Endüstriyel Kauçuk Kesme Makinesi kazası Sonrası Şiddetli Maksillofasiyal Travma: Bir Olgu Sunumu

Öz

Amaç: Endüstriyel makine kazaları, iş ortamlarında görülen ciddi maksillofasiyal travmaların önemli bir nedenidir. Bu olgu sunumunda, yüksek kapasiteli endüstriyel hidrolik kauçuk kesme makinesine sıkışma sonucu ağır maksillofasiyal travma gelişen bir hasta sunulmaktadır. Olgu Sunumu: 55 yaşında erkek hasta, iş yerinde endüstriyel kauçuk kesme makinesine sıkıştıktan dört saat sonra acil servise başvurdu. Muayenede sol mandibuler ve ön maksiller hassasiyet, bilateral oksipitoparietal bölgede ikişer cm'lik oblik laserasyonlar, kısıtlı ağız açıklığı ve korunmuş nörolojik fonksiyon saptandı. Vital bulgular kan basıncı 140/90 mmHg, kalp hızı 95/dk, ateş 37°C ve oda havasında oksijen satürasyonu %94 idi. Maksillofasiyal bilgisayarlı tomografide sol tripod kırığı, septal parçalanma ile birlikte bilateral nazal kemik kırıkları, orbita apeksini de içeren bilateral orbital duvar kırıkları, hemorajik yoğunluklarla seyreden yaygın paranazal sinüs tutulumu ve yaygın subkütan/retroorbital amfizem izlendi. Hasta acil tıp, kulak burun boğaz, nöroşirürji, oftalmoloji ve plastik cerrahi branşlarının katılımıyla multidisipliner olarak tedavi edildi. Sonuç: Hidrolik endüstriyel makinelere bağlı kompresyon tipi yaralanmalar, geleneksel yüz travmasından temelde farklı, kendine özgü bilateral kırık paternleri oluşturur. Acil hekimleri havayolu açısından dikkatli olmalı, gecikmiş komplikasyonlara karşı uyanık kalmalı ve sonuçları iyileştirmek için erken multidisipliner koordinasyonu sağlamalıdır.

Anahtar Kelimeler

• Maksillofasiyal travma
• endüstriyel kaza
• hidrolik yaralanma
• orbital kırık
• acil tıp

Severe Maxillofacial Trauma Following Industrial Rubber Cutting Machine Entrapment: A Case Report

Öz

Objective: Industrial machinery accidents constitute an important cause of severe maxillofacial trauma in occupational settings. This case report presents a patient who sustained severe maxillofacial trauma after entrapment in a high-capacity industrial hydraulic rubber cutting machine. Case Report: A 55-year-old male presented to the emergency department four hours after being trapped in an industrial rubber cutting machine at his workplace. Examination revealed left mandibular and anterior maxillary tenderness, two 2-cm oblique lacerations in the bilateral occipitoparietal region, limited mouth opening, and preserved neurological function. Vital signs were blood pressure 140/90 mmHg, heart rate 95 beats/min, temperature 37°C, and oxygen saturation 94% on room air. Maxillofacial computed tomography demonstrated a left tripod fracture, bilateral nasal bone fractures with septal comminution, bilateral orbital wall fractures with orbital apex involvement, extensive paranasal sinus involvement with hemorrhagic densities, and widespread subcutaneous and retro-orbital emphysema. The patient was managed with a multidisciplinary approach involving emergency medicine, otolaryngology, neurosurgery, ophthalmology, and plastic surgery. Conclusion: Compression-type injuries from hydraulic industrial machinery produce distinctive bilateral fracture patterns that differ fundamentally from conventional facial trauma. Emergency physicians should maintain airway vigilance, remain alert for delayed complications, and ensure early multidisciplinary coordination to optimize outcomes.

Anahtar Kelimeler

• maxillofacial trauma
• industrial accident
• hydraulic injury
• orbital fracture
• emergeny management

Kaynakça

1. Referans 1. Eggensperger NM, Danz J, Zimmermann H, Iizuka T. Occupational maxillofacial fractures: a 3-year survey in central Switzerland. J Oral Maxillofac Surg. 2006;64(2):270-276.
2. Referans 2. Roccia F, Boffano P, Bianchi FA, Gerbino G. Maxillofacial injuries due to work-related accidents in the North West of Italy. Oral Maxillofac Surg. 2013;17(3):181-186.
3. Referans 3. Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10-year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg. 2003;31(1):51-61.
4. Referans 4. Burnstine MA. Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis. Ophthalmology. 2002;109(7):1207-1210.
5. Referans 5. Girotto JA, MacKenzie E, Fowler C, Redett R, Robertson B, Manson PN. Long-term physical impairment and functional outcomes after complex facial fractures. Plast Reconstr Surg. 2001;108(2):312-327.
6. Referans 6. Joseph JM, Glavas IP. Orbital fractures: a review. Clin Ophthalmol. 2011;5:95-100.
7. Referans 7. Barak M, Bahouth H, Leiser Y, Abu El-Naaj I. Airway management of the patient with maxillofacial trauma: review of the literature and suggested clinical approach. Biomed Res Int. 2015;2015:724032. Referans 8. Lima V, Burt B, Leibovitch I, Prabhakaran V, Goldberg RA, Selva D. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol. 2009;54(4):441-449.
8. Referans 9. Rowh AD, Ufberg JW, Chan TC, Vilke GM, Harrigan RA. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med. 2015;48(3):325-330.

9. Referans 10. Murali S, Davis C, McCrea MJ, Plewa MC. Orbital compartment syndrome: pearls and pitfalls for the emergency physician. J Am Coll Emerg Physicians Open. 2021;2(2):12372.
10. Referans 11. Farber SJ, Nguyen DC, Skolnick GB, Woo AS, Patel KB. Current management of zygomaticomaxillary complex fractures: a multidisciplinary survey and literature review. Craniomaxillofac Trauma Reconstr. 2016;9(4):313-322.
11. Referans 12. Saini S, Singhal S, Prakash S. Airway management in maxillofacial trauma. J Anaesthesiol Clin Pharmacol. 2021;37(3):319-327.
12. Referans 13. Pandya RP, Deng W, Hodgson NM. Current Guidelines and Opinions in the Management of Orbital Floor Fractures. Otolaryngol Clin North Am. 2023;56(6):1101-1112.
13. Referans 14. Occupational Safety and Health Administration. Machine guarding [Internet]. Washington (DC): United States Department of Labor; 2025 [cited 2026 Jul 22]. Available from: https://www.osha.gov/machine-guarding