A Comparison Between K-Wire Splinting and Intranasal Gauze Packing in Nasal Bone Fracture.

BACKGROUND: The aim of this study was to compare the outcomes between Kirschner wire (K-wire) splinting and intranasal packing. METHODS: The authors performed a retrospective and comparative analysis of subjective patient discomfort and objective postoperative computed tomography (CT) imaging after closed reduction for treating type II and type III nasal bone fractures from April 2010 to April 2013 in 2 groups, 1 with K-wire splinting and 1 with intranasal packing. RESULTS: Complaints of nasal obstruction, dry mouth, loss of appetite, and sleep disturbance were significantly less in K-wire group. Mean scores for concerns about aesthetics/postoperative asymmetry did not differ significantly between groups. There was no significant difference in accuracy of reduction and support provided to the reduced nasal bones between groups. CONCLUSIONS: The K-wire fixation can be considered a reliable and useful immobilization method for treating type II and type III nasal bone fractures.

Clinical experience with treatment of angioleiomyoma.

BACKGROUND: Angioleiomyoma, a vascular leiomyoma, is a rare, benign smooth-muscle tumor that originates in the tunica media of vessels. It occurs anywhere in the body, most frequently in the lower extremities. METHODS: We reviewed the medical records of 16 patients who were treated for angioleiomyoma between 2000 and 2012. The clinical features of angioleiomyoma and the correlation between symptoms and pathological subtypes were investigated. RESULTS: There were 9 males and 6 females. Ages of the patients ranged from 21 to 61. Pain was the primary symptom in 44% of the patients. Tumors were smaller than 2.0 cm in all dimensions and were located in the face in 4 patients, whereas 5 lesions occurred in the upper extremities and the remaining 7 in the lower extremities. Three histologic subtypes were identified: solid, venous, and cavernous. The subtypes did not correlate with the clinical symptoms. CONCLUSIONS: Angioleiomyoma appears to be a rare tumor that occurs in the face and the extremities. The tumor usually occurs in middle age. A differential diagnosis of this tumor is difficult, but the tumor should be considered in the diagnosis of painful subcutaneous masses. Ultrasonography and magnetic resonance imaging can be helpful in the diagnosis of angioleiomyoma. These tumors can be successfully treated with simple excision, with a low recurrence rate.

Reconstruction of severe medial orbital wall fractures using titanium mesh plates by the pericaruncular approach.

Medial orbital wall fractures can cause severe aesthetic and functional complications, if not treated properly. The aim of this study was to prospectively evaluate the use of titanium mesh plates inserted through the pericaruncular approach for the treatment of medial orbital wall fractures. Between 1 July 2010 and 1 January 2013, a total of 17 patients with large medial orbital wall defects were treated. All of the large bony defects were treated using titanium mesh plates inserted through the pericaruncular approach. All patients had anatomically correct orbital wall reconstruction as accessed by immediate postoperative computed tomography scan. One patient with large bony defects presented with diplopia after the primary procedure. Re-operation was needed for correction. After surgery, the diplopia was corrected. In all patients, postoperative morbidity was minimal and cosmetic results were excellent. Titanium mesh may be a valuable material for the reconstruction of severe medial orbital wall defects. Its advantages include excellent structural support, shorter operative time, and ease of being moulded into the desired shape. The pericaruncular approach may allow for or give direct access to the medial orbital wall and orbital apex without any cutaneous incision or disruption of the medial canthal ligament, and insertion of titanium mesh plates is possible under direct vision. It is proposed that this technique could be advantageous in the reconstruction of severe medial orbital wall fractures.

Analysis of 809 facial bone fractures in a pediatric and adolescent population.

BACKGROUND: Facial fractures are infrequent in children and adolescents and have different clinical features from those in adults. The low incidence in children and adolescents reflects the flexibility and underdevelopment of their facial skeletons, as well as their more protected environments. Only a few reports have reviewed such patients in Korea. The authors performed a retrospective study to analyze the characteristics of facial fractures in the Korean pediatric population. METHODS: We conducted a retrospective review on a series of 741 patients, aged <18 years, with facial fractures who had been treated at our hospital between 2006 and 2010. The following parameters were evaluated: age, sex, cause, location and type of fractures, associated injuries, treatment and complications. RESULTS: A total of 741 consecutive patients met the inclusion criteria. The ratio of boys to girls was 5.7:1. Facial fractures most commonly occurred in patients between 13 and 15 years of age (36.3%). The most common causes of injury was violence. The nasal fracture was the most common type of fracture (69%) and the blowout fracture was the second most common (20%). Associated injuries occurred in 156 patients (21%). CONCLUSIONS: The incidence of pediatric facial fractures caused by violence is high in Korea. Our results show that as age increases, etiological factors and fracture patterns gradually shift towards those found in adults. This study provides an overview of facial fractures in these age groups that helps illustrate the trends and characteristics of the fractures and may be helpful in further evaluation and management.

Absorbable plate as a perpendicular strut for acute saddle nose deformities.

BACKGROUND: Nasal pyramid fractures accompanied by saddle nose deformities are not easily corrected by closed reduction. We used an absorbable plate as a perpendicular strut to support the collapsed "keystone area" and obtained good results. METHODS: Between September 2008 and June 2011, 18 patients who had nasal pyramid fractures with saddle nose deformities underwent surgery. Pre- and postoperative facial computed tomographic images and photographs were taken to estimate outcomes. The operative technique included the mucoperichondrial dissection of the nasal septum, insertion of an absorbable plate prepared to an appropriate length to support the "keystone area", and fixation of the absorbable plate strut to the cartilaginous septum. RESULTS: Functional and esthetic outcomes were satisfactory in all patients. Eleven patients assessed the postoperative appearance of the external nose as 'markedly improved' and 7 patients as 'improved'. The 5 surgeons scored the results as a mean of 4.5 on a 5-point scale. CONCLUSIONS: The use of an absorbable plate as a perpendicular strut requires no additional procedures because the plate is gradually absorbed. The mechanical strength provided by a buttress between the "keystone area" and the maxillary crest lasts for a long time before the strut is absorbed.