Soft tissue response and healing omfs

1. Page 1

2. MODERATOR –
DR. RAJASEKHAR G.
PRESENTED BY-
DR. SHEETAL KAPSE

3. INCLUSIONS
• Introduction
• Soft tissue layers in maxillofacial region
• Soft tissue reactions to trauma
• Healing of soft tissues
• Consequences of improper healing
• Factors affecting wound healing
• Conclusion
• References
Skin
Muscle
Cartilage
Nerve
Mucosa

4. INTRODUCTION
• The capacity for self-repair is crucial for the
survival of any organism, because without it the
organism would likely perish after minimal injury.
• A wound is a disruption in the normal anatomic
structure and function of tissue and is accompanied
by cellular damage.

5. INTRODUCTION
• Wound healing is an intricately coordinated series of
processes that involve cellular and subcellular
responses to tissue injury, leading to the release of
cytokines and growth factors, cell activation, and
resultant tissue regeneration.

6. INTRODUCTION
• The understanding of the remarkable cascade of events
involved in wound repair and healing is advancing
exponentially with the ongoing discoveries of the roles
of growth factors and signaling pathways.
• There is growing interest in stem cell research,
regenerative medicine applications, and bioactive
wound healing products.

7. Soft tissue layers
in
maxillofacial region

9. Five layers of critical anatomy:
1. Skin
2. Superficial fat compartments
3. Superficial
musculoaponeurotic system
(SMAS)
4. Retaining ligaments
5. Mimetic muscles
Deep plane, including the deep
fat compartments
M.A. Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI
10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin Heidelberg 2012
J Ästhet Chir 2015 · 8:157–163 DOI 10.1007/s12631-015-0021-4
© Springer-Verlag Berlin Heidelberg 2015

10. Superficial fat compartments of the face

11. Superficial musculoaponeurotic
system (SMAS)
J Ästhet Chir 2015 · 8:157–163 DOI 10.1007/s12631-015-0021-4
© Springer-Verlag Berlin Heidelberg 2015

13. Ligaments and septa between fat
compartments of the face
P. M. Prendergast. Anatomy of the Face and
Neck. M.A. Shiffman and A. Di Giuseppe
(eds.), Cosmetic Surgery, DOI 10.1007/978-3-
642-21837-8_2, © Springer-Verlag Berlin
Heidelberg 2012

14. Mimetic muscles

15. Deep fat
compartments
The buccal fat pad
and its extensions
The prezygomatic space. This
space extends anteriorly to the
infraorbital area.

18. Michael Miloro, Scott Redlinger, Diane M. Pennington, Tommy Kolodge, In Situ
Location of the Temporal Branch of the Facial Nerve. Journal of Oral and Maxillofacial
Surgery. 2007; 65(12):2466–2469

19. Soft tissue reactions to
trauma

20. Cellular responses to cell injury
autolysis, necrosis & apoptosis
gangrene & pathologic calcification
Harsh Mohan. Textbook of Pathology. India;
Jaypee Brothers Medical Publishers (P) Ltd; 2015.

21. Biosynthesis of prostaglandins (PG) and
leukotrienes(LT)
Tripathi KD. E,ssentials of Medical Pharmacology. India;
Jaypee Brothers Medical Publishers (P) Ltd; 2008.

22. Fonseca Raymond J,
Walker Robert V,
Barber H Dexter,
Powers, Michael P,
Frost David E. oral
and maxillofacial
trauma. China:
Saunders; 2013.

23. Healing of soft tissues

26. Fonseca Raymond J,
Walker Robert V,
Barber H Dexter,
Powers, Michael P,
Frost David E. oral
and maxillofacial
trauma. China:
Saunders; 2013.

31. Types of wound healing

32. Healing by primary intension / primary
wound closure

33. Healing by secondary intension

34. Delayed primary closure / wound repair

35. Wound healing of SKIN
Epidermal wound healing. Injury to
the epidermal layer induces epidermal
keratinocytes to undergo a process of
migration, mitosis, and maturation to
reconstitute the epidermis and restore
barrier function.

36. Overview of the wound healing response.
The panels show progressive phases of
wound healing.
A, The early wound (day 2) exhibits many
migratory responses.
B, As healing progresses (day 4), there is
evidence of mitosis in the several compartments.
C, In the later stages of healing (day 14), the
wound is maturing to establish a new
homeostasis.

37. Wound healing of MUSCLE
• Stages – 3
1. Inflammation – 5 days
2. Proliferation – 2-6 weeks
3. Remodeling - months
• RICE protocol
• Role of NSAIDs
• Role of steroids
• Ideal therapeutic agents
• Growth factors – IGF-1,
• Gene therapy
• Stem cell therapy
• Antifibrosis therapy – decortin, suramin, interferon – Y
• Bionic replacement

38. Wound healing of CARTILAGE
• Physiologically cartilage is considered as an isolated tissue
which is devoid of blood, lymphatic channels and free
nerve endings.
• Inflammatory phase is absent in healing process
• Superficial injury – defects remain unchanged for 2 years
• Penetrating injuries – repair by hyaline cartilage like
tissues.
• Blunt impact – rapid degeneration & osteoarthitic lesions.
• Future trend – tissue engineering & growth factors.

39. Wound healing of
NERVE

40. CLINICAL ASSESSMENT OF HEALING
NERVE INJURY
• An assessment of the status of the sensory nerve can be done in a relatively
short time in everyday clinical setting.
score response
S0 no recovery
S1 recovery of deep cutaneous pain
S1+ recovery of superficial pain
S2 same as S11 with addition of some touch Sensation
S2+ same as S2 but with hyperesthesia
S3 same as S2 but without hyperesthesia and with 2-point
discrimination greater than 15 mm,
S3+ same as S3 with good localization of stimulus and 2-
point discrimination of about 7 to 15 mm
S4 complete recovery (2-point discrimination is now 2 to 6
mm)
Thomas G. Auyong, Anh
Le. Dentoalveolar
Nerve Injury. Oral
Maxillofacial Surg Clin N
Am 23 (2011) 395–400

41. Wound healing of MUCOSA

42. Dressings and topical agents
1. Dressings
2. Negative pressure wound therapy
3. Topical agents
4. Growth factors
Open v/s closed
Dry v/s moist

43. Consequences of
improper healing

44. 1. Dehiscence
2. Evisceration
3. Hemorrhage
4. Adhesion
5. Herniation
6. Sinus tract and
Fistula formation
7. Suture
complications
8. Hypertrophic scar
9. Keloid

45. Factors affecting wound
healing

46. Local Systemic
Foreign bodies Aging
Venous insufficiency Smoking
Pressure, trauma Diabetes
Ischemia, hypoxia Corticosteroids
Radiation Immunocompromised state
Salivary contamination Malnutrition
Scarring Cytotoxic chemotherapy
Hematoma Vitamin deficiency
Chronic illness
Peripheral artery disease

47. Conclusion

48. • When treating facial injuries, knowledge of the wound
healing process is crucial to maximize healing and
minimize adverse outcomes such as infection,
malunion and disfiguring scarring.
• In the trauma arena, oral and maxillofacial surgeons must
not only treat acute traumatic wounds appropriately,
but must also do everything possible to optimize the
wound healing conditions.
• Knowledge of the technologic advances in wound care,
regenerative medicine, and tissue engineering will allow
the surgeon treating maxillofacial trauma to achieve the
best possible outcome in these potentially devastating
facial injuries.

49. References
1. Fonseca Raymond J, Walker Robert V, Barber H Dexter, Powers,
Michael P, Frost David E. oral and maxillofacial trauma. China:
Saunders; 2013.
2. Harsh Mohan. Textbook of Pathology. India; Jaypee Brothers
Medical Publishers (P) Ltd; 2015.
3. Tripathi KD. E,ssentials of Medical Pharmacology. India; Jaypee
Brothers Medical Publishers (P) Ltd; 2008.
4. Hom, Hebda, Gosain, Friedman. Essential tissue healing of the
face and neck. India. Peoples medical publishing house.
5. M.A. Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI
10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin
Heidelberg 2012

50. References
6. J Ästhet Chir 2015 · 8:157–163 DOI 10.1007/s12631-015-0021-4
© Springer-Verlag Berlin Heidelberg 2015
7. Michael Miloro, Scott Redlinger, Diane M. Pennington, Tommy
Kolodge, In Situ Location of the Temporal Branch of the Facial
Nerve. Journal of Oral and Maxillofacial Surgery. 2007;
65(12):2466–2469.
8. Thomas G. Auyong, Anh Le. Dentoalveolar Nerve Injury. Oral
Maxillofacial Surg Clin N Am 23 (2011) 395–400
9. P. M. Prendergast. Anatomy of the Face and Neck. M.A.
Shiffman and A. Di Giuseppe (eds.), Cosmetic Surgery, DOI
10.1007/978-3-642-21837-8_2, © Springer-Verlag Berlin
Heidelberg 2012