Etiology, pattern and management of maxillofacial fractures in patients seen at mayo hospital, Lahore - Pakistan

The objective of the study was to determine the varying etiology, pattern and mode of treatment of maxillofacial injuries in a tertiary care centre, Mayo Hospital, Lahore, Pakistan. This was a retrospective study spread over two years and six months i.e. January 2010 to June 2012. 214 consecutive indoor/ outdoor and emergency patients with maxillofacial injuries farmed the study group. Data concerning the patients' demographics, aetiology, occupation, socioeconomic status and pattern of maxillofacial injuries were obtained and analysed. The most frequent bone fractured was the mandible, which accounted for 106 cases 49.5%, followed by 15.4% of pan facial [full house] fractures and 15.4% of Zygomatic complex fracture. The associated mid face fractures were found in 12.6% and isolated nasal bone fractures were found in 1.5% cases. The most common cause of injury was RTA 58.4%, followed by falls 24%, FAIs 6.1%, interpersonal violences 2.8%, sports and other injuries were 8.4%. Employees 49.5% and students 31.3% in age groups 20-40 years were mostly affected by RTA, while falls 14.4% were more common in age group less than 20 years. Open reduction and internal fixation alone 43.9%, maxillomandibular fixation +/- suspension 38.8% and open reduction and internal fixation with maxillomandibular fixation 14.5% were the main mode of treatment in this centre. In this study, mandible was the most commonly fractured facial bone; RTA especially by motorbike and chigchi rikshaw was the most common etiological factor. Results could be influenced by the personal and working environment

Outcome of transcranial repair of traumatic csf rhinorrhea

Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Posttraumatic CSF rhinorrhea is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcomes of patients with transcranial subfrontal approach for posttraumatic CSF rhinorrhea approach may help the neurosurgeon in the decision-making process. This study was conducted to analyse the outcome of trans-cranial sub-frontal approach for traumatic CSF rhinorrhea, with duroplasty and fibrin glue. This study was carried out in the Department of Neurosurgery, Ayub Medical College, Abbottabad from Jan 2007 to Jun 2011. All patients undergoing trans-cranial sub-frontal repair of traumatic CSF fistulas were included. Where possible primary dural repair was performed under hypotensive general anaesthesia and in the cases where it was not possible, graft was used. This was followed by application of fibrin glue at the repaired site. Graft materials used in this study were taken from fascia lata, pericranium, and temporalis fascia. Out of 27 patients 21 were men and 6 were women. Age of the patients ranged from 17 to 56 [34.5 +/- 4.6] years. Main causes of trauma were road traffic accidents [23, 85%], fall from height [3, 11%], and assaults [1, 4%]. In 23 [85%] cases no CSF leak was observed in immediate postoperative period as well as during the follow-up visits while in 3 [11%] cases additional lumber punctures were required to augment the repair. One patient failed to respond to surgery and lumbar drainage. The CSF rhinorrhea is commonly seen in patients with anterior skull fractures secondary to head injury. Initially conservative trail should be given to the patients, if it fails then on-lay dural technique followed by fibrin glue application through transcranial approach has good outcome with less chances of complications.