ABSTRACT
Background:-Facio-maxillary injuries account for 93.3%of total injuries.Facial injuries occur in a significant proportion of trauma patientsrequiring prompt diagnosis of fracture and soft tissue injuries with possible emergency intervention. Facio-maxillary fractures may present with associated neural and spine injuries. In fact there may be associated limb injuries also.Aim of the Study:-Tofind out about the common causes, different types of fractures, male female ratio, different complications and patientswho needed surgical intervention.Materials and Methods:-This is a prospective cross sectionalstudy comprising of 60 patients who were having different facio-maxillary fracturesand visited to L.G.Hospital from June 2017 to May 2018.Observationand Results: -Facio-maxillary fractures and their incidence varies with different places. Male to female ratio was 14:1in our study. Facio-maxillary fractures are associated mostly with Road Traffic Accidents(RTA80%), followed by fall (12%), assault (5%) and sports injuries (3%).Commonest facial bone to get fractured is nasal bone (53.3%), followed bymandible (43.3%), maxilla (40%), orbit (23.3%), zygoma (10%) andfrontal (6.6%).Condylar fracture is most common amongstmandible fractures, 8cases (30.8%).Most common isolated bone to getfractured is nasal bone (16.7%) followed bymandible (10%), maxilla (6.7%), orbit (6.7%), fontal (3.3%), zygoma (3.3%).Clinical examination of the patient is very importantin terms of facial asymmetry and oedema, mouth opening and teeth occlusion. 3D CT face helps in diagnosis of facio-maxillary fractures. In uncomplicated cases of facio maxillary fracturesof maxilla and mandiblewith proper mouth opening and teeth occlusion, conservative management was done andinpatients with decreased mouth opening and improper teeth occlusion surgical management was done.In cases of nasal bone fractures,if there was external deviation of nose or nasal blockage, patient was managed surgically and if there was absence of externaldeviation or nasal blockage, patient was managed conservatively. Out of 60 patients, 24(40%)patients were operated while 36(60%) patients were managed conservatively. Most of the mandible fractures (76.9%) were operated (20 0ut of 26) while otherbonefractures (Nasal-68.7%, Maxilla-91.7%, Zygoma-33.3%, Orbital and frontal-100%) were managed conservatively.Most commoncomplication following injury was hypoesthesia(4 out of 60 patients). Local site infection, angle of mouth deviation and haematoma were seen in only one patient each. Conclusion:-Based on this study we can conclude that facio maxillary injuries account for major percentage of injuries following RTA(80%). Most of the facial bone fractures were treated conservatively(60%).3D CT face is the gold standard investigation to rule out different facio maxillary fractures.This data is important for evaluation of existing preventing measuresand useful in development ofnew methods of injury preventionand treatment.KEYWORDSFACIAL TRAUMA, FRACTURES, MANDIBLE,MAXILLA.INTRODUCTIONFacio-maxillary injuries account for 93.3% of total injuries[1].There are different types of facio-maxillary fractures according to the involved boneslike nasalbone fracture, maxillary fracture, mandibular fracture,frontalbone fracture, zygoma fracture and orbital fracture. Some of them are isolated fractureswhile some are combinedfractures. In mandible different parts which get fractured are-condyle, body, symphysis, angle, parasymphysis, coronoid process, alveolar process and ramus. Le Fort described three levels of midface fracture(FIG-7)[2].Le Forttype I-fracture runs above the floor of the nasal cavity, through nasal septum, maxillary sinuses and inferior parts of medial and lateral pterygoid plates. Le Forttype II-fracture runs from the floor of the maxillary sinuses superiorly to the infra-orbital margin and through the zygomatico-maxillary suture, within orbit it passes across the lacrimal bone to the nasion. In Le Fort type III,there isdisconnection of thefacial skeleton from the cranial base. Facial injuries occur in a significant proportion of trauma patients requiring prompt diagnosis of fractures and soft tissue injuries with possible emergency interventions[3].There are many studies in the literature that have analysed the demographic factors associated with facial trauma according to various criteria[3, 4, 5]. The epidemiology of fractures varies with regard to injury type, severity and cause, depending on the population study[6].The differences in populations with regard to the causes of fractures may be the resultof differences in culture and varietiesof risk factors. Continuous long-term collection of data regarding the epidemiology of facial fractures is important because it provides information necessary for the development and evaluation of preventive measures that might help reduce the incidence of facial injuries [6].The aim of this study was tofind out about the common causes, different types of fractures, male female ratio, different complications and patientswho needed surgical intervention.METHODThis is aprospective cross sectional study comprising of 60 patients who were having different facio-maxillary fractures and visited to L.G.Hospital from June2017 to May 2018. Patientswereevaluatedthoroughly by history taking,properexamination and routine investigations. In generalexamination-Consciousness, orientationto time, placeand person, neckmovements and generalmobility of the patients were checked. In local examination -Facial oedema, facial asymmetry, skinlacerations, deepcuts, decreasedmouth opening, improperteeth occlusion, teethloss, nasal bleeding,blackeye, epiphora, eyeball movementsand rednessof eyeswere checked. We carried out investigations such as2D & 3D CT Facial bones,CT Brainand CT cervical spine (if needed)and all routine blood investigations.Inclusioncriteria:-All cases with facio-maxillary fractures of all age groupswere included in our study
ABSTRACT
Background and objectives: Solitary thyroid nodule(STN} is a common clinical entity encountered in routine clinical practice.STN is defined as a single swelling involving either lobe of thyroid or isthmus of thyroid gland. Present study was undertaken to know distribution of lesion according to age and sex, and also to evaluate efficacy of FNAC in diagnosis of clinically obvious and palpable solitary thyroid nodule. Method: This study was done on 75cases operated in our hospital from May 2012 to May 2016. All patients included in the study were submitted to FNAC and ultrasonography. All patients were subjected to surgery and histopathology examination was obtained. Results: Out of 75 cases of thyroid lesions, 63 cases were benign (84%), 6 cases were malignant (8%) and 6 cases were suspicious(8%) on FNAC. On Histopathological examination, 60 cases were benign(80%) and 15 cases were malignant(20%). Conclusion: FNAC is a single best investigation for preoperative evaluation for STN to differentiate between benign and malignant nodules with 88% accuracy rate.[Doshi H NJIRM2016; 7(5):53-55]