Neumomediastino secundario a fractura aislada de piso de órbita / Pneumomediastinum secondary to isolated fracture of orbit floorx

Resumen Introducción: El neumomediastino se define como la presencia de aire o gas dentro de los planos fasciales del mediastino. Por lo general, es un fenómeno secundario a perforaciones traumáticas del tracto aerodigestivo. El neumomediastino secundario a una fractura orbitaria es un evento raro. Se asocia a complicaciones potencialmente mortales como el neumotórax, el neumopericardio y la mediastinitis. Objetivo: Describir un caso de neumomediastino secundario a una fractura aislada de piso orbitario y su manejo médico-quirúrgico. Caso clínico: Paciente de sexo femenino de 42 años que sufre traumatismo en regiones facial, cervical y torácica desarrollando secundariamente un enfisema subcutáneo panfacial y un neumomediastino, el cual se resuelve exitosamente. Discusión: El neumomediastino secundario a una fractura aislada de piso orbitario es un evento muy raro. El aire puede descender a lo largo de los espacios fasciales hasta el mediastino. En este sentido, sonarse la nariz es un factor de riesgo para desarrollar esta pa-tología. Conclusión: Ocurrido un trauma maxilofacial puede presentarse enfisemas de espacios profundos de la cabeza, cuello e incluso el mediastino.

Introduction: Pneumomediastinum is defined as the presence of air or gas within the fascial planes of the mediastinum. It is usually a phenomenon secondary to traumatic perforations of the aerodigestive tract. Pneumomediastinum secondary to an orbital fracture is a rare event. And it is related to life-threatening complications such as pneumothorax, pneumopericardium and mediastinitis. Aim: To describe a case of pneumomediastinum secondary to an isolated orbital floor fracture and its medical-surgical management. Clinical case: A 42-year-old female patient who suffers trauma to the facial, cervical and thoracic regions, secondary development of a subcutaneous panfacial emphysema and pneumomediastinum, which resolves successfully. Discussion: Pneumomediastinum following an isolated orbital floor fracture is a very rare event. The air can descend along the fascial spaces to the mediastinum. In this sense, blowing your nose is a risk factor to develop this pathology. Conclusion: After a maxillofacial trauma, emphysema of the deep spaces of the head, neck and even the mediastinum can occur

Sensory Impairment in Infraorbital Nerve Following Mid-Facial Fractures

PURPOSE: Sensory impairment in infraorbital nerve is common symptom following mid-facial fractures. The purpose of this study is to document the incidence of sensory impairment in infraorbital nerve following mid-facial fractures and its recovery. METHODS: Three hundreds fourteen patients with mid-facial fracture were included involving emergence areas of infraorbital nerve. Fractures were classified into zygoma fracture, maxilla fracture, complex comminuted fracture and pure blow out fracture. Neurosensory function was assessed with clinical symptoms and light touch test in infraorbital nerve regions. Patients were followed and sensory function was evaluated immediately, 1, 3 and 6 months after trauma. RESULTS: The total series consisted of 198 zygoma fractures, 19 maxilla fractures, 30 complex comminuted fractures and 67 pure blow out fractures. The incidence of sensory impairment was 60% (63% in zygoma fractures, 84% in maxilla fractures, 93% in complex comminuted fractures, 31% in pure blow out fractures). Persistent sensory impairments were remained in 32% (33% in zygoma fractures, 47% in maxilla fractures, 73% in complex comminuted fractures, 6% in pure blow out fractures) 6 months after trauma. Younger patients had better prognosis than older patients in recovery of infraorbital nerve function(p<0.05, chi2-test). Mean recovery time was 11 weeks. CONCLUSION: The incidence of post-traumatic sensory impairment was different according to fracture types. Age of patients and fracture type were important factors that influence to recovery of sensory impairment. Complex comminuted fracture had poor prognosis, and pure blow out fractures had better prognosis than other fractures.

Rigid Fixation using Bioabsorbable Mesh and Screws in Facial Bone Fracture

PURPOSE: Absorbable plate and screw fixation is widely used technique for internal rigid fixation in craniomaxillofacial surgery. However, there are some potential problems associated with the use of plate. The purpose of this study is to evaluate the feasibility of bone fixation in facial fracture using absorbable mesh in place of absorbable plate. METHODS: The records of 55 patients with zygomaticomaxilla fractures treated by open reduction, performed by the author from February 2008 to May 2009, were retrospectively reviewed. Patients were selected to receive absorbable mesh fixation. The incidence of all complications including infection, hypoesthesia, and deformity was examined. Analysis with postoperative computed tomography follow-up demonstrates degree of reduction. RESULTS: Forty-six patients met criteria for inclusion in the study. All patients went on to satisfactory healing without complication. Postoperative computed tomography revealed good bony alignment similarly non affected side. CONCLUSION: This study demonstrates that the rigid internal fixation of fractured bone fragments using absorbable mesh is more effective than absorbable plate, especially in comminuted fracture of maxilla.

Rigid Fixation using Bioabsorbable Mesh and Screws in Facial Bone Fracture

PURPOSE: Absorbable plate and screw fixation is widely used technique for internal rigid fixation in craniomaxillofacial surgery. However, there are some potential problems associated with the use of plate. The purpose of this study is to evaluate the feasibility of bone fixation in facial fracture using absorbable mesh in place of absorbable plate. METHODS: The records of 55 patients with zygomaticomaxilla fractures treated by open reduction, performed by the author from February 2008 to May 2009, were retrospectively reviewed. Patients were selected to receive absorbable mesh fixation. The incidence of all complications including infection, hypoesthesia, and deformity was examined. Analysis with postoperative computed tomography follow-up demonstrates degree of reduction. RESULTS: Forty-six patients met criteria for inclusion in the study. All patients went on to satisfactory healing without complication. Postoperative computed tomography revealed good bony alignment similarly non affected side. CONCLUSION: This study demonstrates that the rigid internal fixation of fractured bone fragments using absorbable mesh is more effective than absorbable plate, especially in comminuted fracture of maxilla.

A clinical analysis of 86 maxillofacial fractures in children / 实用口腔医学杂志

An analysis of the characteristics of the facial fractures in children was performed in this paper by investigating the cases of the facial fractures in children.In the study,86 cases of facial fractures in children under 12 years from January 2000 to June 2008 were reviewed,who were treated by the Fourth Military Medical University. The information included the age,gender,time distribution of jury,type of fracture, nerve injury, and associated systemic injuries. The youngest age was 13 months, the ratio of male to female was 2.19∶ 1. The majority of fractures were occurred in summer. The most cases were caused by the traffic accidents, and the mandible fractures were higher than others. The number of conservative treatment were higher than operation,78% cases of condyle fractures were treated conservative, the operation of maxilla and zygomatic arch fracture were less than 50%. The males were higher than the females according to the facial fracture in children.Traffic accident was the main risk factor of condylar fracture. The mandibular fractures were occurred frequently and treated normally by conservative method.

The Relationship between Facial Fractures and Radiologically-proven Cranial Injuries

PURPOSE: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. METHODS: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. RESULTS: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. CONCLUSION: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.

Submental Intubation in Panfacial Trauma Patient: A Case Report

Seven-year retrospective study of facial fracture

Fracture of the coronoid and pterygoid processes by firearms: case report

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Um caso raro de fratura dos processos coronóide e pterigóide por arma de fogo é descrito. Paciente do sexo masculino, 28 anos de idade, foi atingido por projétil de arma de fogo na face, resultando em limitação na abertura da boca, dificuldade para mastigar e dor ao abrir a boca. Exame clínico revelou ferimento perfurante em região parotídea direita e ferida similar do lado esquerdo na mesma região. Tomografia computadorizada (TC) mostrou fratura cominutiva do processo coronóide esquerdo e fratura cominutiva bilateral dos processo pterigóides. O tratamento foi conservador, através de fonoterapia, obtendo-se sucesso. Uma descrição detalhada das características clínicas, radiológicas (TC com reconstrução 3D), tratamento e proservação do caso é apresentada.

Clinical Analysis of Facial Bone Fractures

PURPOSE: As modern civilization and transportation systems have developed, the incidence of facial bone fractures has increased. The purpose of this study was to develop a criteria for proper use of computed tomography in cases of facial bone fracture, so that an accurate diagnoses can be made and proper treatment can be given. METHODS: This study included patients who visited the emergency center from March 2005 to December 2005. A total of 513 patients received facial bone computed tomography. The patients were divided into 2 groups: 242 patients who were diagnosed with facial fractures, and 271 patients without facial fractures. General, physical, and neurological examinations were analyzed to determine the degree of correlations with facial fractures. RESULTS: In facial fractures group, the sex ratio was 2.7:1 (M:F=177:65). The patients were mainly younger. There were two common causes of injuries; 117 cases (48.3%) were caused by fisticuffs, and 54 cases (22.3%) resulted from traffic accidents. Orbital fractures were the most common injury, comprising 156 cases (64.5%). The average injury severity score (ISS) of the patients was 6.5+/-4.0. As determined by multiple logistic regression analysis based on controlled physical examination and neurologic examination, significant risk factors related to facial fracture are abrasion, swelling, bruise, laceration, conjunctival hemorrhage, epistaxis, enophthalmos, extraoccular muscle limitation, temporo-mandible malocclusion and paresthesia. CONCLUSIONS: Facial bone fractures mostly occurred among active males between the ages of 20 to 40, and the most common causes are fisticuffs and traffic accidents. When facial injuries are associated with physical symptoms, such as swelling, laceration, conjunctival hemorrhage, epistaxis, enophthalmos, extraoccular muscle limitaion, temporo-mandible malocclusion and paresthesia, facial bone computed tomography is essential to proper diagnosis.

Correlation Between Facial Fracture and Cranial Injury

PURPOSE: There are two theories about the relationships between facial fractures and cranial injuries. One is that facial bones act as a protective cushion for the brain, and the other is that facial fractures are the marker for increased risk of cranial injury. They have been debated on for many years. The purpose of this study is to identify the relationship between facial fractures and cranial injuries. METHODS: A retrospective study was performed on 242 patients with facial fractures. The data were analyzed based on the medical records of the patients: age, gender, cause of injury, Injury Severity Score (ISS), alcohol intake, type of facial fractures, and type of cranial injury. The patients were divided into two groups: facial fractures with cranial injury and facial fractures without cranial injury. We compared the general characteristics between the two groups and evaluated the relationship between each type of facial fracture and each type of cranial injury. RESULTS: Among the 242 patients with facial bone fractures, 96 (39.7%) patients had a combination of facial fractures and cranial injuries. Gender predilection was demonstrated to favor males: the ratio was 3:1. The mean age was 36.51+/-19.63. As to the injury mechanism, traffic accidents (in car, out of car, motorcycle) were statistically significant in the group of facial fractures with cranial injury (p=0.038, p=0.000, p=0.003). The ISS was significant, but alcohol intake was not significant. No significant relationship between facial fractures and skull fractures was found. Only maxilla fractures, zygoma fractures, and cerebral concussion had a significant difference in cranial injury (p=0.039, p=0.025). CONCLUSION: There is a no correlation between facial fractures and skull fractures, which suggests that the cushion effect is the predominent relationship between facial fractures and cranial injuries.

Correlation Between Facial Fracture and Cranial Injury

PURPOSE: There are two theories about the relationships between facial fractures and cranial injuries. One is that facial bones act as a protective cushion for the brain, and the other is that facial fractures are the marker for increased risk of cranial injury. They have been debated on for many years. The purpose of this study is to identify the relationship between facial fractures and cranial injuries. METHODS: A retrospective study was performed on 242 patients with facial fractures. The data were analyzed based on the medical records of the patients: age, gender, cause of injury, Injury Severity Score (ISS), alcohol intake, type of facial fractures, and type of cranial injury. The patients were divided into two groups: facial fractures with cranial injury and facial fractures without cranial injury. We compared the general characteristics between the two groups and evaluated the relationship between each type of facial fracture and each type of cranial injury. RESULTS: Among the 242 patients with facial bone fractures, 96 (39.7%) patients had a combination of facial fractures and cranial injuries. Gender predilection was demonstrated to favor males: the ratio was 3:1. The mean age was 36.51+/-19.63. As to the injury mechanism, traffic accidents (in car, out of car, motorcycle) were statistically significant in the group of facial fractures with cranial injury (p=0.038, p=0.000, p=0.003). The ISS was significant, but alcohol intake was not significant. No significant relationship between facial fractures and skull fractures was found. Only maxilla fractures, zygoma fractures, and cerebral concussion had a significant difference in cranial injury (p=0.039, p=0.025). CONCLUSION: There is a no correlation between facial fractures and skull fractures, which suggests that the cushion effect is the predominent relationship between facial fractures and cranial injuries.

Zygomatic fracture at Siriraj Hospital.

A prospective study was made of patients with zygomatic bone fracture at Siriraj Hospital from January 1st, 1995 to December 31st, 2000 to evaluate their etiology, type of fracture, complications of fracture, operative techniques used and the results of treatment. Out of 2127 cases that presented to the Facial Fracture Clinic, Division of Trauma Surgery, Department of Surgery during this period, there were 431 cases of fractured zygoma. Most of the cases, which were more common in males, were caused by traffic accidents. The peak age-incidence was 21-30 years old and the most common type of fracture was trimalar. Common complications of fracture were sensory impairment, limitation of opening the mouth and diplopia. In order to reduce the fractures, a Gillies' approach was used in 210 cases, an infraorbital approach in 203 cases, Dingman's approach in 87 cases and a Gingivo buccal approach in 20 cases and applied internal fixation in 216 cases. The floor of the orbit was repaired in 36 cases. The post-operative wound infection rate was 1.1%. The authors conclude that zygomatic fracture is a common facial fracture caused by traffic accidents. Open reduction with or without internal fixation by a variety of approaches provides good functional and cosmetic results with very few complications.

Radiological analysis of maxillary sinus density changes after mid-facial fractures / 实用口腔医学杂志

Objective:To evaluate the changes of maxillary sinus density after mid-facial fractures.Methods: A retrospective review was performed on patients with mid-facial fractures from 1995 to 2006.The changes of maxillary sinus density were evaluated by Water's view.Results: There were 219 cases,including 165 male and 54 female patients,who showed changes of maxillary sinus density on Water's view.Their ages ranged from 3 to 78 years.78 cases had follow-up plain radiograph.Among them,51 cases had normal maxillary sinus density,the density of sinuses of 19 cases became lower and the density of sinuses of 8 cases did not change or became higher.Conclusion: The maxillary sinusitis is a late complication and develops in some maxillary sinus after treatment of mid-facial fractures.Attention to the maxillary sinus density should be paied when following-up.

Optic Nerve Injury Associated with Facial Trauma

The traumatic optic neuropathy occurs in 0.5 to 5% of closed head trauma cases. Because it may cause permanent blindness, the early diagnosis and proper treatment are very important. We have treated 6 traumatic optic neuropathy patients among 433 head trauma cases from Sep, 1997 to Aug, 1998. Four patients showed visual recovery with steroid therapy. The diagnosis can be made clinically when the patient suffers from acutely decreased vision, Marcus-Gunn pupil, with its relatively normal fundoscopic finding, is considered as the most sensitive indicator and the first herald of visual tract injury, even though visual acuity is normal at the initial stage. The megadose steroid therapy must be diagnosed for the recovery of incompletely injured axons rather than regeneration. The optic canal decompression surgery must be spared for the delayed onset optic neuropathy patients who do not respond to the steroid therapy. In a case of indirect optic neuropathy, the associated orbital fracture reduction should not be undertaken until the optic neuropathy has stabilized. But severely displaced blow-in fracture of the orbit that decreases orbital volume should repaired early for orbital decompression.