Removal of Foreign Body in the Rafe Pterigomandibular: Case Report / Remoção de Corpo Estranho Alojado na Rafe Pterigomandibular: Relato de Caso

Introduction: Penetrating lesions in the oral cavity, caused by foreign bodies, is an event of significant clinical relevance and presents itself as an important etiological factor, especially in pediatric patients. Several objects are related to this type of trauma, such as knife blades, nails, pencils, wood, firearm projectile, and glass, among others. Case Report: This report describes a case of removal of a pencil lodged in the left pterygomandibular raphe of a pediatric patient, as well as all the conduct adopted by the team of surgeons. Discussion: Pterygomandibular raphe has an intimate relationship with noble structures, and injuries by penetrating instruments in this region can result in important clinical repercussions. Due to this, it is necessary to have an efficient clinical-anamnesis examination, with adequate analysis of the affected structures, in order to provide a fast and effective treatment. Conclusion: For this, it is essential to have qualified professionals, adequate equipment available, and the proper management of the victim.

Introdução: As lesões penetrantes em cavidade oral, ocasionadas por corpos estranhos, é um evento de relevância clínica significativa e se apresenta como um importante fator etiológico, principalmente, em pacientes pediátricos. Diversos objetos estão relacionados a esse tipo de trauma, como lâmina de faca, prego, lápis, madeira, projétil de arma de fogo, vidro, entre outros. Relato de Caso: Este relato descreve um caso de remoção de um lápis alojado na rafe pterigomandibular esquerda de um paciente pediátrico, assim como toda a conduta adotada pela equipe de cirurgiões. Discussão: A rafe pterigomandibular possui uma íntima relação com estruturas nobres e as lesões por instrumentos penetrantes nessa região podem acarretar uma repercussão clínica importante. Devido a isso, se faz necessário, um exame clínico-anamnese eficiente, com análise adequada das estruturas acometidas, para assim fornecer um tratamento rápido e eficaz. Conclusão: Para isso, é fundamental profissionais qualificados, equipamentos adequados disponíveis e o manejo adequado da vítima.

Anterior segment reconstruction and secondary posterior chamber intraocular lens implantation supported by fibromembrane / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the methods and effects of secondary intraocular lens implantation based on proliferative membrane in anterior segment reconstruction.<p>METHODS: Totally 156 eyes with penetrating injury had varying degrees of anterior segment disorders which had secondary intraocular lens implantation based on proliferative membrane to anterior segment reconstruction. Including partial penetrating keratoplasty, front-adhesion release, iris root suture, post-adhesion release, pupillary plasty, hole making in pupil area proliferative membrane and secondary intraocular lens implantation based on proliferative membrane. All patients were followed up 3-18mo.<p>RESULTS: The surgeries were successful in all patients. The corrected visual acuity of 123 eyes(78.8%)were ≥0.5, 17 eyes(10.9%)were ≥0.8 and 33 eyes(21.2%)were ≤0.4. Postoperative intraocular lens position was 133 eyes(85.3%), intraocular lens slightly off the center of 23 eyes(14.7%). Anterior chamber hemorrhage occurred in 8 eyes, 6 of them were recovered by conservative treatment and the blood membrane in another 2 eyes were sucked out through primary incision, and 5 cases of corneal plaque dense in the center of the cornea are partially penetrating keratoplasty. After 2mo, a rejection reaction occurs, which is cured by conservative treatment. All patients had slight postoperative inflammation and without severe long-term complications.<p>CONCLUSION: Reconstruction of the anterior segment of the eye, proliferative membrane can support the intraocular lens at the pre-implantation of the intraocular lens, without the need for suture fixation, thus avoiding various complications due to sutures.

Manejo del trauma penetrante de cuello en dos hospitales de Bogotá, Colombia / Management of penetrating neck trauma at two hospitals in Bogotá, Colombia

Introducción. El manejo del trauma penetrante de cuello en pacientes estables, según la zona de Monson lesionada, orienta la solicitud de pruebas diagnósticas para identificar lesiones vasculares, de las vías aéreas y del tubo digestivo. Materiales y métodos. Se trata de un estudio observacional, descriptivo y retrospectivo. Se incluyeron pacientes de 15 años o más con trauma penetrante de cuello, que consultaron a los dos hospitales de la Sociedad de Cirugía de Bogotá en un periodo de cinco a seis años. Se recolectó la información demográfica, clínica y de las pruebas diagnósticas practicadas, para determinar su utilidad. Las variables cualitativas se describieron con frecuencias relativas y absolutas, y las cuantitativas, con medias y desviaciones estándar. Resultados. Inicialmente, se incluyeron 148 pacientes, de los cuales 133 fueron catalogados como estables durante la valoración primaria, con un promedio de edad de 33,04 años (desviación estándar, DE=12,9); la mayoría (88,7 %) eran hombres. La mediana de la estancia hospitalaria fue de dos días (rango intercuartílico, RIQ=1-4 días). En la mayoría (117; 87,9 %) de los casos, la herida fue causada con arma cortopunzante. En casi todas las pruebas diagnósticas, se reportaron pocos hallazgos anormales, a excepción de la angiotomografía (angio-TC) que se practicó en 59 pacientes y demostró 43 resultados anormales. Se decidió tratamiento quirúrgico en siete pacientes catalogados como estables al ingreso y, en 14, por resultados anormales de las pruebas diagnósticas. Se presentaron cinco fallecimientos. Conclusión. El examen físico, la observación clínica y la angio-TC son suficientes para identificar lesiones vasculares, de la vía aérea o del tubo digestivo en los pacientes con trauma penetrante de cuello, en hospitales que no son considerados como especializados en trauma

Introduction: Management of penetrating neck trauma in stable patients according to the affected Monson zone directs the diagnostic tests to identify vascular, airway and digestive tract lesions. Materials and methods: A retrospective descriptive observational study was conducted. We included 15 year-old or older patients with penetrating neck trauma that consulted at the two hospitals of the Sociedad de Cirugía in Bogotá, Colombia, during a 5 to 6 year period. Demographic and clinical information was collected, as well as the results of the diagnostic tests applied in order to determine their utility. Qualitative variables were described with relative and absolute frequencies and quantitative variables with median and standard deviations. Results: 148 patients were enrolled initially, of which 133 were classified as stable during the primary assessment, with an average age of 33.04 years (SD: 12.9), the majority being men (88.7%). The median hospital stay was 2 days (IQR=1-4 days). The most frequent wound mechanism was a sharp bladed weapon in 117 cases (87.9%). A low proportion of abnormal findings were reported in the diagnostic tests, except for angiography CT which was performed in 59 patients with 43 with abnormal findings. Surgical management was defined for 7 patients classified as stable at admission and for 14 patients after abnormal findings found in the diagnostic tests. Five deaths were registered. Conclusion: Physical examination, clinical observation and angiography CT are sufficient to identify vascular, airway and digestive lesions in patients with penetrating neck trauma at hospitals that are not considered specialized in trauma

Pattern of Chest Injuries in a Tertiary Care Centre in Western U.P.

Background: Chest trauma is a leading cause of morbidity and mortality among all age groups.. This retrospective study has been undertaken to analyse the pattern of chest injuries among patients admitted in a tertiary care centre. Methods: All the in-patient records of patients, admitted with abdominal injuries in the emergency department of the Teerthankar Mahaveer Medical College & Research Centre, located in Moradabad (U.P.). Results: There were total 139 cases of chest injuries, during the study period. 84 victims were in 2nd to 4th decades of life, 18 in 5th decade, 8 in 1st decade and the remaining 19 patients were in either extremes of age groups. The male to female ratio was 2.4:1. There were 111 cases of blunt chest injuries and 28 cases of penetrating injuries. Most common X ray findings were haemothorax, seen in 94 cases followed by pneumothorax in 59 cases and multiple rib fractures in 50 cases. Blunt injuries were caused due to accidents in 102 cases and homicides in 9 cases. Penetrating injuries were caused due to accidents in 15 cases and homicides in 13. The mortality rate was 6.4%. Conclusion: Chest Injuries were more common among males than females.

Pattern of Abdominal Injuries in A Tertiary Care Centre in Western U.P.

Background: Abdominal trauma is a leading cause of morbidity and mortality among all age groups. This retrospective study has been undertaken to analyse the pattern of abdominal injuries among patients admitted in a tertiary care centre. Methods: All the in-patient records of patients, admitted with abdominal injuries in the emergency department of the Teerthankar Mahaveer Medical College & Research Centre, located in Moradabad (U.P.) during the one year period from 1st December 2011 to 30th November 2012, were analysed. Results: There were total 87 cases of abdominal injuries, during the study period. 51 victims were in 2nd to 4th decades of life, 12 in 5th decade, 11 in 1st decade and the remaining 12 patients were in either extremes of age groups. The male to female ratio was 3.3:1. There were 61 cases of blunt abdominal injuries and 26 cases of penetrating injuries. Most commonly injured viscus in blunt trauma was bowel, and in cases of penetrating injuries, spleen. Blunt injuries were caused due to accidents in 57 cases and homicides in 4 cases. Penetrating injuries were also most commonly caused due to accidents in 16 cases and homicides in 10 the mortality rate was 4.6%. Conclusion: Abdominal Injuries were more common among males than females.

Fatores associados ao óbito e à reposição volêmica em pacientes com trauma por lesões penetrantes / Factors associated with death or volume replacement in patients with trauma due to penetrating injuries

Objective: to evaluate the prognostic factors of volume replacement in patients with trauma due to penetrating injuries. Methods: retrospective cohort study whose data were obtained by analyzing medical records of 544 patients who were admitted to the emergency unit, victims of penetrating trauma. Results: among the victims, 282 (51.9%) suffered stab wound, 262 (48.2%) injury by firearms, 486 (89.3%) were male, 382 (70.2%) were aged between 14 and 30 years. Most who received volume greater than 2000ml, systolic blood pressure ≤90mmHg and mean arterial pressure ≤65mmHg presented more mortality, with p <0.05, p <0.002 and p <0.003, respectively. Conclusion: the limited volume replacement can help in the good prognosis of victims of penetrating trauma.

Avaliar os fatores prognósticos da reposição volêmica em pacientes com trauma por lesões penetrantes. Métodos: estudo de coorte retrospectiva cujos dados foram obtidos através da análise de prontuários de 544 pacientes que deram entrada no serviço de emergência, vítimas de traumatismo penetrante. Resultados: dentre as vítimas, 282 (51,9%) sofreram ferimento por arma branca, 262 (48,2%) ferimento por arma de fogo, 486 (89,3%) eram do sexo masculino, com idade entre 14 e 30 anos 382 (70,2%). A maioria que recebeu fluído maior que 2000ml, pressão arterial sistólica ≤90mmHg e pressão arterial média ≤65mmHg, apresentou mais mortalidade, com valor de p<0,05, p<0,002 e p<0,003, respectivamente. Conclusão: a reposição volêmica limitada pode auxiliar no bom prognóstico do paciente vítima de trauma penetrante.

Multiple glass pieces in paranasal sinuses.

Here, a case has been reported of a road traffic accident with multiple glass pieces arranged in an unusual pattern in the left maxillary sinus, ethmoid sinus, nasopharynx and medial side of the orbit, as seen in the radiographs. Combined surgical approach through the existing wound and endoscopic surgery was successfully used to remove nearly all the glass pieces.

Penetrating Injuries by Foreign Body in the Head and Neck Region

Clinical Evaluations of Penetration Ocular Injuries

The authors retrospectively analyzed 188 eyes of 188 patients with penetrating ocular injuries who visited Seoul National University Hospital and Kim's Eye Clinic from 1986 to 1989. Clinical pictures of injuries and factors influencing visual outcome were evaluated. The patients were mostly male (93.0%) and in third decade were 42.0%, and second and fourth decades was 17.0% respectively. Industrial injuries (70.0%) was the most common type of injury and among the vectors of injuries, sharp objects (83.0%) were more commonly found than blunt objects (17.0%). The sites of injury were in cornea, sclera, corneosclera and among them the cornea was most frequently involved (61.2%). Lens damage (51.6%), hyphema (38.4%), intraocular foreign body (34.6%) were most commonly associated. 60.9% of patients underwent operation within first 24 hours. Primary closures (67.6%) were the leading procedures among the operations. Postoperative visual acuity was better in corneal laceration, anterior segment injury, and injury by sharp objects than in corneoscleral or scleral laceration, posterior segment injury, injury due to blunt trauma. Complications included corneal opacity (55.3%), cataract (11.2%), retinal degeneration (11.2%), vitreous opacity (7.4%), retinal detachment (5.3%), secondary glucoma (2.1 %), endophthalmitis, phthisis, preretinal membrane (1.6%).