Kraniofasial Kemik Travma ve Fraktürlerinin Yönetimi
Özet
Maksillofasiyal yaralanmalar, hafif laserasyonlardan komplike kemik fraktürlerine kadar değişen ve teknolojik gelişmelerle erken müdahale şansı artan acil durumlardır. Erkeklerde kadınlara kıyasla 8 kat daha sık görülen bu travmalar, erişkinlerde en çok nazal kemiği, çocuklarda ise zigoma ve mandibulayı etkiler. Frontal sinüs fraktürleri tüm fasiyal kırıkların %5-15'ini oluşturur; tedavisinde intrakranial bariyerin restorasyonu, drenaj yolunun onarımı ve kozmetik görünüm hedeflenerek konservatif veya cerrahi (obliterasyon/kranializasyon) yöntemler uygulanır. Yüz bölgesinde en sık görülen nazal fraktürler ile yüksek enerjili travmalar sonucu oluşan nazo-orbito-etmoidal (NOE) kırıkların yönetiminde havayolu açıklığı, kozmetik düzeltme ve MKT stabilitesi esastır. Orbitozigomatik fraktürlerin tedavisinde deplase durumlarda cerrahi eksplorasyon ve plak-vida fiksasyonu gerekirken, görmeyi doğrudan etkileyen orbita fraktürleri işlevsel ve psikolojik etkileri nedeniyle KMF travmaları içindeki gerçek acillerdendir. Şiddetli kuvvetlerle oluşan maksilla fraktürleri Le Fort sınıflamasına göre (1, 2, 3) değerlendirilir ve havayolu stabilizasyonu sonrası mikro/mini plaklarla fikse edilir. Fasiyal kemiklerin en güçlüsü olan mandibula fraktürleri ise çocuklarda en sık, erişkinlerde ikinci sıradadır; kırığın tipine göre kapalı veya açık redüksiyon yöntemleriyle tedavi edilerek yüzün kozmetik ve fonksiyonel yapısı yeniden tesis edilir.
Maxillofacial injuries are emergencies ranging from mild lacerations to complicated bone fractures, with early intervention opportunities increasing due to technological advancements. These traumas, which are 8 times more common in men than in women, mostly affect the nasal bone in adults, and the zygoma and mandible in children. Frontal sinus fractures constitute 5-15% of all facial fractures; their management targets the restoration of the intracranial barrier, repair of the drainage pathway, and cosmetic appearance using conservative or surgical (obliteration/cranialization) methods. In the management of nasal fractures, which are the most common in the facial region, and naso-orbito-ethmoid (NOE) fractures resulting from high-energy traumas, airway patency, cosmetic correction, and MCT stability are essential. While surgical exploration and plate-screw fixation are required in displaced cases for orbitozygomatic fractures, orbital fractures directly affecting vision are true emergencies among CMF traumas due to their functional and psychological impacts. Maxilla fractures caused by severe forces are evaluated according to the Le Fort classification (1, 2, 3) and fixed with micro/mini plates after airway stabilization. Mandible fractures, the strongest of the facial bones, are the most common in children and the second most common in adults; they are treated with closed or open reduction methods depending on the fracture type to re-establish the cosmetic and functional structure of the face.
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