ABSTRACT
This study investigates the postoperative complication rate in American military members treated for fractures of the facial skeleton with either immediate fixation in the Operation Iraqi Freedom combat theater or delayed fixation after transport out of the combat theater. Based on an army head and neck surgeon's case log, retrospective chart review was performed on 21 American active-duty patients evaluated for facial fractures in Balad, Iraq, between April 16, 2006, and October 30, 2006. Follow-up standardized patient interviews and review of electronic medical records were conducted to assess the postoperative clinical course and identify postoperative complications. Facial fractures involved the mandible (62%), the orbit (62%), nasal bones (48%), the midface (38%), the frontal bone (29%), the zygoma (24%), and the temporal bone (5%). Fourteen patients (67%) with facial fractures were treated definitively with open reduction and internal fixation surgery in Balad. Seven patients (33%) had delayed treatment. Overall, the major complication rate was 7% in the immediate fixation group, compared with 57% in the delayed treatment group (P < 0.04). Infectious complications occurred in 1 patient (7%) from the immediate fixation group requiring removal of exposed hardware, whereas 3 patients (43%) from the delayed treatment group experienced infectious complications requiring reoperation (P < 0.09). Although major complications were associated with both immediate and delayed definitive treatment, major complications were more likely to be associated with delayed treatment. The deployed surgeon should use clinical judgment in repairing facial fractures in theater. If treatment is delayed, every effort should be made to affect a timely repair of the fractures.
Subject(s)
Facial Bones/injuries , Facial Injuries/surgery , Fractures, Bone/surgery , Iraq War, 2003-2011 , Military Personnel , Postoperative Complications/epidemiology , Skull Fractures/surgery , Adult , Chi-Square Distribution , Facial Bones/diagnostic imaging , Facial Injuries/diagnostic imaging , Facial Injuries/epidemiology , Female , Fractures, Bone/diagnostic imaging , Fractures, Bone/epidemiology , Humans , Interviews as Topic , Male , Retrospective Studies , Skull Fractures/diagnostic imaging , Skull Fractures/epidemiology , Tomography, X-Ray Computed , Treatment Outcome , United States/epidemiologyABSTRACT
As the military medical treatment facilities of Operation Iraqi Freedom have transitioned from make-shift tent facilities to more formal fixed facilities, the capability to deliver more complex care has markedly improved. Using case presentations, the authors illustrate the integration of advances in surgical technology in managing complex and devastating craniofacial trauma at the 332nd Air Force Theater Hospital in Balad Iraq during Operation Iraqi Freedom 2006.
Subject(s)
Facial Injuries/surgery , Iraq War, 2003-2011 , Military Dentistry/trends , Military Medicine/trends , Plastic Surgery Procedures/methods , Bone Plates , Bone Transplantation , Continuity of Patient Care , Emergency Service, Hospital , Female , Head Injuries, Penetrating/surgery , Humans , Intensive Care Units , Interprofessional Relations , Male , Mandibular Fractures/surgery , Mandibular Injuries/surgery , Maxillary Fractures/surgery , Nasal Bone/injuries , Nasal Bone/surgery , Nasal Septum/injuries , Nasal Septum/surgery , Operating Rooms , Orbital Fractures/surgery , Skin Transplantation , Skull Fractures/surgery , Tongue/injuries , Zygomatic Fractures/surgerySubject(s)
Burns, Inhalation , Burns, Inhalation/physiopathology , Burns, Inhalation/therapy , TexasABSTRACT
As in many specialties, otolaryngology is not without diagnosis surrounded by controversy. This report discusses the entity known as the primary branchial cleft carcinoma, which has been argued by some to be no more than metastatic disease of the unknown primary. Although the disease is rare, the consideration of this diagnosis requires careful thought and analysis by the otolaryngologist, pathologist, and radiation oncologist so that a rational treatment plan can be offered to the patient.
