Hemi Le Fort III Fracture with Subdural and Subarachnoid Pneumocephalus with a Mild Mount Fuji Sign

ABSTRACT: Extensive fractures in the fixed facial skeleton combined with traumatic brain injury can cause functional and esthetic impairments, possibly threatening the patient's life. Male patient, 50-year-old, victim of physical aggression, presented with persistent headache and dizziness, fractures in the naso-orbito-ethmoidal, zygomatic-maxillary and right pterygoid process regions, among other minor patterns of facial fracture, with mobility to maxillary traction of the third midface unilaterally. Clinical-imaging findings revealed a Hemi Le Fort III fracture and subdural and subarachnoid pneumocephalus with a mild Mount Fuji Sign. The proposed treatment was facial osteosynthesis and conservative intravenous drug treatment of the pneumocephalus. The patient had a good recovery, with no postoperative motor or functional deficits. The correct management of the patient with facial trauma associated with craniotrauma offers benefits, restoring stability of facial architecture and preventing or correcting neurosurgical complications.

RESUMEN: Las fracturas extensas en el esqueleto facial combinadas con una lesión cerebral traumática pueden causar deficiencias funcionales y estéticas, que posiblemente pongan en peligro la vida del paciente. Paciente de sexo masculino, 50 años, víctima de agresión física, que presentó cefalea persistente y mareos, fracturas en las regiones naso-orbito-etmoidal, cigomático-maxilar y pterigoides derecha, entre otros patrones menores de fractura facial, con movilidad a tracción maxilar del tercio medio facial unilateralmente. Los hallazgos de las imágenes clínicas revelaron una hemifractura de Le Fort III y neumocefalia subdural y subaracnoidea con un leve signo del Monte Fuji. El tratamiento propuesto fue la osteosíntesis facial y el tratamiento farmacológico intravenoso conservador de la neumocefalia. El paciente tuvo una buena recuperación, sin déficit motor ni funcionales postoperatorios. El manejo adecuado del paciente con trauma facial asociado a craneotrauma ofrece beneficios, devolviendo la estabilidad de la arquitectura facial y previniendo o complicaciones neuroquirúrgicas.

Use of Vacuum-suction in Depressed Skull Fractures ­ Case Report and Technical Nuances of Nonoperative Treatment

Up to 20% of victims from skull fractures are represented by the pediatric population, and 50% of these lesions are depressed skull fractures. The treatment is multimodal in nature, ranging from conservative treatment to open surgical repair. The last one is associated, although in a small proportion, to complications, such as infections, hematomas and even death, besides the risks of the anesthetic procedure itself. The authors of the present article present a case report of the successful treatment of a depressed skull fracture in a newborn patient, using the vacuum-suction technique. The use of vacuum-suction may be beneficial for the pediatric patients, as it is a quick, non-invasive procedure, without the need for general anesthesia.

Enfoque terapéutico para la fractura atípica de Le Fort I / Therapeutic approach to atypical Le Fort I fracture

ABSTRACT Objective: Describe the clinical management of an atypical Le Fort I fracture case. Case presentation: A 33-year-old patient was brought to the Surgical and Maxillofacial Traumatology Service of Humberto Lucena Senatorial Emergency and Trauma Hospital in Joao Pessoa (PB), Brazil, after undergoing physical aggression. The patient was conscious and lucid. Clinical examination revealed sinking of the middle third of the face with edema and bilateral periorbital ecchymosis. Visual acuity and ocular motricity were preserved in both eyes. A cut-contusion injury on the upper lip, maxillary mobility when handled and discrete occlusal dystopia were also observed. Imaging examination identified a high bilateral Le Fort I fracture. The therapeutic approach chosen was fracture reduction and fixation with plates and screws. After a period of two months, the patient is healing well without any apparent functional or aesthetic alteration. Conclusions: Atypical Le Fort I fractures are not frequent; however, a number of etiologies besides the impact force may bring about them. Treatment should be based on the one for classical Le Fort I fractures with adjustments to the surgical access approach(AU)

RESUMEN Objetivo: Describir los manejos clínicos realizados en una víctima de fractura de Le Fort I atípica. Reporte de caso: Un hombre de 33 años fue llevado al Servicio de Traumatología Quirúrgica y Maxilofacial del Hospital de Trauma y Emergencias Senatorial Humberto Lucena - Joao Pessoa (PB), Brasil, víctima de agresión física. El paciente estaba consciente y lúcido. Clínicamente, se observó hundimiento del tercio medio de su cara con edema y equimosis periorbital bilateral. La agudeza visual y la motricidad ocular se conservaron en ambos ojos. También se observaron herida constuso-cortante en el labio superior, movilidad maxilar cuando se manipula y discreta distopia oclusal. El examen de imagen identificó una fractura bilateral alta de Le Fort I. El enfoque terapéutico elegido fue la reducción de la fractura y la fijación con placas y tornillos. Después de un período de 2 meses, el paciente está evolucionando bien sin aparentes alteraciones funcionales o estéticas. Conclusiones: las fracturas atípicas de Le Fort I no son frecuentes, sin embargo, diferentes etiologías añadidas a la fuerza de impacto pueden justificarlas. El tratamiento debe basarse en las fracturas clásicas de Le Fort I con ajustes en el abordaje de acceso quirúrgico(AU)

Middle meningeal vein dural arteriovenous fistula: A report of nine cases and literature review / 第二军医大学学报

Objective To summarize the clinical symptoms, imaging features and endovascular treatment outcomes of the middle meningeal vein dural arteriovenous fistula (MMV-DAVF). Methods The data of nine MMV-DAVF patients admitted to our hospital from Jan. 1999 to Apr. 2020 were retrospectively collected. A total of 16 Chinese and English articles, including 23 cases of MMV-DAVF, were retrieved from the database between Jan. 1, 1960 and Aug. 30, 2020. The clinical symptoms, imaging features and endovascular treatment outcomes were analyzed. Results Of the nine MMV-DAVF patients in our hospital, seven patients had a clear history of head trauma. Headache (five cases) and intracranial murmur (five cases) were the most common clinical symptoms. Six patients had computed tomography (CT) data, and four of them had skull fracture and five had intracranial hemorrhage. All the nine patients were drained from the middle meningeal vein (MMV) to adjacent venous sinus or venous plexus. The nine patients were treated with Onyx-18 glue endovascular intervention via middle meningeal artery (MMA) approach, and seven patients had complete embolization immediately after operation and two had subtotal embolization. No recurrence or new onset of DAVF was found in four patients having CT data half a year after operation. Among the 32 patients from our hospital and literatures, 26 patients (81.2%) had a clear history of head trauma, 16 patients (50.0%) suffered from headache, and 12 patients (37.5%) suffered from intracranial murmur. Twenty-five patients had CT data, including 21 patients (84.0%) with skull fracture, 16 patients (64.0%) with intracranial hematoma. Twenty patients (62.5%) were treated with endovascular interventional therapy via MMA approach, and 16 patients (80.0%) had complete embolization immediately after operation. Among them, seven cases had imaging follow-up data half a year after operation, and no recurrence or new onset of DAVF was found. Conclusion MMV-DAVF is rare, and many patients have head trauma history combined with skull fracture or intracranial hematoma. Endovascular embolization via MMA approach is safe and effective in treating MMV-DAVF.

Restoration of the Fronto-Orbital Buttress with Primary Bone Fragments / 대한신경손상학회지

OBJECTIVE: Forehead deformities are often caused by lack of treatment or incorrect restoration of the frontal buttress, so the underlying frontal buttress should be restored to its previous position to ensure that the previous forehead contour is restored in cases of complex depressed skull fractures. However, since brain injuries from skull fractures could have fatal consequences, the clinical concern in primary surgery has been to save the patient's life, and cosmetic concerns have always been secondary. We retrospectively reviewed fronto-orbital fracture patients who underwent primary restoration with primary bone fragments or an alloplastic implant and compared the surgical outcomes of autologous bone (group 1) and artificial materials (group 2). METHODS: A retrospective review was conducted of 47 patients with fronto-orbital fractures between March 2012 and January 2018. The patients underwent primary reconstruction with primary bone fragments or an alloplastic implant. The surgical results were evaluated by the incidence of infection and cosmetic satisfaction of patients. RESULTS: Infections occurred in one patient (5%) in group 1 and in two patients (15.3%) in group 2, which was not a statistically significant difference. In contrast, at 6 months after surgery, patient satisfaction showed a statistically significant between-group difference (group 1: 4.32 points, group 2: 3.54 points, p=0.001). CONCLUSION: Primary reconstruction using fractured bone fragments is an effective and preferable method that could result in better surgical outcomes than restoration using an alloplastic implant.

Factors affecting outcomes in compound depressed frontal bone fractures: Institutional study

xIntroduction: Compound depressed frontal bone fractures exhibits some peculiarities such as frequent involvement of frontal sinus and olfactory nerve and tract, which lie on the floor of the anterior cranial fossa. The primary aim of our study is analyzing factors influencing the outcomes in compound depressed fractures of frontal bone .This will help in improving outcomes and management of compound depressed frontal bone fracture. Material and methods: Study was conducted at tertiary care institute by collecting data of 40 patients operated surgically from August 2018 to July 2019. The study included patients who were diagnosed with compound depressed frontal bone fracture and underwent surgical management at our institute. Follow-up was performed at least 3 months after the trauma. The variables evaluated were mortality, GOS, occurrence of rhinorrhea, meningitis, late post-traumatic epilepsy and smell disturbances. Results: Most of our patient with GCS 13-15 was discharged with good clinical outcome and no complication on follow-up. Patient with low GCS and delayed presentation are at risk and adds up morbidity and mortality. Conclusion: Early surgical intervention in patients with GCS 13-15 is associated with good outcomes and low complication rate associated with meningitis or CSF leak.

Death due to fracture of thin calvarial bones after a fall: A forensic approach / 中华创伤杂志(英文版)

A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature.

Clinical Features and Outcomes of Bilateral Decompression Surgery for Immediate Contralateral Hematoma after Craniectomy Following Acute Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Immediate contralateral epidural hematoma (EDH) and traumatic intracerebral hematoma (T-ICH) after craniectomy for traumatic subdural hematoma (SDH) are rare but devastating post-operative complications. Their clinical features and outcomes are not well studied. In this report, we present the clinical features and outcomes of immediate contralateral acute hematoma cases requiring a second operation. METHODS: This study includes 10 cases of immediate contralateral EDH and T-ICH following bilateral craniectomy for the evacuation of traumatic SDH and contralateral hematoma between 2004 and 2015. Their medical records and radiographic findings were reviewed and analyzed retrospectively. RESULTS: Ten of the 528 patients (1.89%) who underwent craniectomy for the evacuation of traumatic SDH developed post-operative EDH (n=5), T-ICH (n=5). The trauma was caused by a fall in 5 patients and by a traffic accident in 5 patients. The patients who suffered trauma due to pedestrian accidents died. Seven patients had a low admission Glasgow Coma Scale (GCS; GCS≤8) score in the preoperative state (average admission GCS, 7.7; average discharge GCS, 3.4; and average discharge Glasgow Outcome Scale, 2.0). Severe intra-operative brain swelling was noted in all patients, while skull fracture was observed in 8. Multiple associated injuries and medication for heart disease were characteristic of patients who died. CONCLUSION: The prognosis of delayed contralateral hematoma was very poor. Multiple associated injuries, past medical history and traffic accidents, especially pedestrians were seemed to be associated with higher mortality rates. Finally, contralateral skull fractures can indicate high risk of delayed contralateral acute intracranial hematoma.

Reduction of Closed Frontal Sinus Fractures through Suprabrow Approach

BACKGROUND: The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. METHODS: From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. RESULTS: Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. CONCLUSION: The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.

Profile of Hospitalizations and Deaths from Craniofacial Fractures in Brazilian Children and Adolescents: An Ecological Study

Objective: To characterize the profile of hospitalizations and deaths related to craniofacial fractures in Brazilian children and adolescents. Material and Methods: This is an ecological cross-sectional study with inductive approach with comparative-descriptive procedure and indirect documentation technique. Data were obtained from the DATASUS / SIH-SUS website for the years 2010-2014, considering information for each state of the five Brazilian regions. Admission rates were calculated per 100,000 inhabitants, and data were analyzed by population rates, averages and absolute and relative frequencies. Results: The Northeastern region of Brazil showed the highest hospitalization rate (81.72), followed by the Northern (56.84), Southern (50.94), Midwestern (44.25) and Southeastern regions (30.28). In all regions, the years with the highest hospitalization rates were: 2010 for the Northern (13.17) and Southeastern regions (6.61), 2013 for the Northeastern (20.07) and Midwestern regions (10.17) and 2014 for the Southerner region (10.52). The highest hospitalization rates in all regions of the country in the last five years were observed for male children and adolescent. In relation to age group, higher rates were recorded from 15 to 19 years. Of the total of 27,244 hospitalizations (3.8%), 1028 patients died and 35.5% of them occurred in the Northeastern region. Considering the years under study, the average length of stay and average daily hospitalization cost were respectively 4.0 days and US$ 82.7. Conclusion: The Northeast region of Brazil had the highest hospitalization rate of children and adolescents by craniofacial fractures, and male adolescents and those aged 15-19 years were the most affected in different regions of the country. Costs of hospital admissions due to this type of injury are significant, with more deaths as a result of these injuries in Brazil in the last 5 years evaluated with the highest prevalence in the Northeastern region of Brazil.

Traumatic Dural Venous Sinus Injury / 대한신경손상학회지

OBJECTIVE: The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. METHODS: We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. RESULTS: Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. CONCLUSION: When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.

Bi-Coronal Separated Skull Fracture: A Unique and Fatal Type of Traumatic Head Injury in Infancy: A Case Report / 대한신경손상학회지

The infantile skull is malleable, and its sutures are tightly adhering to the underlying dura and venous sinus. These characteristics, in association with the small amount of total blood volume, can result in a specific fatal type of skull fracture, which is unique to infancy. The authors report a case of this injury, and stress the need to pay attention to the possibility of massive bleeding during operation in infants. A 23-month-old female baby presented with semicomatose mentality after sustaining injuries by falling from a second-floor. Plain skull films showed bi-frontal skull fracture crossing the midline. Computed tomography revealed an acute subdural hematoma along the right convexity with severe brain edema. In the emergency operation, the scalp incision exposed massive bleeding from the fracture site. The bleeding was identified as arising from the lacerated and widely separated sagittal sinus beneath the fracture. The patient entered hypovolemic shock immediately after the scalp incision, and died from severe brain edema two days after the trauma and surgery. This case implies that special care should be paid during the operation of patients that have skull fracture overlying the venous sinus, especially when the fracture line is separated.

Fratura evolutiva de crânio na infância ? Relato de cinco casos e revisão de literatura / Growing skull fracture of childhood ? Report of five cases and literature review

A fratura evolutiva é uma rara complicação que se observa geralmente na infância. Caracteriza-se por afastamento progressivo das bordas das fraturas, às vezes associado à formação de um cisto leptomeníngeo, também conhecido como cisto leptomeníngeo pós-traumático. De acordo com a literatura internacional, sua prevalência varia entre 0,03% e 1,6%. Analisamos a casuística de pacientes internados com traumatismo cranioencefálico no Hospital da Restauração de Recife (Brasil), um centro de referência em neurocirurgia pediátrica, no período de 1° de dezembro de 2000 a 30 de abril de 2008. O grupo de estudo compreendeu crianças de 0 a 14 anos. Durante essa investigação foram realizadas 19.758 admissões na emergência pediátrica por traumatismo cranioencefálico, e 74% foram admitidos da área metropolitana e 26% do interior do estado de Pernambuco. Foi observada fratura craniana em 6,3% dos casos, dos quais cinco crianças (menores de 3 anos) desenvolveram fratura evolutiva, representando 0,4% das fraturas de crânio e 0,02% dos traumatismos cranioencefálicos admitidos. Foi achada em todos os casos uma massa pulsátil, que apareceu em média no quarto mês após o trauma. As cinco crianças foram submetidas a tratamento cirúrgico, que compreendeu a ressecção do cisto leptomeníngeo e do tecido cerebral herniado, reparo do defeito dural e cranioplastia. A nossa experiência e a revisão bibliográfica mostram que crianças menores de 3 anos com história de traumatismo cranioencefálico e fratura de crânio apresentam risco de desenvolver fratura evolutiva. No entanto, sendo uma condição rara crianças com fratura de crânio menores de 3 anos, é obrigatório o acompanhamento clínico. Quando diagnosticado, o tratamento cirúrgico imediato é indicado para prevenir déficit neurológico.

Growing fracture is a rare complication that usually is observed in childhood. It is characterized by a progressive opening from the edges of fractures, sometimes associated with the formation of leptomeningeal cyst, also known as post-traumatic leptomeningeal cyst. According to the literature, its prevalence ranges from 0.03% to 1.6%. We analyzed a casuistic of patients hospitalized with head trauma at the Hospital da Restauração of Recife (Brazil), a referral center for pediatric neurosurgery, in the period from December 1st 2000 to April 30th, 2008. The study group consisted of children aged 0 to 14 years. During this research, were analyzed 19,758 emergency admissions for pediatric traumatic brain injury, which 74% were admitted to the metropolitan area and 26% were from the countryside, in the state of Pernambuco. Skull fracture was observed in 6.3% of cases, including 5 children under 3 years old, who developed growing fracture, constituting 0.4% of skull fractures and 0.02% of traumatic brain injury admitted. In all cases, it was found a pulsating mass that appeared in an average time in the 4th month after the trauma. The five children were submitted to surgical resection of the leptomeningeal cyst and of the herniated brain tissue, repair of dural defect and cranioplasty. Our experience and review of the literature show that children under 3 years old, with a history of traumatic brain injury and skull fracture, present at risk of developing a growing fracture. Even though, it is a rare condition, a clinical follow-up is mandatory for these children. When the growing fracture is diagnosed, an immediate surgical treatment is indicated to prevent neurologic deficit.

Perfil das Internações de Crianças eAdolescentes com Fraturas do Crânio e Ossos da Face na Região Nordeste do Brasil / Profile of Hospitalization of Children and Adolescents with Fractures of the Skull and Facial Bones in Northeastern Brazil

Analisar o perfil das internações de crianças eadolescentes com fraturas do crânio e ossos da face naregião Nordeste, Brasil, no período de 2008 a 2010. Materiale Métodos: Utilizou-se uma abordagem indutiva comprocedimento comparativo-descritivo e técnica dedocumentação indireta. Os dados foram obtidos medianteconsulta aos sítios do DATASUS para os anos de 2008 a2010, nas faixas etárias de 0 a 19 anos, considerando asinformações disponíveis para cada estado da regiãonordeste, sendo analisados descritivamente por meio defrequências absolutas e percentuais. Resultados: No anode 2008, obteve-se um valor total de 1.418 notificações, commaior prevalência do gênero masculino (77,36%) e faixaetária mais acometida a de 15 a 19 anos, sendo a Bahia oestado com número mais expressivo de internações (n=274;17,42%). No ano de 2010, foram registradas 1.352internações, evidenciando-se maior envolvimento do gêneromasculino (79,66%) e da faixa etária de 15 a 19 anos,constatando-se que o Ceará apresentou valores maiselevados de internação (n=301; 22,26%). Conclusão: Houveuma maior ocorrência de fraturas em indivíduos do sexomasculino e a faixa etária mais acometida foi a de 15 a 19anos. Os estados da Bahia e do Ceará apresentaram o maiornúmero de internações, já os estados de Sergipe e doMaranhão foram os menos acometidos no período estudado...

To analyze the profile of hospitalization of childrenand adolescents with fractures of the skull and facial bonesin the Northeastern Brazil from 2008 to 2010. Material andMethods: We used an inductive approach with descriptivestatisticalprocedure and technique of indirect documentation.Data were obtained by consulting the DATASUS websitesfor the years 2008 to 2010, in the age group 0-19 years.Results: In 2008, we obtained a total of 1,418 notifications,with higher prevalence in males (77.36%); the most affectedage group was 15-19 years, and the state of Bahia had themost significant number of hospitalizations (n = 274; 17.42%).In 2010, there were 1,352 admissions, with greaterinvolvement of males (79.66%) aged 15 to 19 years, and thestate of Ceará showed significantly higher hospitalizationrates (n = 301, 22.26%). Conclusion: There was a higherincidence of fractures in males and the most affected agegroup was 15-19 years. The states of Bahia and Ceará hadthe largest number of admissions and the states of Maranhãoand Sergipe were the least affected in the studied period...

Comportamiento de las fracturas maxilofaciales atendidas en el Hospital Universitario de Maabar, República de Yemen / Behavior of the maxillofacial fractures in the Maabar's University Hospital, Yemen Republic

Introducción: las fracturas maxilofaciales constituyen más del 50 porciento del total de fracturas, y en muchas ocasiones están asociadas a otras fracturas del cuerpo humano. Objetivos: estudiar el comportamiento de estas lesiones en el Hospital Universitario de Maabar, de la Universidad de Thamar (Yemen), determinar su relación con la edad, sexo, etiología y localización, y compararlo con los resultados de otros estudios realizados en Cuba y en otros países. Métodos: se realizó un estudio estadístico descriptivo retrospectivo de las fracturas maxilofaciales atendidas por la brigada de profesores cubanos en este hospital entre los años 2006 y 2009. Las variables estudiadas fueron: sexo, edad, causa de la fractura y región afectada, así como el tipo de fractura y los traumatismos asociados. Resultados: el sexo masculino fue mucho más afectado que el femenino. Los accidentes del tránsito fueron la causa más común (más del 50 por ciento de los casos). La fractura nasal fue la más frecuente, y en más de 150 casos se detectaron traumatismos asociados, muchos muy graves, como fracturas de cráneo, de miembros y heridas de partes blandas. Conclusiones: se confirman los resultados que el sexo masculino es el más afectado, y que los accidentes del tránsito son la principal causa de fracturas en la cara. La fractura nasal es la más frecuente de todas las de los huesos faciales (más del 50 por ciento de los casos), pero otros registran la mandíbula o la región zigomática como la zona más frecuente. Impresionaron las fracturas mandibulares en niños, lo cual no es frecuente en Cuba(AU)

Introduction: the maxillofacial fractures account for more than the 50 percent of the total of fractures and often are associated with other fractures of the human body. Objectives: to study the behavior of these lesions in patients from the Maabar's University Hospital of the Thamar's University (Yemen), to determine its relation to age, sex, etiology and location and to compare it with the results of other studies conducted in Cuba and other countries. Methods: a retrospective, descriptive and statistic study was conducted on the maxillofacial fractures seen by the Cuban professor brigade in this hospital between 2006 and 2009. The study variables were: sex, age, cause of the fracture and involved region, as well as the type of fracture and associated traumata. Results: the male sex was more involved that the female one. The road accidents were the commonest cause (more than the 50 percent of cases). The nose fracture was the more frequent and in more than of 150 cases there were associated traumata much of them very severe including skull fracture, of extremities and soft tissue wounds. Conclusions: the results confirm that the male sex is the more involved one and that the road accidents are the leading cause of face fractures. The nose fracture is the more frequent of all that of facial bones (more than 50 percent of cases), but others register the mandible or the zygomatic region as the more frequent involved zone. The mandibular fractures were impressive in children, something not frequent in Cuba(AU)

Original research paper patterns of head injuries in fatal road traffic accidents in a rural district of Maharashtra- autopsy based study.

Road traffic accidents are the major causes of death worldwide. Head injury is the single most common cause of mortality in road traffic accidents; head being the most vulnerable part of the body. The present study was undertaken on 138 victims of road traffic accidents, died due to head injury to find out the patterns of head injuries, their age and sex distribution and site distribution of different types of fractures. The highest incidence was seen in age group of 21-30 years and males clearly outnumbered females. In the present study, most of the incidents occurred between 1200 to 1800 hours. The maximum number of victims (39.57%) died while on the way to hospital. The motor-cyclists were the commonest group of victims and trucks being the commonest offending vehicles. Intracranial haemorrhages were seen in 113 cases, skull fractures were found in 95 cases and injury to brain in 51 cases. Linear fracture of skull with basal fracture was the commonest type and temporo-parietal region was involved predominantly. Subdural haemorrhage was the commonest haemorrhage observed.

Endovascular treatment of nose and mouth bleeding caused by traumatic skull base fractures / 中华创伤杂志

Objective To explore the treatment strategy for mouth and nose bleeding caused by skull base fractures. Methods A retrospective analysis was done on 14 patients with severe skull base fracture combined with nose and mouth bleeding admitted to hospital. Tracheotomy or tracheal intubation was performed to ensure airway patency. When anti-shock was performed, the patients were sent for carotid artery angiography to identify the blood vessel. Then, hemostasis was done by means of direct intravascular interventional embolization. Results Timely and successful hemostasis was achieved in all 14 patients after embolization, with no complications occurred. Of all patients, there were 10 patients with good recovery, three with disability and one death. Severe disability and death were related to brain injury. Conclusions After maintenance of airway patency and effective blood pressure, emergency endovascular embolization can effectively improve the rate of successful treatment of nose and mouth bleeding caused by traumatic skull base fractures, especially for patients combined with traumatic brain injury.

Clinical application of computer-aided design of composite materials with epoxide acrylate maleic and hydroxyapatite in cranioplasty / 中华创伤杂志

Objective To evaluate the effect of computer-aided design of composite materials with epoxide acrylate maleic (E) and hydroxyapatite (H) in cranioplasty. Methods A total of 45 patients with cranium defects were treated with cranioplasty by using skull bone flaps made of composite materials including epoxide acrylate maleic (E) and hydroxyapatite (H) ,which was designed with computer aid according to individual requirements. The patients were followed up for 6-36 months. Results After cranioplasty with composite EH, there occurred subcutaneous fluid in one patient and mild bone collapse in one. The composite EH showed good histocompatibility, with no infection or rejection. Conclusion During cranioplasty, use of computer-aided design of composite EH takes advantages of good accuracy, short operation time, good biocompatibility and good clinical efficiency.

Utility of Brain Computed Tomography in Detecting Fractures of the Temporal Bones Correlated with Patterns of Fracture on High-Resolution Computed Tomography

PURPOSE: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. METHODS: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. RESULTS: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. CONCLUSION: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.

Pneumolabyrinth Associated with Otic Capsule-Violating Fracture: Diagnosis and Clinical Features / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pneumolabyrinth, the presence of air in the inner ear is an evidence of a pathological connection between the fluid-filled space of inner ear and the air-filled space of mastoid/middle ear cavity. The aim of this study is to evaluate the clinical characteristics of pneumolabyrinth combined with temporal bone fracture. SUBJECTS AND METHOD: Among 51 patients with temporal bone fracture, those who visited a secondary referral center between January 2005 to March 2008, 6 patients (7 ears, one bilateral case) with pneumolabyrinth were selected for a retrospective review on their medical records and radiologic findings. RESULTS: All six patients were male, and had concomitant otic capsule-violating fracture in the affected side. All pneumolabyrinths were diagnosed in the CT images taken on the date of trauma, and in one case, the pneumolabyrinth disappeared in a follow-up CT which was taken after 5 days. Six affected ears out of 5 patients showed profound sensorineural hearing loss and one patient with down-sloping severe sensorineural hearing loss showed partial recovery of hearing threshold a month later. Vestibular function tests were performed in four cases and vestibular weaknesses were identified in all affected ears. CONCLUSION: Immediate high-resolution CT might improve the detection rate of pneumolabyrinth combined with temporal bone fracture. Otic capsule-disrupting fracture has been considered to be synonymous with irreversibly severe to profound sensorineural hearing loss, but one case showed partial recovery in this study. Follow-up audiometric tests are needed to check the recovery of hearing threshold.