ABSTRACT
The purpose of this study was to evaluate whether orientation of a firearm predicts survival, and to identify risk factors associated with fatality in subjects with self-inflicted craniomaxillofacial gunshot wounds. A retrospective cohort study design was used. The primary predictor variable was orientation of the weapon, defined as in the coronal (lateral) or sagittal (anterior-posterior) trajectory pattern. The primary outcome variable was death for subjects on arrival or during their hospital stay. Other covariates measured include demographic, firearm-related, and psychosocial variables. Risk factors for fatality were identified using multivariate logistic regression. Of the 92 subjects that met study inclusion criteria, 47 (67.2) held the firearm in the coronal position. In the full multivariate model, coronal gun orientation (OR=7.7, 95% CI: 2.0, 30.1, p=0.003) and the absence of a psychiatric diagnosis were associated with an increased risk of fatality (OR=0.1, 95% CI: 0.04, 0.5, p=0.002). Coronal firearm orientation was associated with an increased risk of fatality following self-inflicted craniomaxillofacial gunshot injuries. A patient with a documented psychiatric disorder was not found to be more likely to succumb to this type of injury.
Subject(s)
Firearms , Head Injuries, Penetrating/classification , Maxillofacial Injuries/classification , Suicide, Attempted , Wounds, Gunshot/classification , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Cohort Studies , Ethanol/blood , Female , Follow-Up Studies , Humans , Male , Marijuana Smoking/blood , Mental Disorders/diagnosis , Middle Aged , Retrospective Studies , Risk Factors , Substance Abuse Detection , Suicide, Attempted/classification , Suicide, Attempted/psychology , Survival Rate , Young AdultABSTRACT
The purpose of this study was to determine whether chemotherapy delivered concurrently with external beam radiation therapy for loco-regionally advanced head and neck cancer affects the rate or severity of postoperative complications in patients who underwent salvage surgery for recurrent or persistent disease with simultaneous microvascular free flap reconstruction. The primary study group consisted of patients with head and neck malignancies that had undergone surgical salvage with microvascular free flap reconstruction for persistent or recurrent disease following definitive radiation or concomitant chemoradiation treatment. A group of demographically matched patients who underwent microvascular free flap reconstruction for non-malignant and malignant conditions who never received radiation were randomly selected to serve as a control group. The study cohort was divided according to radiation treatment. The overall success rate of flap reconstruction was 92%, with an overall complication rate of 23%. Concurrently administered chemotherapy did not appear to affect the type of or the complication rate. The results of this investigation indicate that microvascular free flap reconstruction of head and neck defects is highly predictable, results in relatively few major complications, and suggests that neither radiation alone nor concomitant chemoradiation has a statistically significant effect on overall flap survival or complication rate.
Subject(s)
Chemoradiotherapy , Free Tissue Flaps , Mouth Neoplasms/surgery , Oropharyngeal Neoplasms/surgery , Plastic Surgery Procedures/methods , Salvage Therapy , Bone Transplantation , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/therapy , Case-Control Studies , Cohort Studies , Fascia/transplantation , Female , Follow-Up Studies , Graft Survival , Humans , Male , Middle Aged , Mouth Neoplasms/therapy , Muscle, Skeletal/transplantation , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/therapy , Neoplasm Staging , Oropharyngeal Neoplasms/therapy , Postoperative Complications , Radiotherapy, High-Energy , Reoperation , Retrospective Studies , Skin Transplantation , Surgical Wound Infection/etiology , Treatment OutcomeSubject(s)
Bone Transplantation/adverse effects , Eikenella corrodens , Gram-Negative Bacterial Infections/drug therapy , Surgical Wound Infection/drug therapy , Tobramycin/administration & dosage , Adult , Ameloblastoma/surgery , Bone Transplantation/methods , Drug Implants , Humans , Male , Mandibular Neoplasms/surgery , Methylmethacrylate , Methylmethacrylates , Osteomyelitis/drug therapy , ReoperationSubject(s)
Crutches , Crutches/economics , Crutches/standards , Equipment Design , Humans , Patient Education as TopicABSTRACT
Surgical intracapsular concylar fractures were initiated on young monkeys followed by prolonged intermaxillary fixation in an effort to create facial asymmetry and induce temporomandibular joint ankylosis. Implanted head positioners and metallic bone markers were used to document developing facial asymmetry in all animals. Vertical opening capabilities were fully recovered and the procedures had no discernible functional impact. Slight limitation of movement persisted only in the translation of the damaged condyles. It was concluded that trauma followed by long term fixation had no effect in promoting ankylosis or significant limitation of jaw movement. It is suggested that when considering the role of trauma in the aetiology of ankylosis, attention be given to those factors which may complicate an existing trauma.
Subject(s)
Facial Asymmetry/etiology , Mandibular Condyle/injuries , Mandibular Fractures/complications , Animals , Ankylosis/etiology , Cephalometry , Fracture Fixation , Haplorhini , Macaca , Macaca mulatta , Mandible/growth & development , Mandible/physiology , Maxillofacial Development , Movement , Temporomandibular JointABSTRACT
Primary closure of intraoral wounds can be done up to 24 hours after the injury. A mucosal seal decreases the possibility of infection and allows the wound to heal more rapidly and less painfully than a wound left open to heal by secondary intention. Defects of the lips must be closed with exact alignment of the vermilion-cutaneous margins. Nerve repairs must be done without tension at the repair site. Parotid duct repairs are mandatory to prevent cyst and fistula formation. Anterior permanent teeth may be replanted.