Facial Fracture-Associated Blindness.

INTRODUCTION: Yet uncommon, blindness is a potential associated injury of facial fractures. METHODS: Epidemiology, mechanisms, fracture types, and outcome of facial fractures-associated blindness in a 10-year period are retrospectively reviewed. RESULTS: Out of 907 facial fractures patients, 10 had blindness, giving a frequency of 1.1%. There were 9 men and 1 woman whom age range was 6 to 59 years (mean: 31.2 years). Intentional injury patients were significantly the most at risk of blindness (P = 0.02). In all the patients, the fracture involved at least 1 of the orbit walls. Risk of blindness was significantly higher in naso-fronto-orbito-ethmoidal complex fractures (P = 0.03). The vision loss was recorded in 13 eyes (unilateral in 7 patients and bilateral in 3). Its predominant mechanism was a globe rupture or perforation, recorded in 8 eyes. A treatment with intention to improve the vision was attempted in 1 patient only. None of the patients had vision recovery. DISCUSSION: The findings of this study commend comprehensive ophthalmologic evaluation in any patient with an orbit wall fracture.

Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures.

In some developing countries wire is still widely used in facial fractures internal fixation. This study presents the effectiveness and complications of wire osteosynthesis in a university teaching hospital in Burkina Faso and discusses some of its other benefits and disadvantages. Notes of 227 patients with facial fractures treated by wire internal fixation at department of stomatology and maxillofacial surgery of CHU Souro Sanou, Burkina Faso between 2006 and 2010 are reviewed retrospectively. A satisfactory treatment outcome was recorded in 91.2% of the 227 patients. Complications occurred in 8.8% of the patients who had operative site infection (3.1%), malocclusion (1.8%), sensory disturbance (1.8), facial asymmetry (1.3%), delayed bone union (0.9%) or enophtalmos (0.4%). The overall complications rate was 7.4% after mandibular osteosynthesis, 6.9% after Le Fort osteosynthesis and 6.5% after zygoma osteosynthesis. Post operative infections occurred irrespective to the surgical site. The other complications were more specific to the surgical site. Wire internal fixation may be a reasonable alternative for the surgical treatment of non-comminuted facial fractures and those without bone substance loss, in the setting of limited resources.

Maxillary melanotic neuroectodermal tumor of infancy management: is conservative surgery the best approach?

Melanotic neuroectodermal tumor of infancy (MNTI), an uncommon neoplasm that involves predominantly the maxilla, is classically benign but clinically aggressive. Surgery is the mainstay of the treatment with a proven efficacy, but its optimal method is not entirely clear. A case of maxillary MNTI in a 4-month-old male infant treated by radical surgery without recurrence after more than 3 years of follow-up is presented. On the basis of this experience and a review of the literature, the optimal method of MNTI surgery is discussed. To improve the prognostic of this neoplasm, the role of conservative surgery should be limited to the treatment of tumors where clear surgical margins excision should require sacrifice of functional or vital structures.

Associated injuries in patients with facial fractures: a review of 604 patients.

Facial fractures may be associated with concomitant lesions of other parts of body with some of these injuries being life-threatening. This retrospective study reports the types of associated injury and the factors influencing their occurrence, in patients with facial fractures. In 18.2% of 604 patients, one associated injury at least was recorded. The most common associated injury was cranial trauma (9.9%), followed by limbs fractures (9.1%), chest trauma (2%), spine injury (0.5%) and eye ball rupture (0.5%). A poly trauma was recorded in 3.2% of the patients who had sustained a cerebral trauma, a spinal injury or a thoracic trauma. Death occurred in two patients (0.3%) who had respectively a spinal injury and a chest trauma. The occurrence of associated injuries correlated significantly with the fracture type with solitary mandibular fracture being a significant predictor of associated injuries. Although not statistically significant, multiple facial fractures and violence were more associated with concomitant injuries. The findings of this study recall the need for initial full examination of the trauma patients particularly victims of violence, patients presenting with multiple facial fractures or single facial bone fracture involving the mandible, the trauma patients? multidisciplinary management as well as trauma prevention.

Endemic Burkitt lymphoma of maxillofacial region: results of induction treatment with cyclophosphamide plus methotrexate in West Africa.

BACKGROUND: Burkitt lymphoma is frequent a cancer in the developing countries where its treatment is based on non-intensive chemotherapy protocols. The purpose of this study was to assess the effectiveness and the toxicity of a non-intensive chemotherapy protocol combining cyclophosphamide and methotrexate in children with Burkitt lymphoma of the maxillofacial region. PROCEDURE: A retrospective descriptive study was carried out in patients with Burkitt lymphoma of maxillofacial region who received at least one weekly treatment with intravenous cyclophosphamide and methotrexate between 1999 and 2006 in a university teaching hospital in Burkina Faso. The demographic characteristics of the patients, the effectiveness and the toxicity of the treatment were recorded. RESULTS: A total of 58 patients were included. The mean age was 7.2 years. According to Murphy's staging, 28 patients (48%) were at stage I, 18 (31%) at stage II, 11 (19%) at stage III and 1 (2%) at stage IV. Among 28 patients who received all the cycles of the protocol, 21 (75%) achieved complete remission, 6 (21%) had partial remission and 1 (4%) had progressive disease. The major complications during the treatment were febrile leucopenia and anemia. The mortality rate was 19% (11/58). CONCLUSION: Non-intensive chemotherapy protocol with cyclophosphamide and methotrexate could be an alternative to intensive chemotherapy protocols for the management of the stage I-III endemic Burkitt lymphoma in developing countries.