lips : Within normal limit
Gingiva : Within normal limit
Buccal mucous : Within normal limit
Floor of mouth : Within normal limit
Tonsil : T1-T1
Odontogram

CM CM
V IV III II I I II III IV V

V IV III II I I II III IV V
CM CP
Laboratory Results:

- PT : 11.8 10,4-14,4 second


- INR : 0.94 0.81-1.18
second
- APTT : 25.8 14,9-34,9 second
- Hb : 12.3 L(11.5-13.5) g/dL
- Ht : 37 L(34 - 40)
%
- RBC : 4.77 L (4.11- 5.95) juta/uL
- WBC : 10600 (5000-14500) /mm3
- Platelet count : 492000 (150.000-450.000) /mm3
A:
Lacerated wound at dorsal tongue
Treatment :

Routine blood count, PT-APTT


R/ Amoxycillin syr 125mg 2 cth
Paracetamol syr 120mg 2 cth
Suturing of Intra Oral lacerated wound
Suggestion :
- Soft diet
- R/ : Amoxycillin syr 125mg 3x2 cth
Paracetamol syr 120mg 3x2 cth
- OHI
- Aplication of hyaluronic acid gel at post IO suture
- Control to OMFS clinic on Monday (13/10/2014)

Discharged

Indra H., drg./Agus N., drg., Sp.BM


Post Treatment
Emergency Report
Wednesday, January 28th 2015
Name : Agastia Wryyoga, an
Sex : Male
Age : 3 years old
Address : Kp. Kp Palalangon rt 04/05 kel
cempaka mulya, kec. cimaung,
Kab.Bandung
Religion : Moeslem
Status : Single
Medical Rec No. : 1500002908
Time of arrival : 21.11 PM
PS : bleeding from the mouth
S:
A 3 y.o male patient came with bleeding from the mouth. 7
hours prior to admission, when the patient was playing around
his home in Banjaran area, suddenly the patient fell with
mechanism his lips hit board first. History of unconsciousness
(-), nausea and vomiting (-), bleeding from mouth (+),
bleeding from ear and nose (-). The patient was taken to the Al
Ihsan hospital, but there was nothing done there.Then, his
parents brought him to Hasan Sadikin ER department. History
of immunization was complete.
O:
Primary Survey
A: Clear
B: symmetrical shape and movement,
VBS R=L, RR= 25x/m
C: HR= 95 x/minutes
D: GCS15 (E4M6V5)
Pupil :Round equal RL 3/3 mm, LR +/+
Motoric: No parese

Secondary survey: within normal limit


General status :

Skin : Turgor (+)


Head : Symmetrical face
Eyes : Non anemic konjunctiva, Non icteric sclera
Neck : JVP not rising
Submandible lymph nodes : not palpable, no pain
Thorax : Symmetrical shape and movement
Pulmo : VBS R=L, Rh -/-, Wh-/-
Cor : Pure Regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Hepatic & Lien : not palpable
Extremity : Warm, CRT < 2
Local status :
Extra Oral : Symmetrical face
Intra Oral :
Lip : Oedema at upper lip
Gingiva : Lacerated wound at teeth 51- 61 with
1,3x0.5x0.5 cm in size, irreguler edge, bone
based
Vestibulae : Lacerated wound at tooth 61 with
0.5x0.5 cm in size, irreguler edge, muscle
based
Tongue : Within normal limit
Buccal mucosa : Within normal limit
Palate : Within normal limit
Floor of mouth : Within normal limit
Tonsils : T1-T1
Odontogram

Mobility grade II

V IV III II I I II III IV V
V IV III II I I II III IV V

Occlusion (+)
Laboratory findings :

Hematology
- PT : 10.7 (8,9-12,9) second
- INR : 0.99 (0,83-1,16) second
- APTT : 26,1 (15,4-35,4) second
Hb : 11.4 (11.5-13.5) g/dL
Ht : 33 (34- 40) %
WBC : 22.600 (5500-15.500)/mm3
RBC : 4.52 (3,95-5.26) million/uL
Platelets : 381.000 (150.000-450.000)/mm3
A:
Dentoalveolar fracture of teeth 51-61 with mobility
grade II + lacerated wound at gingiva of teeth 51 -
61 + lacerated wound at vestibulae of tooth 61
P : Oral surgery treatment

RBC, PT-APTT
R/ Amoxycillin syr 125 mg 1 cth PO
Paracetamol syr 120 mg 1 cth PO
Diazepam supp 2,5 mg Supp.
Debridement
Suturing at Intra oral
Suggestions :
Soft diet
Oral hygiene instruction
R/ Amoxycillin syr 125 mg 3 x 1 cth PO
Paracetamol syr 120 mg 3 x 1 cth PO
Aplication of hyaluronic acid gel at post suturing intra oral
Control at Oral Maxillofacial Surgery Clinic on Thursday, Jan 29th 2015

Discharged

Yuli Indrawati., drg/ Winarno,drg., SpBM


Post Treatment
Emergency Report
Monday, March 30th 2015
Referred from Private Clinic
Name : Jason
Sex : Male
Age : 9 y.o
Address : Jl. Sersan Bajuri No.42
Religion : Moeslem
Status : Single
Medical Rec No. : 1500008942
Time of arrival : 04.00 PM
PS : Bleeding from the mouth
S:
A 9 y.o male patient came with bleeding from the mouth.
2 hours prior to admission, when the patient was riding a
motorcycle as a passenger at Setiabudi area in low speed,
suddenly came another motorcycle from his right and
crashed onto them and the patient fell with mechanism his
face hit the asphalt first. Helmet (+) half face. History of
unconsciousness (-), nausea and vomiting (-), bleeding from
mouth (+), bleeding from ear and nose (-). The patient was
taken to Private Clinic at Hegarmana area and received
wound toilet, injection of TT, and prescribed medicines
(Amoxycilin, Paracetamol, Multivitamin). The patient then
was referred to Hasan Sadikin hospital.
O:
Primary Survey
A: Clear
B: Symmetrical shape and movement
VBS R=L, RR= 22x/m
C: HR= 84 x/minutes
D: GCS15 (E4M6V5)
Pupil :Roundequal RL 3 mm, LR +/+, parese -/-

Secondary survey:
Abrasivum wound at left knee and ankle region
General status :

Skin : Turgor (+)


Head : Asymmetrical face, oedem at right zygomaticotemporal
and chin region
Eyes : Non anemic konjunctiva, Non icteric sclera
Neck : JVP not rising
Submandible lymph nodes : not palpable, no pain
Thorax : Symmetrical shape and movement
Pulmo : VBS R=L, Rh -/-, Wh-/-
Cor : Pure Regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Hepatic & Lien : not palpable
Extremity : Warm, CRT < 2
Local status :
Extra Oral :
Asymmetrical face, oedem at right zygomaticotemporal and chin region
Multiple abrasivum wound at facial region
Intra Oral :
Lips : Oedema and hematoma at upper lip region,
Lacerated wound at lower lip region with
1x0.5x0.3 cm in size, irregular edge, muscle
based
Vestibule : Hematoma and lacerated wound at teeth 11- 21
region with 2x1x0.5 cm in size, irregular edge,
muscle based
Gingiva : Lacerated wound at teeth 11- 21 region with
2x1x0.3 cm in size, irregular edge, bone
based
Tongue : Within normal limit
Buccal mucosa : Within normal limit
Palate : Within normal limit
Floor of mouth : Within normal limit
Tonsils : T1-T1
Odontogram

# Crown #1/3 Crown


Mob gr.2
CM CM
CM GR

6 5 IV III 2 1 V56
1 2 III IV
6 5 IV III 2 1 1 2 III IV 5 6

Mob gr.2
Occlusion (+)
Skull X-Ray AP Lateral

Impression :
Dentoalveolar fracture of teeth 12-22
Laboratory findings :

Hematology
- PT : 10,4 (9,3-13,3) second
- INR : 0,97 (0,84-1,15) second
- APTT : 26,1 (16-36) second
Hb : 14,6 (11.5-15.5) g/dL
Ht : 42 (35- 45) %
WBC : 11.100 (4500-13.500)/mm3
RBC : 5,52 (4,43-6,02) million/uL
Platelets : 284.000 (150.000-450.000)/mm3
A:
Dentoalveolar fracture of teeth 12-22 with mobility
grade II of teeth 12-22 + crown fracture of tooth
21 + 1/3 incisal fracture of tooth 11
Lacerated wound at vestibule and gingiva of teeth
11-21 + Lacerated wound at lower lip
P : Oral surgery treatment

Routine blood count, PT-APTT


Injection of ATS
Skull AP-Lateral X-Ray
R/ Amoxycillin syr 125 mg 3 cth P.O.
Paracetamol syr 120 mg 3 cth P.O.
Debridement
Suturing of lacerated wound intraorally
IDW at upper jaw (16-26)
Pressure bandage at nasolabial region
Suggestions :
Plan to perform panoramic x-ray
Soft diet
Oral hygiene instruction
R/ Amoxycillin syr 125 mg 3 x 3 cth P.O.
Paracetamol syr 120 mg 3 x 3 cth P.O.
Application of hyaluronic acid gel at post suturing intraorally
Application of chloramphenicol zalf at abrasivum wound extraorally
Plan to perform extraction of teeth 54, 64, 73, 74 in pedodontic clinic at office hours
Plan to perform filling of teeth 11, 21 in pedodontic clinic at office hours
Control at Oral Maxillofacial Surgery Clinic on Tuesday, Mar 31st 2015
Suture removal POD VII 6th April 2015
Maintain pressure bandage until POD III
Discharged

Eka M., drg/ Ida Ayu A., drg., SpBM


Post Treatment
Emergency Report
Friday, December 27th 2014
Name : Rafka R.
Sex : Male
Age : 3 years old
Address : Kp. Cijulang, Sukabumi,
Bandung
Religion : Moeslem
Status : Single
Medical Rec No. : 1400042362
Time of arrival : 06.00 PM
PS : Wound on the tongue

S:
A 3 y.o male patient came with wound on the tongue. 2
hours prior to admission, when the patient was jumping
around on the bed at his home in Cisarua area, suddenly the
patient felt from the bed with mechanism his chin hit the
edge of the table first. History of unconsciousness (-),
nausea and vomiting (-). Bleeding from mouth (+), bleeding
from ear and nose (-). Then the patient was brought to
Cibabat Hospital but no treatment was performed there.
Then, his parents brought him to Hasan Sadikin ER
department
O:
Primary Survey
A: Clear
B: symmetrical shape and movement,
VBS R=L, RR= 24x/m
C: HR= 90 x/minutes
D: GCS15 (E4M6V5)
Pupil :Round equal RL 3/3 mm, RC +/+
Motoric: No parese

Secondary survey: within normal limit


General status :

Skin : Turgor (+)


Head : Symmetrical face
Eyes : Non anemic konjunctiva, Non icteric sclera
Neck : JVP not rising
Submandible lymph nodes : not palpable, no pain
Thorax : Symmetrical shape and movement
Pulmo : VBS R=L, Rh -/-, Wh-/-
Cor : Pure Regular heart sound
Abdomen : Flat and soft, bowel sound (+) N
Hepatic & Lien : not palpable
Extremity : Warm, CRT < 2
Local status :
Extra Oral : Symmetrical face
Intra Oral :
Tongue : Lacerated wound at regio dorsal of the tongue
4x0.5x0.5 cm in size, irreguler edge, muscle
based
Lips : Within normal limit
Buccal mucosa : Within normal limit
Gingiva : Within normal limit
Palate : Within normal limit
Vestibulae : Within normal limit
Floor of mouth : Within normal limit
Tonsils : T1-T1
Odontogram

CS CS
V IV III II I I II III IV V
V IV III II I I II III IV V

Occlusion (+)
Laboratory findings :

Hematology
- PT : 10.6 (10.3-14.3) second
- INR : 0.99 (0,83-1,17) second
- APTT : 23.4 (15-35) second
Hb : 12.4 (11.5-15.5) g/dL
Ht : 36 (35- 45) %
WBC : 13.100 (4500-13.500)/mm3
RBC : 4.96 (4.19-5.96) million/uL
Platelets : 495.000 (150.000-450.000)/mm3
A:
Lacerated wound at dorsal of the tongue
P : Oral surgery treatment

Sysmex, PT-APTT
R/ Amoxycillin syr 125 mg 1 cth PO
Paracetamol syr 120 mg 1 cth PO
Diazepam supp 50mg 1 tube Supp.
Necrotomy debridemen
Suturing laceration wound at dorsal of the tongue
Suggestions :
Regular diet
R/ Amoxycillin syr 125 mg 3 x 1 cth PO
Paracetamol syr 120 mg 3 x 1 cth PO
Aplication of hyaluronic acid gel at post suturing intra oral
Plan to perform dental filling of teeth 51 61 at dental clinic, pedodontic
department on office hour
Control at Oral Maxillofacial Surgery Clinic on Monday, Dec 29th 2014

Discharged

Irmawati R., drg/ Agus Nurwiadh,drg., SpBM


Post Treatment
LAPORAN EMERGENSI
Nama : Salsabila
JK : Perempuan
Umur : 5 tahun
Alamat : Jl. Cihampelas Gg. Swadaya III
Cipaganti, Kota Bandung
Agama : Islam
Status : Tidak Kawin
No. Medrek : 1000035185
Waktu masuk : 18.30 WIB
KU : Luka di dekat sudut mulut

Anamnesa :
2 jam SMRS, saat pasien sedang bermain-main
dengan temannya di luar rumah, tiba-tiba pasien
terjatuh dengan mulut membentur batu. Pingsan (-),
Mual-Muntah (-), PTH (-), PM(-). Pasien langsung
di bawa ke RSHS (Riwayat imunisasi tidak
lengkap).
Primary Survey
A : Clear
B : VBS ka=ki, B/G Simetris, R: 23 x/menit
C : N= 75 x/menit
D : GCS=15, pupil bulat isokor 3mm, RC +/+,
parese -/-
Secondary Survey : tak

Status lokalis
EO :
- Wajah simetris
- Konjungtiva tidak anemis
IO :

- Bibir : VL a/r labii superior uk. 1x0,5x0,2 cm,


tepi tidak rata, dasar otot.
- Gingiva : Tak
- Palatum : Tak
- Vestibulum : Tak
- Lidah : Tak
- Dasar mulut : Tak
- Mukosa Bukal : Tak
- Tonsil : T1-T1
Status Gigi geligi
Karies Media

V IV III II I I II III IV V
V IV III II I I II III IV V
Hasil Laboratorium:
HB : 11, 9 (11,5 13,5) g/dL
HT : 36 (34 40)%
Leukosit : 6700( 5000 14500) /mm3
Trombosit : 265000 (150000 450000) / mm3

BT :3 (1-3) menit
APTT : 10 (5-11) menit
DK/VL a/r Labii Superior

Tindakan BM :
-Sysmex, BT-CT
-TT-ATS
- R/ Amoxicillin Syr. 3 x 1
Ibufropen Syr 2 x 1
Kenalog Orobase
-Debridement
- Hecting a/r Labii Superior
- Aplikasi kenalog a/r post hecting
-
Saran :
Pro Foto Panoramik
Diet lunak
Aplikasi kenalog orobase a/r post hecting IO
Kontrol Poli BM 10-10-2010

ACC BLPL
Afif/Vera/Siti
FOTO POST TREATMENT
LAPORAN EMERGENSI
Nama : Bintang
JK : Laki-laki
Umur : 3 tahun
Alamat : Jl. Ciawi Tali
Citeureup, Cimahi
Agama : Islam
Status : Tidak Kawin
No. Medrek : 1000035207
Waktu masuk : 19.30 WIB
KU : Luka di gusi rahang atas

Anamnesa :
1 jam SMRS, saat pasien sedang naik tangga
keramik di dalam rumahnya, tiba-tiba pasien
terpeleset sehingga terjatuh dengan mulut mengenai
tepi tangga. Pingsan (-), Mual-Muntah (-), PTH (-),
PM(+). Pasien kemudian di bawa ke RSU Dustira,
tidak dilakukan tindakan apa-apa, kemudian pasien
di rujuk ke RSHS (Riwayat imunisasi lengkap).
Primary Survey
A : Clear
B : VBS ka=ki, B/G Simetris, R: 30 x/menit
C : N= 110 x/menit
D : GCS=15, pupil bulat isokor 3mm, RC +/+,
parese -/-
Secondary Survey : tak

Status lokalis
EO :
- Wajah asimetris, odem a/r labii superior
- Konjungtiva tidak anemis
IO :

- Bibir : VL a/r labii superior uk. 1x0,5x0,2 cm,


tepi tidak rata, dasar otot. + Oedem
- Gingiva : VL a/r 51-62, uk. 1.5 x 0.3 x 0.3 cm, tepi
tidak rata, dasar tulang.
- Vestibulum : VL a/r 51-61, Uk. 0.5 x 0.3 x 0.3 cm,
tepi
tidak rata, dasar tulang
- Palatum : Tak
- Lidah : Tak
- Dasar mulut : Tak
- Mukosa Bukal : Tak
- Tonsil : T1-T1
Status Gigi geligi

V IV III II I I II III IV V
V IV III II I I II III IV V
Hasil Laboratorium:
HB : 12,2 (11,5 13,5) g/dL
HT : 36 (34 40)%
Leukosit : 16000 ( 5000 14500) /mm3
Trombosit : 450000 (150000 450000) / mm3

BT : 1.3 (1-3) menit


CT :6 (5-11) menit
DK/VL a/r Labii Superior + VL a/r Vestibulum 51-61 + VL a/r
Gingiva 51-62

Tindakan BM :
-Sysmex, BT-CT
- R/ Amoxicillin Syr. 3 x 1
Ibufropen Syr 2 x 1
Kenalog Orobase
-Debridement
- Hecting a/r IO
- Aplikasi kenalog a/r post hecting
Saran :
Pro Foto Panoramik
Diet lunak
Aplikasi kenalog orobase a/r post hecting IO
Kontrol Poli BM 10-10-2010

ACC BLPL
Afif/Vera/Siti
FOTO POST TREATMENT
Nama : Itazza Abdul Mughni
J. Kelamin : Laki-laki
Umur : 4 tahun
Alamat : Margahurip, Kab. Bandung
No telp : 081313422288
Agama : Islam
Status : Tidak kawin
No. Medrek : 35433
Waktu masuk : 17:55 WIB
KU : Perdarahan pada mulut

Anamnesa :
1,5 jam SMRS saat pasien sedang belajar naik
sepeda di daerah Margahurip, tiba-tiba pasien
terjatuh dengan mulut membentur aspal terlebih
dahulu. Helm (-), pingsan (-), mual-muntah (-),
PTH (-), PM (+). Kemudian pasien dibawa ke RS
Al Islam, tidak dilakukan apa-apa dan langsung
dirujuk ke RSHS.
Primary Survey
A : Clear.
B : VBS ki = ka, B/G Simetris, R: 24 x/menit
C : N= 97 x/menit
D : GCS=15, pupil bulat isokor 3 mm,
RC +/+, Parese -/-
Status Lokalis
EO : - Wajah simetris
- Konjungtiva non anemis
IO :
- Vestibulum :VL a/r 52-62, ukuran
2x0,5x0,5cm, tepi tidak rata, dasar
tulang
- Bibir : tak
- Gusi : tak
- Palatum : Tak
- Lidah : Tak
- Dasar Mulut : Tak
- Mukosa Bukal : Tak
- Tonsil : T1-T1
Status Gigi geligi
CS
Mobility grade 3

V IV III II I I CM
II III IV V
X V IV III II I I II IIIIV V X
X
G X
CS P
Hasil Lab :
DARAH RUTIN
BT : 130 1-3 menit
CT : 430 3-5 menit
Hb : 12,9 g/dL 11,5-13,5 g/dL
Ht : 39 % 34-40%
Leukosit : 17.400 /mm3 5.000-14.500/mm3
Eritrosit : 4.90 jt/uL 3.95-5.26jt/uL

Trombosit : 418.000 /mm3 150000-450000/mm3


DK/ :

VL a/r vestibulum 52-62


Tindakan BM :
- Sysmex, BT CT
- ATS-TT
- Debridement
- Hecting VL a/r vestibulum 52-62
- R/ : Amoxycillin Syr 3 x 2 cth
Paracetamol Syr 3 x 1 cth
Kenalog orabase
- Aplikasi kenalog di daerah post hecting intra oral
Post Treatment
Saran :
Diet lunak
Panoramik foto
Aplikasi kenalog a/r post hecting IO
Kontrol poli BM, hari Selasa, 12 Oktober 2010

Wassalam

( Vera, Conny, Irfan)


LAPORAN EMERGENSI

Selasa, 22 Juni 2010


Nama : An Cahyadi
JK : Laki-laki
Umur : 7 tahun
Alamat : Kp Warung Peuteuy Kab. Bandung
Agama : Islam
Status : tidak kawin
No. Medrec : 10 00021498
Waktu masuk : 02.00 WIB
KU : Perdarahan setelah pencabut gigi
Anamnesa:
14 jam SMRS pasien dicabut giginya yang berlubang
di sebelah belakang kanan atas di RSUD Cicalengka
lalu diberi obat antibiotik dan penahan rasa sakit
(orangtua pasien lupa nama obatnya). Sesampainya di
rumah tidak terjadi apa-apa pada daerah bekas
pencabutan. 2 jam SMRS saat pasien tidur, tiba-tiba
keluar darah yang tidak berhenti-berhenti dari daerah
bekas pencabutan sampai membasahi baju pasien.
Diketahui sebelum tidur pasien suka memegang-
megang daerah luka dengan tangannya. Lalu pasien
dibawa ke RSUD Cicalengka, diberi obat asam
traneksamat dan pasien langsung dirujuk ke RSHS.
Pasien memiliki riwayat tidak bisa berjalan dan
berbicara normal sejak usia 1 tahun
Pemeriksaan fisik

K : CM
N : 102 x/mnt
R : 24 x/mnt
S : 35,6 C
Status Lokalis
Ekstra Oral :
Wajah simetris,
Konjungtiva non anemis,
Sklera non ikterik
KGB submandibula ki = ka tidak teraba, tidak sakit
Intra Oral :
Gingiva : Perdarahan post ekstraksi a/r gigi 55
Bibir : Tak
Vestibulum : Tak
Lidah : Tak
Palatum : Tak
Mukosa bukal : Tak
Dasar mulut : Tak
Tonsil : T1 T1
Status gigi geligi

CM

GP
M GR


6 V IV III II I I II III IV V 6
6 V IV III II I I II III IV V 6
GP CS
Hasil Laboratorium :

- Hb : 22 (11,5-16,5)g/dl
- Ht : 69 (34 - 40) %
- Lekosit : 13.300 (5000-14.500)mm3
- Eritrosit : 4,00 (3,95 5,26) juta /uL
- Trombosit : 353.000 (150000-450000)mm3
- PT : 12,7 detik ( 9 13)
- APTT : 32,3 detik ( 16,1 36,1)
Diagnosa kerja :
Bleeding post ekstraksi gigi 55
Tindakan BM:
Sysmex , PT, APTT
Debridement
Dep KassaTampon
Aplikasi spongostan
Observasi perdarahan 30 menit
R/ - Asam traneksamat caps 250 mg No III
Saran BM :
Diet lunak di daerah yang tidak dicabut gigi
Instruksi post ekstraksi
Kontrol ke poli BM (Rabu, 23/6/2010)

ACC BLPL

Vera / Laura / Findo / Isnandar


Post treatment
LAPORAN EMERGENSI
17 September 2010
Nama : Cici
JK : Perempuan
Umur : 6 tahun
Alamat : Kp. Patamon, Sindang Laya, Kab.
Bandung
Agama : Islam
Status : Tidak kawin
No. Medrec : 1000032343
Waktu masuk : 16.21 WIB
KU : gigi depan atas lepas

Anamnesa :
1,5 jam SMRS, saat pasien sedang bermain-main
sepeda, tiba-tiba pasien terjatuh dengan mulut
membentur stang terlebih dahulu. Pingsan (-), mual
muntah (-), PTH (-), PM (+). Kemudian pasien langsung
dibawa ke RSHS. Riwayat imunisasi lengkap. Riwayat
perdarahan lama (-)
Primary survey :
A = Clear
B = VBS Ka=Ki, B/G Simetris, R= 28x/menit
C = N = 120 x/mnt
D = GCS = 15, pupil bulat isokor 3 mm
RC +/+, parese -/-

St. Lokalis:
EO : wajah simetris, konjunctiva non anemis
VA a/r philtrum dex uk. 2x2 cm
IO :
- Gingiva : VL a/r 52, 61 uk. 0,5x0,2x0,3 cm, tepi tdk
rata, dasar tulang
- Dasar mulut : Tak
- Bibir : Tak
- Vestibulum : Tak
- Palatum : Tak
- Lidah : Tak
- Mukosa Bukal : Tak
- Tonsil : T1-T1
Status Gigi geligi

ekstruksi avulsi o3

V IV III II 1 I II III IV V

V IV III II I I II III IV V 6
Hasil Laboratorium

- BT : 3 (1-3) menit
- CT : 7 (3-5) menit
- Hb : 12,0 (11,5-13,5)g/dl
- Ht : 36 (34 - 40) %
- Leukosit : 14.400 (5.000 14.500)/mm3
- Eritrosit : 4,56 (4,11 5,95) juta /uL
- Trombosit : 224.000 (150.000 450.000)/mm3
DK/ :

# dentoalveolar a/r 52-62 disertai ekstruksi 52, avulsi


61, mobility o3 62
Tindakan :
- Sysmex, TT
- R/ Amoxycillin syr. forte cth I
Paracetamol syr. cth I
Kenalog orabase
- Ekstraksi 52, 61, 62
- Debridement
- Alveolektomi a/r 52-62
- Observasi perdarahan selama 30 menit
- Aplikasi Kenalog a/r post hecting IO
Saran:
- Diet lunak
- Panoramik foto
- Kontrol poli BM hari Sabtu, 18/9/2010

Acc BLPL
Conny/Heri/Ahyar
Post Treatment
LAPORAN EMERGENSI

Minggu, 17 Oktober 2010


Nama : Indah Bt Muhtar
JK : Perempuan
Umur : 11 Tahun
Alamat : Negla sari, Kabupaten Bandung Barat
Agama : Islam
Status : Tidak Kawin
No. Medrec : 10 000036248
Waktu masuk : 22.15 WIB
KU: Perdarahan dari bibir dan dagu
Anamnesa:
3,5 jam SMRS saat pasien sedang dibonceng
mengendarai motor oleh ayahnya bersama
saudaranya dengan kecepatan sedang di daerah
Cililin Kabupaten Bandung, saat jalan menurun
tiba-tiba motor slip, sehingga pasien terjatuh ke
dalam jurang sedalam 6 meter dengan
mekanisme jatuh tidak diketahui. Helm (-), pingsan
(+), mual muntah (-), PTH(-), PM (+). Lalu pasien
dibawa ke RS Cibabat Cimahi, dilakukan
pembersihan luka dan injeksi obat anti tetanus
(ATS,TT) kemudian pasien dirujuk ke RSHS
Primary Survey :
A : Clear
B : VBS Ka=Ki, B&G simetris R: 27 x/menit
C : N= 102 x/menit,
D : GCS=15, pupil bulat isokor 3mm,
RC +/+, Parese -/-
Secondary Survey : TAK

Status Lokalis
Ekstra Oral :
Wajah asimetris, oedem a.r fasial sin
VL a/r mentale Uk. 4x1x2 cm , tepi tidak rata, dasar tulang
VP a/r labiomentalis Uk. 2x 0,5x2 cm tepi tidak rata
Konjungtiva tidak anemis
Foto EO
Intra Oral :
Bibir : VP a/r labii inferior uk. 1,5x 0,5x1,5 cm tepi
tidak rata
Palatum : Tak
Vestibulum : Tak
Bibir : Tak
Lidah : Tak
Mukosa bukal: Tak
Dasar mulut : Tak
Tonsil : Tdn
Status gigi geligi

Persistensi # mahkota
UE UE
8 7 6 5 V 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 V 4 3 2 1 1 2 3 4 5 6 7 8
UE UE

Persistensi
Hasil Laboratorium :

- Hb : 10,2 (11,5-15,5) g/dL


- Ht : 34 (35 - 45) %
- Lekosit : 24.900 (4500-13.500)mm3
- Trombosit : 433.000 (150.000-450.000)mm3
- Eritrosit : 5,61 (4,43-6,02) jt/l
- PT : 12,2 (10 14) detik
- APTT : 27,6 (15,7-35,7) detik
Schedel AP lateral
Foto Thorax, Servikal
Diagnosa kerja :
Mild HI + VL a/r mentale + VP a/r labiomentale-
labii inferior + Susp. # condylus mandibula
bilateral + # mahkota gigi 21
Tindakan
Sysmex
BU
Collar neck
Schedel AP-Lat, Cervical, Thorax AP
Pro NC
Pro BM

Samuel/Farul/Jerry/Andi
Tindakan NC
DK/ : Mild HI
IVFD NaCl 0,9 % 20 gtt/mnt
O2 Nasal canul 4 ltr/mnt
Observasi GCS
Head up 30o
R/ Ceftriaxone inj 500 mg
Ranitidine inj ampul
Ketorolac inj ampul

Dito/Zainal/Selvi/Bradi
Tindakan BM :
Sysmex , PT- APTT
Debridement
Hecting a/r VL dan VP
Aplikasi kenalog orabase a/r hecting IO
Aplikasi ikamicetine in a/r post hecting EO
Verban tekan a/r post hecting EO
R/ Cefadroxil syr forte
Paracetamol syr
Kenalog in orabase
Ikemicetin
Saran:
- Panoramik foto
- Aplikasi kenalog post hecting IO
- Aplikasi ikemicetin post hecting EO
- Diet lunak
- Perawatan endodontik gigi 21 di poli Gigi Mulut bagian
konservasi gigi pada jam kerja

Pasien pulang paksa

Findo/Conny/Irfan
Post Treatment
LAPORAN EMERGENSI

Minggu, 17 Oktober 2010


Konsul dari BU
Nama : Resti
JK : Perempuan
Umur : 9 Tahun
Alamat : Negla sari, Kabupaten Bandung Barat
Agama : Islam
Status : Tidak Kawin
No. Medrec : 10 000036247
Waktu masuk : 22.15 WIB
KU: Perdarahan Mulut
Anamnesa:
3 jam SMRS saat OS dibonceng sepeda motor
oleh ayahnya, bersama temannya di daerah Cililin
dengan kecepatan sedang , saat jalanan menurun
tiba-tiba motor slip sehingga OS terjatuh
(mekanisme jatuh tidak diketahui). Helm (-),
pingsan (+), mual muntah (-), PTH(-), PM (+). OS
dibawa ke RS Cibabat Cimahi, dilakukan
pembersihan luka dan injeksi obat anti tetanus.
Kemudian pasien dirujuk ke RSHS.
Primary Survey :
A : Clear , C-spine control
B : VBS Ka=Ki, B&G simetris R: 22 x/menit
C : N= 108 x/menit,
D : GCS=15, pupil bulat isokor 3mm,
RC +/+, Parese -/-
Status Lokalis
Ekstra Oral :
Wajah asimetris
VL a/r frontal sin uk. 4x0,3x0,8 cm , tepi tidak rata, dasar otot
VA a/r zygoma sin uk. 2x1 cm
Oedema & hematoma a/r orbita sin
Konjungtiva tidak anemis
Intra Oral :
Vestibulum : VL a/r vestibulum 75-43 uk. 6x 0,5x0,5 cm, tepi
tidak rata, dasar tulang
Palatum : Tak
Bibir : Tak
Bibir : Tak
Lidah : Tak
Mukosa bukal: Tak
Dasar mulut : Tak
Tonsil : T1-T1
Persistensi

UE UE
8 7 6 5 4 3 2 1 1 2 III 4 5 V 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 V 6 7 8
UE UE

Persistensi
Hasil Laboratorium :
- PT : 11,9 (10 14) detik
- INR : 0,96 (0,82 1,18)
- APTT : 26,3 (15,7 - 35,7) detik
- Hb : 11,9 (11,5-15,5) g/dL
- Ht : 36 (35 - 45) %
- Lekosit : 17.100 (4.500-13.500)/mm3
- Trombosit : 346.000 (150.000-450.000)/mm3
Schedel AP lateral
Foto Cervical Lat & Thoraks
Diagnosa kerja :
Mild HI + VL a/r vestibulum 75-43
Tindakan BU
IVFD RL 20 gtt/mnt
Sysmex
O2 canul 3L/menit
Collar neck
Schedel AP-Lat, Cervical, Thorax

Samuel/Farul/Jerry/Andi
Tindakan NC
Head up 30o
Observasi GCS TNSR
R/ Ceftriaxone inj 500 mg
Ranitidine inj ampul
Ketorolac inj ampul
Hecting VL a/r frontal sin

Dito/Zainal/Selvi/Bradi
Tindakan BM :
PT- APTT
Debridement
Hecting VL a/r vestibulum 75-43
Aplikasi kenalog orabase a/r post hecting IO
Perban tekan a/r mental
R/ Cefadroxil syr forte cth II
Paracetamol syr cth II
Kenalog orabase
Ikemicetin
Post Treatment
LAPORAN EMERGENSI
Selasa, 27 Juli 2010
Konsul dari IKA

Nama : An. Hatta Putra P


JK : Laki-laki
Umur : 10 tahun
Alamat : Pasar selatan, Jatisari Sumedang
Agama : Islam
Status : Tidak Kawin
No. Medrec : 10000266001
Waktu masuk : 21.00 WIB
Surat
Kepada Konsul
Yth.
TS Bedah Mulut
DH,
Mohon konsul atas pasien : Hatta, laki-laki, 10 th
dengan DK/: Hemofilia A + perdarahan gusi
Atas bantuan dan kerjasamanya, kami ucapkan BTK
Wassalam

Dessy
KU : Perdarahan dari mulut

Anamnesa :
3 hari SMRS pasien mengeluh gusinya berdarah,
perdarahan terjadi sejak pasien mengorek-ngorek gusinya
sehabis makan daging. Oleh orang tua pasien, pasien
disarankan untuk kumur-kumur air es dan betadine
kumur, namun perdarahan tidak berhenti. Kemudian
pasien berobat ke RS Sumedang dan pasien dirujuk ke
RSHS. Pasien mempunyai riwayat memiliki kelainan
hemofili A ( didiagnosis 2007) dan riwayat imunisasi
lengkap.
Pemeriksaan fisik :
K = CM
T = 100/60 mmHg
N = 94 x/mnt
S = 36,5 C
R= 24 x/mnt
EO :
- Wajah simetris
- Konjungtiva tidak anemis
- KGB submandibula kiri = kanan : tidak teraba, sakit
- Sklera tidak ikterik
IO :
- Bibir : tak
- Gingiva : Perdarahan a/r 12-53
- Vestibulum : tak
- Lidah : tak
- Mukosa Bukal : tak
- Palatum : tak
- Dasar Mulut : tak
- Tonsil : T1-T1`
Status Gigi geligi

6 V IV III 2 1 1 2 III IV V 6
6 V IV III 2 1 1 2 III IV V 6
HASIL LABORATORIUM:
PT : 13.3 (10.2-14.2) detik
INR : 1.07 ( 0.84-1.15)
APTT : 59.9 (16.2-36.2) detik
Hb : 11.1 (11.5-15.5) g/dL
Ht : 32 (35 - 45) %
Eritrosit : 4.01 (4.43-6.02) juta/L
Leukosit : 11400 (4500 -13500) /mm3
Trombosit : 378000 (150.000-440.00)/mm3
DK/:
Hemofilia A + gingival bleeding ec trauma

Tindakan IKA:
Istirahat
IVFD NaCl 0,9% untuk jalur tranfusi
Cryopresipitat 20 unit/Kg BB ~ 420 unit
Tindakan BM:
Pembersihan regio perdarahan
Dep tampon + pehacaine
Observasi perdarahan
Saran:
- Daerah perdarahan tidak boleh dihisap-hisap
- Daerah perdarahan tidak boleh dimainkan dengan
lidah
- Jangan kumur-kumur untuk sementara waktu
- Th/ lain sesuai TS IKA

Atas kepercayaan dan kerjasamanya BTK

Wassalam
Deni/Diki/Vera/Ocky/ahmad/Siti
Foto Post Treatment
Saran:
- Diet lunak
- Aplikasi kenalog a/r post hecting IO
- Aplikasi ikemicetin a/r VA a/r zygoma sin
- Panoramik foto
- Kontrol poli BM hr. Senin, 18/10/2010

Acc BLPL

Conny/Findo/Irfan
Surat Pernyataan

Saya yang bertanda-tangan dibawah ini selaku kakak


kandung dari pasien a.n Indah bt Muhtar / Pr / 11 tahun,
setelah mendengar penjelasan dari dokter bagian Bedah
Mulut dengan ini saya menyatakan menolak untuk
dirawat inap dikarenakan alasan biaya dan bersedia
menaggung segala resiko yang mungkin terjadi di
kemudian hari.

Bandung, 18-10-2010
ttd
Asep Olay
Lacerated wound at palatinal soft tissue

24
0
Question #1

Which teeth are most commonly affected by oral injury?

A. Central maxillary incisors


B. Central mandibular incisors
C. Canines
D. Molars
E. There is no common pattern to oral injuries

24
1 www.aap.org/oralhealth/pact
Answer

Which teeth are most commonly affected by oral injury?

A. Central maxillary incisors


B. Central mandibular incisors
C. Canines
D. Molars
E. There is no common pattern to oral injuries

24
2 www.aap.org/oralhealth/pact
Question #2

Which of the following is not a risk factor for oral trauma?

A. Malocclusion
B. Child abuse or neglect
C. Early childhood caries
D. Hyperactivity
E. Substance abuse within the family

24
3 www.aap.org/oralhealth/pact
Answer

Which of the following is not a risk factor for oral trauma?

A. Malocclusion
B. Child abuse or neglect
C. Early childhood caries
D. Hyperactivity
E. Substance abuse within the family

24
4 www.aap.org/oralhealth/pact
Question #3

Which of the following is most likely following intrusion of a


primary tooth?

A. Root resorption
B. Re-eruption of the primary tooth
C. Pulpal necrosis with possible root infection
D. Fracture of the underlying permanent tooth
E. Damage to the underlying tooth and failure of permanent tooth to
erupt

24
5 www.aap.org/oralhealth/pact
Answer

Which of the following is most likely following intrusion of a


primary tooth?

A. Root resorption
B. Re-eruption of the primary tooth
C. Pulpal necrosis with possible root infection
D. Fracture of the underlying permanent tooth
E. Damage to the underlying tooth and failure of permanent tooth to
erupt

24
6 www.aap.org/oralhealth/pact
Question #4

Which of the following is the proper management of an


avulsed primary tooth?

A. The tooth should not be re-inserted


B. The tooth should be transported in milk and the child rushed to a
dentist or ER for re-insertion
C. The tooth should be transported in water and the child rushed to a
dentist or ER for re-insertion
D. It should be re-inserted immediately
E. None of the above
24
7 www.aap.org/oralhealth/pact
Question #4

Which of the following is the proper management of an avulsed


primary tooth?

A. The tooth should not be re-inserted


B. The tooth should be transported in milk and the child rushed to a dentist
or ER for re-insertion
C. The tooth should be transported in water and the child rushed to a dentist
or ER for re-insertion
D. It should be re-inserted immediately
E. None of the above

24
8 www.aap.org/oralhealth/pact
Question #5

Which of the following is a consequence of oral injury?

A. High cost
B. Impaired oral or phonetic function
C. Pain
D. Infection, including abscess
E. All of the above

24
9 www.aap.org/oralhealth/pact
Answer

Which of the following is a consequence of oral injury?

A. High cost
B. Impaired oral or phonetic function
C. Pain
D. Infection, including abscess
E. All of the above

25
0 www.aap.org/oralhealth/pact