title: [Damage control applied to severe maxillofacial trauma].
abstract: Damage control is defined by the extreme emergency implementation of a first resuscitation and surgical step, during which there is no attempt at repairing lesions but only at restoring adequate physiological function. In recent years, "damage control" has considerably improved the management of polytrauma patients, especially in war surgery. Respiratory distress or hemorrhagic shock requirements are critical maxillofacial emergencies. We present the specificities of "damage control" management for patients with severe maxillofacial trauma. Some clinical and biological criteria have been defined to choose "damage control" strategy, in patients presenting with life-threatening facial hemorrhage after facial trauma. A rapid initial stage restores vital functions. Airways are maintained and secured: oro-tracheal intubation, cricothyroidotomy, surgical tracheotomy. Facial bleeding is controlled with various means: oronasal packing, angiographic embolization, selective ligation then external carotid artery if necessary. The resuscitation step stabilizes the lethal triad: hypothermia, coagulopathy, metabolic acidosis. The second step that comes in later is a surgical repair of facial injuries. "Damage control" can be adequately applied to the management of patients with severe maxillofacial trauma.
authors: Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France. Electronic address: sophielaversanne@hotmail.fr.
authors: S
authors: S
authors: Laversanne
authors: Service d'anesthésie-réanimation, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France.
authors: C
authors: C
authors: Pierrou
authors: Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France.
authors: P
authors: P
authors: Haen
authors: Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France.
authors: L
authors: L
authors: Brignol
authors: Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France.
authors: G
authors: G
authors: Thiéry
mesh_terms: D003422:Critical Care / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D006801:Humans; D063175:Mandibular Reconstruction; D008446:Maxillofacial Injuries / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012151:Resuscitation / Q000379:methods; D012771:Shock, Hemorrhagic / Q000628:therapy; D015599:Trauma Severity Indices
keywords: Choc hémorragique; Détresse respiratoire; Facial injury; Hemorrhagic shock; Lésions faciales; Respiratory distress