Massive Hemorrhage Facial Fracture Patient Treated by Embolization

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.

Three Cases of Acquired Simulated Brown Syndrome after Blowout Fracture Operations

Brown syndrome is known as limited elevation of the affected eye during adduction. It is caused by a disorder of the superior oblique tendon, which makes it difficult for the eyeball to look upward, especially during adduction. It is classified into congenital true sheath Brown syndrome and acquired simulated Brown syndrome. Acquired simulated Brown syndrome can be caused by trauma, infection, or inflammatory conditions. The surgical restoration of blowout fractures can also lead to limitations of ocular motility, including Brown syndrome. We report on three patients with acquired simulated Brown syndrome, who complained of diplopia and limitation of ocular motility after operations to treat blowout fractures.

The Advantages of Using Laryngeal Mask Airway in Case of Burn Eschar Excision Under General Anesthesia

PURPOSE: The most commonly used way of keeping airway, during general anesthesia, is endotracheal intubation. However, in case of short and simple surgery like escharectomy of burn wounds with Versajet(R), less invasive method using laryngeal mask airway is recommended rather than using endotracheal tube. The purpose of this study is to compare between laryngeal tube and endotracheal tube in case of escharectomy of burn wounds with Versajet(R), so that it may contribute to improving the ability of surgeon to carry out advanced airway management. METHODS: We selected 60 patients undergoing general anesthesia randomly who were to be given short operation lasting less than one hour and then anestheize each 30 patients by using endotracheal tube and laryngeal mask airway. Patients who underwent escharectomy of deep secondary burn wounds less than 9% of body surface with Versajet(R) were also divided into two groups (laryngeal mask airway, LMA group: 30 people, endotracheal tube, ETT group: 30 people). The size of laryngeal tube and laryngeal mask airway is chosen by body weight and sex. The laryngeal mask airway and endotracheal tube are both properly positioned and the ventilation efficient was not significantly different. We estimated the number of insertion attempts and the insertion time of endotracheal tube and laryngeal mask airway. Proper positioning, effect on cardiovascular system and postoperative airway problems (sore throat, nausea) after the recovery were also recorded. Successful insertion was judged by the Anesthesiologist. RESULTS: Probability of success rate were higher in the LMA group than in the ETT group in the first attempt (P-value= 0.028). Time used in successful insertion in the first attempt with LMA insertion group was significantly shorter than ETT insertion group (P-value= 0.014). Mean dosage of the muscle relaxants used were higher in the ETT group than in the LMA group (P-value= 0.012). No significant differences were observed in incidences of Myalgia between the two groups. There is statistically significant difference in incidences of postoperative sore throat in the two groups (P-value= 0.0058). There is no statistically significant difference in incidences of postoperative nausea or vomiting in the two groups. CONCLUSION: This comparative study suggests that Laryngeal mask airway (LMA) are useful for simple surgery of escharectomy of burn wounds with Versajet(R) and relatively more safer than using endotracheal tube (ETT) in general anesthesia for educated plastic surgeon in case of short and simple surgery like escharectomy of burn wounds.

Central Nervous System Toxicity Following Topical Anesthetics: A Case Report

In treating deep second degree burn, it is important to induce reepithelization as soon as possible. So it is crucial to remove eschar after appropriate anesthesia. But in case of extensive wound area or anxiety of needle, we have been used topical anesthetics alternative to lidocaine injection based on its efficacy and safety. Even though it is rare but, we experienced a patient who suffered Central nervous system toxicity following topical anesthetics of lidocaine application. So we report a case with review of related articles.

Clinical Significance of Orbital Inferiomedial Blow Out Fracture

BACKGROUND: The incidence of blow out fractures is increasing and the techniques of diagnosis and treatment have been recently evolving. Despite its clinical significance, there has been no study on orbital inferiomedial blow out fractures. Therefore, this study was designed to investigate the clinical significance of treatment of orbital inferiomedial blow out fractures. METHODS: A retrospective review of fifty-seven patients who could be followed up for at least 1 year after surgical reconstruction of pure inferiomedial blow out fracture was undertaken. The transconjunctival approach was performed in all cases. The onlay technique was used in 32 patients and the inlay/sheet method was used in 25 patients. We evaluated the clinical outcomes using the chi-square test. RESULTS: In the group using the onlay technique, postoperative diplopia and enophthalmos were observed in 14 cases and 3 cases, respectively. Of these, 5 cases and 3 cases lasted for more than 6 months, respectively. In the group using the inlay/sheet method, postoperative diplopia was observed in 9 cases, but there were no cases of enophthalmos. Among the 9 diplopia cases, 4 lasted for more than 6 months. CONCLUSION: Postoperative diplopia and enophthalmos were increased after treatment of inferiomedial blow out fractures compared to isolated medial (0.6%, 0.3%) or inferior (1.8%, 0.6%) blow out fractures. Therefore, careful dissection is necessary not to injure the inferior oblique muscle to decrease the incidence of postoperative diplopia. Moreover, the inlay/sheet method is an effective option for reconstruction of inferiomedial blow out fractures.

The Effect of Valproic Acid on Ovary of Pubertal Child / 대한소아신경학회지

PURPOSE: Valproic acid is effective and safe in adults and children for the treatment of a variety of seizure types. But, according to the recent reports, this drug induce hyperandrogenism, obesity, and polycystic ovaries, particularly when the medication is started before the age of 20. This research was designed to study the effect of valproic acid on ovary of pubertal child. METHODS: The sample group consisted of 23 girls who were diagnosed to epilepsy by our department of pediatrics, and were taking valproic acid from January 2000 to July 2000. They were evaluated reproductive endocrine function with the serum sex hormones and ultrasonographic study of ovary. RESULTS: 1) The mean serum sex hormones concentration of prepubertal, pubertal, and postpubertal girls taking valproic acid were belong to the normal range of reference values of textbook of Nelson and Park's report. 2) The obesity were seen in two of the 23 girls taking valproic acid. 3) The rate of polycystic ovaries in normal girls with regular menstruation has been reported in 9%, but, in our report, polycystic ovaries were seen in five of the 20 girls taking valproic acid(25%). CONCLUSION: Ultrasonographic study of ovaries is required for the girls taking valproic acid. If the problems from the polycystic ovary are developed on patients taking valproic acid, the substitution of other anticonvulsant drug for valproic acid may be required. However, further study was needed to clarify whether this ovarian morphologic changes were elicited by valproic acid or not.