TAP CHlY DUOC LAM S A N G 108 Tap 12 - S6 5/2017
Nhan xet dac diem hinh thai ton thu*oiig trong ch^n thtfotig gay xu-ong vung ham mat tai Benh vien Trung tfOTig Quan doi 108
The damages characteristics of the maxillofacial fractures were treated in the 108 Military Central Hospital
Vu Ngoc Lam*, Nguyen Quang Dire*, *Benh vien Trung uang Qudn dpi 108 Phan Duy Vinh** **Benh vien Trung uang Thdi Nguyen
Muc tieu: Rut ra mot sd d i e d i i m djch te, dac d i i m chan thUPng gay xuOng vung h i m mat va phdong phap dieu tri dUpc I p dung vdi cac hinh thai gay xUong ham mat tai Benh vien Trung Uong Quan dpi 108. Ddi tugng vd phuang phdp: 586 benh nhan chan thuong gay xuong ham mat do ele nguyen nhan khienhau dupe kham va dieu trj tai Benh vien Trung UPng Quan dpi 108 t d t h i n g 2/2014 den t h i n g 2/2017. Nghien cdu md t l cat ngang, hdi cdu. Kitqud: €)ac diem chung cua ddi tupng nghien edu; Ty le nam/nd I I 5/1, nam chilm 84,1 %. Nhdm tuoi 19 - 39 chiem ty le eao nhat la 65,4%, nhdm tudi 40 - 60 I I 24,6%. Nguyen n h i n chu y l u do tai nan giao thdng chiem 84,3%, tai nan sinh hoat chilm 15,7%. V I hlnh thai g l y xUong ham mat; 66,4% gay tang gida mat, 21,5% gay xUong ham dUdi, 11,4%
gay lien tang mat. Oieu trj phau t h u l t chiem 88%. K i t q u i tdt ve chdc nang la 93% v l ve g i l i phau I I 90,1%./fit/udn: Gay XUPng vung ham mated nguyen nhan chfnh fatal nan giao thong, nam gidi chilm phan Idn. Tdn thuong xay ra d c l 3 tang mat trong dd tang gida chilm ty le cao nhat. Dieu trj phau thuat nan chinh md - ket hpp xUOng I I chfnh.
Tdkhda: Gay xdPng h i m mat.
Summary
Objective: To sum up some epidemiologic and damaged characteristics in maxillofacial fractures that were treated in the Maxillofacial and Plastic Surgery Department at the 108 Military Central Hospital.
Subject and method: 586 patients with jaw and facial injuries were treated in the 108 Military Central Hospital from February 2014 to February 2017. Cross sectional descriptive, retrospective study. Result The common characteristic o f t h e patients; Rate of male/female is 5/1, men occupied 85.8%. The 1 9 - 3 9 age group accounted for the highest rate (65.4%), the 40 - 60 age group is 24.6%. The main reason due to traffic accidents, accounting for the 84.3%, mean while other aaivities took for 15.7%. For the maxillofacial fracture: The midfaeial fracture occupied 66.4%, the mandibular fratures: 21.5%, the panfacial fracture: 11.4%. Surgical treatment occupied 88%. Good functional results of 93% and 90.1 % got the good anatomical correction. Conclusion: Traffic accident was the most common cause of
Ngdy nhdn bdi: 17/4/2017, ngdy chdp nhdn dang: 21/4/2017
Ngumphdn hdi: Phan Duy Vinh, Email, [email protected] - Benh vipn Trung uang Thdi Nguyen
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''5/2017 maxillofacial fracture, male patients was 5 times higher than female patients. Damages occured in all the upper face, midface and lower face but fracture of the middle part of the face accounted for the highest percent. The main treatment procedure was open reduction with plate fixation.
Keywords: Maxillo facial fractures.
1 . Dat van de
Chan thuong vung h i m mat la mot cap cdu hay gap trong cupc sdng hang ngay do nhieu nguyen nhan nhU tai nan giao t h d n g , tai nan sinh boat... Vdi ha t i n g giao thdng va mat dp sd dung xe may nhd d Viet Nam hien nay, tinh trang tai nan giao thdng van ludn d mdc cao (tfnh chung trong 2 t h i n g dau n I m 2017, ca nude da xay ra 3.465 vu tai nan giao t h d n g , lam 1.570 ngUdi thiet mang, 2.660 ngddi bj thucfng - Ngudn: U;y' ban An toan giao thdng qudc gia/VTV.vn). Khi qui djnh bat budc dpi mu b i o h i l m dugc I p dung, nguy eP c h i n thuong so nao cd g i l m tuy n h i l n tinh trang chan thuong ham mat van d mdc cao.
Chan thuong gay xdPng vting ham mat ngay c I n g da dang v l phdc tap. Tdn thdPng ed the don thuan hoac phdi hpp vdi cac cd quan khIc tren CP the nhu chan thuong sp nao, chan thddng ngdc, c h i n thuong bung, ehi...
Gay xdong viing h i m mat ed the gay anh hddng nang ne tdi chdc n l n g v l tham my, tham chf tfnh mang neu khdng dupe chan d o l n sdm va dieu trj kjp thdi dung phdong phap.
Tai Khoa Phau thuat Ham mat va Tao hlnh, Benh vien Trung dong Quan ddi 108 mdi nam tiep nhan h I n g tram ca chan thdong vung ham mat vdi eac hlnh thai tdn thddng k h I c nhau. De ed mpt c l i nhin k h i i q u i t ve tinh hlnh chan thdong ham mat. Chiing tdi t i i n h l n h n g h i i n cdu de tai vdi muc tieu Rut ra mdt so dgc diem dich te, dgc diem chdn thuang gdy xuang vdng hdm mat va cdc phuang phdp dieu tri da dugc dp dung.
2. Ddi taong va phuong phap
2.1. Doi tuang
Benh an ciia benh nhan bj chan thuong gay Xdong vdng ham mat dieu tri tai Khoa Phau t h u l t
Ham mat va Tao hinh - Benh vien Trung Udng QuIn dpi 108 t d 0 2 / 2 0 1 4 d e n 02/2017.
2.2. Phucmg phdp
Thiet ke n g h i i n edu: L I phdOng p h I p nghiin edu md t l , hdi edu.
Mau nghien edu: B l n h an eua b l n h nhan chan thdPng gay xdong vung ham mat vao dieu trj tai Khoa Phau thuat H i m mat va Tao hinh - Benh vi^n Trung uong Q u I n dpi 108td02/2014den02/2017.
Mau nghien cdu t h u duoc n = 586 benh an (benh n h i n ) .
Tiiu chuan lUa chgn: Cae benh an b l n h nhan c h i n thUPng mdi ehUa dugc dieu tri chuyen khoa c6 day dd c l e thdng tin theo yeu cau eua muc tieu nghien cdu, duoc ghi c h i p rd rang, cd dien bi^n dieu tri va k i t qua luc ra vien.
Tiiu chuan logi trd; Blnh I n benh n h i n di chdng chan thddng, khdng cd dCi thdng tin can nghien cdu.
3. K^t quS
3.1. Dgc diem cua ddi tugng nghien cCtu Tuoi vd gidi
I Mam
Bieu do 1 . Phln bd theo gidi Nhgn xet Cd su khIe biet ve gidi, 84,1% la nam gidi. Ty I I n a m / n d la 5 / 1 .
TAP CHl Y DL/OC LAM SANG 108 Tap12-S6 5/2017
Bang 1 . Phan bd theo tudi Tudi
0-5 6-18 19-39 40-60
>60 TSng
n 0 40 383 144 19 586
TJIe%
0 6,8 65,4 24,6 3,2 100
Nhdn xit Nhdm tudi 19 - 39 chiem ty" le cao nhat 65,4%, t i l p dd la nhdm tudi 40 - 60 chiem 24,6%.
Cdc ddc diem khac
m Tai nan giao thdng
• Tai nan »nh ho^t
Bieu do 2. Nguyen n h i n chan thuong
Nhdn xet 84,3% nguyen n h i n g l y chan t h u o n g gay xuong ham mat la do tai nan giao thdng.
B i n g 2 . ThcN gian den vien Thcri gian den vien
24 gid dau 2 - 5 ngay 6 -10 ngay
> 10 ngay Tong
n 394 108 40 44 586
TJIc%
67,2 18,5 6,8 7,5 100 Nhdn xit Phan Idn eae trddng hpp d i n vien ngay trong 24 gid dau sau chan thUdng (67,2%).
Bang 3. Scf cdu trade khi vao vien Stf cOu tritforc vao vien
Co Khong
Tong
n 411 175 586
T y l e % 70,1 29,9 JOO Nhdn xet Phan Idn ele trddng hpp sau Idii bj tai nan ed d i n mdt CP sd y te khac de x d ly ban dau trddc khi chuyen d i n B6nh vien Trung UPng Quan dpi 108.
3.2. Cdc hinh thai gdy xuang vung ham mat
Bang 4. Sd lUtfng tang mat bi ton thiTong
So tang So lUdng T^IS%
Tang tren 4 0,7
Tang giQa 389 66,4
Tang dutfi 126 21,5
Tang tren-)• dudi
1 0,2
Tang tren + giiSa
6 1
Tang giOa + dirdi
36 6,1
CS 3 t i n g 24 4,1
Tdng 586 100 Nhdn xit Tdn t h d o n g tang mat gida don t h u I n hay gap nhat, chiem X^ le 66,4% cac trddng hpp ed chan thuong h i m mat. Gay e l 3 tang mat chiem t y l e 4,1%.
Bdng 5. Gay xUtfng tang mat giufa (n = 455}
DUcmg gay Soluong Tyle%
Lefort 1 3 0,66
Lefort 2 36 7,9
Lefort 3 3 0,66
Ham tren 131 28,8
Go ma 365 80,2
Kliau cai 3 0,66
IVIui 58 12,7 Nhgnxit Gd m l eung tiep la xUdng hay bj g l y nhat trong ele xddng thudc tang mat gida, c h i l m ty le 80,2%.
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Bang 6. Gay phtfc htfp t a n g m a t giuTa (n = 102) Oi/tfng gay
Soluong T y l e %
Ham tr§n -f go ma 88 19,3
Kliac 14 3,1
Nhdn xet Gay phdc hpp g d m l - ham tren c h i l m da sd c l e k i l u gay phdc hpp t i n g mat gida va chiem 19,3% ele trddng hpp gay xdong tang mat gida.
B i n g 7. Gay xiiong ham dUcri (n = 187) DUomg gay
Soluong T y l e %
Vung cam 120 64,17
Ngdng ngang 21 11,23
G6c ham 38 20,3
Nganli len 12 6,4
IVIdm vet 11 5,9
Ldi cau 69 36,9
drang 6 3,2 Nhdn xet Vj trf hay gap nhat trong gay xdOng ham dddi chfnh la g l y tai vung earn (64,17% eac trUcing hpp cd gay tai-vung cam), tiep theo la tai Idi cau vdi 36,9%.
Bang 8. Gay phiiTc htfp xtftfng ham d t f c l (n = 70) Dadng gay
Sd lupng T ^ l e %
Gay cam + Idi cau 37 19,8
Gay cam -i- goe ham Gay khac 18 1 15 9,6 1 8,02 Nhdn xet G l y phdc hpp cam + Idi eau chiem phan Idn trong gay phdc hdp xdong h i m dddi va chilm 19,8% eae trddng hpp gay xdong h i m dddi.
3.3. Diiu tri
Bang 9. Phiftfng p h a p d i ^ u t r j PliUtfng phap dieu t r i
Sdluong T y l i %
Dieu t r i phau t h u i t 516
88
Oieu t r i b i o t d n 65 11,1
Bd dieu trj 5 0,9
Tdng 586 100 Nhdn xit Oieu trj phau thuat la phUPng p h I p chu yeu trong eac trddng hop bj chan thUdng gay xddng viing h i m mat chiem ty le 88%, d i l u trj bao tdn c h i l m 11,1%.
B i n g 10. Ket quit stf m sau p h a u t h u a t
Tieu chi
Ket qua didu trj Chijfc nang
Giai phau
Tdt n 545 525
T J I e % 93 90,1
Trung binh n 36 56
T ^ l e % 6,2 9,6
Kem n 5 5
TylS%
0,8 0,9 Nhdnxet K i t q u i d i l u trj t d t theo tdng t i l u chf. 93% phuc hdi t d t v l chdc n l n g va 90,1% phuc hoi giai phau tdt.
TAP CHl Y DdOC LAM SANG 108 Tap 12-So 5/2017
4. Ban luan
4.1. Ogc diem chung cua doi tU^g nghien cUu Vdn de vi tuoi vd gidi
Trong nghien edu nay, b l n h n h i n nhd tudi nhat la 7 v l Idn tudi nhat la 73 tudi. Chd y l u I I nam gidi chilm 84,1%, ty- le n a m / n d la 5 / 1 . Theo BIng 1, nhdm tudi 1 9 - 3 9 c h i l m t / le eao nhat vdi 65,4%, theo sau I I nhdm tudi 40 - 60 tudi chiem 24,6%. Bay la hai nhdm tudi tham gia vao h l u h i t e l e boat ddng trong xa hpi va I I ngudn lao dpng chfnh trong x l hpi nen c h i l m ty I I cao trong sd ele trddng hop bj chan thddng gay xddng ham mat la phCi hop. T;^' le n l y phu hdp vdi eac nghien cdu trudc day. Lam Ngpc An khi tdng k i t 2989 benh nhan c h i n thdong ham mat thdi blnh t h I y 50,12% benh nhan d nhdm tudi 21 - 30 tudi [1 ]. Pham Van Lieu khi tham k h I o 49 de tai dUpc bao cao t d nam 1955 den 2009 vdi tdng sd 45376 benh n h i n chan thddng h i m mat thay Ida tudi hay gap n h l t I I 21 - 30 (38,1%) [2]. Cung theo Pham Van L i l u thi X^ I I m I e chan thUPng h i m mat cua nam/nd la 4 / 1 . Ket q u i trong k h I o sat cda chung tdi eung phu hop vdi k i t q u i nghien edu eua Robert Gasner vdi 9543 benh nhan chan thuong ham mat trong 10 nam [6],
Nguyen nhdn chdn thuang
Cd nhieu n g u y i n n h i n gay chan thUPng ham mat, trong nghien edu nay ehung tdi chia thanh hai nhdm nguyen nhan chfnh la tai nan giao thdng va tai nan sinh boat. Tai nan giao thdng, dac biet I I tai nan xe mIy c h i l m 84,3%. Theo Pham Van Lieu thi nguyen nhan chan thUOng do tai nan giao thdng chiem ty le cao nhat (52%), eua L l m Ngoc An la 79,5% [1], [2].
Dilu nay ndi len y thde cda mdt bd phan ngUdi dan khi tham gia giao thdng con chua eao.
Cdc dgc diim khac
Theo BIng 2, 67,2% c l e trUdng hop den vien trong vdng 24 g i d dau sau chan thdong. Viec den vien sdm de ddpc kham va x d ly tdn t h d d n g cang sdm cang tdt, k i t q u i thu ddpc cang cao v l t r i n h dupe nhdng bien chdng va di chdng cd the x l y ra sau nay. Cd 44 trddng hop (7,5%) den vien mudn sau 10 n g l y x l y ra t h d d n g t d n , ca b l l t cd trddng hpp bj chan thuong ham m I t nhUng khdng den vien k h I m ,
trong qua trinh sinh hoat tai nha thay ed n h i l u dau hieu bat thudng n h u khdng h i dupe mieng, an xdong dau nhdi... thi mdi chju d i n vien kham, lam cho viec d i l u trj sau d d gap n h i l u khd khan.
Cd 70,1% ele trUdng hpp bj chan t h u o n g h i m mat duoc sP edu tai eac co sd y te khIe trUde khi den vien. Chan thUOng ham mat I n h hUdng khdng ehl tdi chdc nang ma eon ca tham my eua mdi eon ngddi. V l y nen khi bj tdn thdOng vung h i m mat eae benh nhan ludn mudn t i m den eo sd y te uy tfn d l duoc dieu tri vdi mong mudn chdc n l n g I n nhai va tham my cua minh dUpc phuc hdi mdt each t d t n h l t .
4.2. Cdc hinh thdi gay xUOng
Trong chan thUOng ham mat, chan thuong gay 1 t i n g mat hay xay ra va nhat la tang mat gida vdi 66,4%. Chi cd 4 trUdng hpp cd tdn thddng gay xdong tang mat tren don thuan, chiem ty le rat nhd (BIng 4). Ket qua nay phii hpp vdi nghien cdu eiia Pham Van Lieu (59,3%) [2], Hoang Tien Cdng (58,75%) [4]. Trong gay phdc hop viJng ham mat thi gay phdc hpp tang mat gida + dddi hay gap nhat, chiem 6,1% c l e trddng hpp chan thuong ham mat.
Tang mat gida bao gdm nhieu xuong mdng ndi k i t vdi nhau tao thanh mdt khdi. Vi bao gdm nhieu xddng mdng nen khi bi chan thuong vung mat thi eae xUPng tang mat gida de bi tdn thuong nhat.
Trong tang mat gida thi 80,2% ele trddng hpp ed g l y gd m l - eung tiep, chlem ty le cao nhat trong e l e xdOng gay tai tang gida mat (Bang 5). XUOng gd ma eung t i l p la mot phdc hpp xdPng mdng, xdp, nhd, udn cong va la vung nhd ra phfa trUdc cda khdi xdong vung ham mat nen khi cd Idc t i e ddng true t i l p va thang vao vung mat thi day la khdi xUOng de bj gay nhat. Sd lieu eda chdng tdi eao hon eua Hoang T i i n Cdng (51,7%) [4].
Gay Le Fort la dang gay ngang t o l n bd xUOng ham tren, chiem 11,2%, trong d d g l y Le Fort II gap n h i l u hon ca (7,9%). Ty le gay Le Fort gap trong nghien cdu cda Hoang T i i n Cdng la 29,6% [4]. Trong c l e loai gay Le Fort g l y Le Fort 111 I I hlnh thai chan t h d o n g nang thudng kem theo chan thddng sp nao.
Trong n g h i i n edu nay ehung tdi gap 102 trddng hpp ed gay phdc hpp cac xdong thudc tang mat
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N=5/2017
gida, trong dd g l y phdc hpp h i m t r i n - go ma hay gap nhat, chiem 19,3% cac trddng hpp g l y xUOng t i n g mat gida (BIng 6). Nghien cdu cda Pham Van Lieu thi ty- le nay la 33,7% [2].
Vj trf hay gap t i l p theo trong chan thdOng ham mat I I g l y xdong tang mat dUdi vdi ty le 21,5%. Ket qua nay khac vdi nghiSn edu cda Pham Van Lieu la 40,7% [2]. Mac du xUdng ham dudi I I xUPng Idn n h l t va khde nhat trong toan bd khoi xdong mat nhung gay xUong ham dUdi lai hay x l y ra. XUPng h i m dudi cd mdt sd diem yeu m l sang chan de lam gay xUPng qua c l e diem nay, gdm cd: Vung rang eda, Id e l m , goe ham, ed Idi cau. Theo Bang 7 thi vung cam I I noi hay x l y ra gay nhat, chiem 64,17%
trong gay xUPng ham dddi. Tiep theo I I Idi cau va vung gdc ham. B i l u nay hoan t o l n phu hop vi do la c l e diem yeu cCia xUPng ham dudi. Trong nghien edu cua Tran Qudc KhInh gap 35% trudng hop cd gay xdong ham dddi vung cam [51.
Nghien edu nay gap 70 trUdng hpp cd g l y phdc hop XUdng ham dudi, nhu gay phdc hop cam - Idi c l u , g l y phdc hpp cam - gdc h i m . . . Trong dd g l y phdc hpp cam - Idi cau hay gap nhat, ehlem 19,8%
eae trddng hop g l y xUong ham dddi (BIng 8).
TrUong Nhdt Khue khi nghien cdu ve dac ^ e m gay xuong ham dudi thay g l y phdc hpp e l m - gdc ham hay gap nhat c h i l m 49,05% c l e trudng hop gay xuong ham dUdi [6].
Gly lien tang mat la tdn thdong gay nhieu xUOng vung ham mat. Cae xUOng gay cd the d ca 3 tang mat.
Trong nghien edu nay chiing tdi gap 67 trddng hop g l y lien tang mat, chlem ty le 11,4% tdng sd ea chan thddng ham mat. Theo William Curtis va cdng sU thi gay lien tang mat chiem xap xi 4 - 1 0 % tat ea c l e chan thuong ham mat [5]. Tuy ehi c h i l m mpt ty le nhd nhung d^y la mpt chan thUPng nang, thudng kem theo tdn thddng ele cO quan khac nhu sp n I o , cdt sdng, ngdc... N l u dieu trj khdng tdt cd the d l lai nhdng di chdng nang n l ve sau.
Kit qud dieu tri
Cd nhieu phdong p h I p d i l u trj chan thUOng g l y Xdong viJng ham mat, trong d d ed 2 phdong phap chinh la dieu trj phau t h u l t va d i l u trj bao t d n .
Phuong p h I p dieu trj phau t h u l t chu yeu tcii Khoa Phau t h u l t H i m mat va Tao hinh - Blnh vien Trung uong Q u I n dpi 108 la phau t h u l t nan chfnh ket hop xdPng bang nep vit. PhUOng p h I p nlyddOc I p dung vdi 88% sd benh n h i n chan thuong ham mat trong nghien cdu tren. Nd cd Uu diem la ed dinh xdong vdng chac, vi the thdi gian hdi phuc nhanh hon. Chi ed 11,1% e l e trUdng hpp la dieu trj b i o ton.
Viec d i l u trj b i o tdn dddc ch! dinh trong cle trudng hop gay kfn khdng di lech hole di lech ft. B i l u tri sdm gidp v i l e can thiep de dang, hieu q u i hon nhieu so vdi nhCfrig trUdng hpp den muon, tuy n h i l n thdi d i i m can thiep cu t h l ddpc danh gia tot n h l t khi tinh trang sUng ne g i l m , nhd nhcin xet cua MJL Hurrell [7].
Oanh gia sdm sau dieu trj cd 93% phuc hdi tdtve mat chdc n l n g . 90,1% dat ddpc sU can ddi gida cac tang mat, phuc hdi tdt theo phuong d i f n g i l i phau.
5. K^t luan
Qua k h I o sat 586 benh I n eua b l n h n h i n chan thUPng g l y xUOng vung ham mat dieu tn trong 3 nam tai Benh vien Trung dOng Q u I n dpi 108, chung tdi rut ra mdt sd ket luan sau:
B l e diem ehung eua ddi tdpng nghien cdu:
Nam gidi c h i l m 84,1%, t y le nam/nd la 5/1. Nhom tudi 19 - 39 c h i l m ty le cao nhat I I 65,4%, nhdm tuoi 40 - 60 la 24,6%. Nguyen n h i n chd y l u do tai nan giao thdng, chlem 84,3%.
Cac hinh t h i l gay xuong vCing ham mat: Tang mat gida hay gay nhat chiem t y le 66,4%, trong do 80,2% la g l y g d m l - cung tiep.
Ty le gay tang mat dddi la 21,5%, trong do 64,17% cd gay d vijng cam, t i l p theo la g l y vung gdc ham va Idi cau. Gay lien tang mat chiem ty le nhd la 11,4% eae trddng hpp chan thuong viing ham mat.
K i t q u i dieu trj: 88% b l n h n h i n dupe d i l u trj b i n g phUPng phap dieu tri phau thuat, 11,1% ddpc ap dung phdOng phap d i l u tri bao tdn. Ket q u i 93%
phuc hdi t d t ve mat chdc nang. 90,1% phuc hdi tot theo phuong d i f n g i l i phau.
TAP CHl Y DUOC LAM SANG 108 Tap 12-565/2017
Tai lieu t h a m k h i o
1. Lam Ngpc An, Bang Duy Hieu, Huynh Bai HIi, Tran Hdng Hanh, Lam Hoai Phuong, Bui Hdu L l m , Tran Ngpc QuIng Phi (1993) Chdn thuang vung mat do nguyin nhdn thdng thUdng. K'jf yeu cong trinh khoa hpc, Vien Rang Ham Mat Thanh phd Hd Chf Minh, tr. 127-131.
2. Pham Van Lieu (2006) Tong quan ve chdn thuang gdy xuang vdng hdm mat vd phuang phdp diiu tri.
Tuyen tap cdng trinh NCKH - RHM, TrUdng BH Y DUpc TP Hd Chf Minh, NXB Y hpc, tr. 123-130.
3. Hoang T i i n Cdng (2011) Nghiin cdu ddc diem Idm sdng, X-quang vd kit qud diiu tri gdy khdi xUang tdng gida tgi Binh viin DiCTLf Thdi Nguyin. Tap chf Khoa hoc vS Cdng nghe, 89(01 )/1, tr. 238-244.
4. Tran Qudc Khanh (2013) Nghiin cdu dp dung nep vit tu tieu trong dieu trj gdy xuang hdm dudi. Luan an Tien sT y hpc, tr. 66-67.
Truong Nhut Khue (2012) Nghiin cdu ddc diem gdy xuang hdm dudi vd ddnh gid kit qud dieu trj tgi Benh viin da khoa Trung uang Cdn Tha giai dogn 2009-2010. Luan I n T i l n sty hpc, tr. 71-72.
Robert G (2003) Cranio-maxillofacial trauma: A 10 year review of 9543 cases with 21067 injuries.
Journal ofCranio-Maxillofacial Surgery 31:51-61.
William C, Bruce BH (2013) Panfacial fracture an approach to management. Oral and Maxxillofacial Surgery Clinics 25(4): 649-660.
MJL Hurrell, MD Batstone (2014) The effect of treatment timing on the management of facial fractures: A systematic review. Int. J. Oral Maxillofac.
Surg 43: 944-950.
