Trivial trauma to the cheek: significant complications in the chest.

A man in his 30s presented to the emergency department with a history of injury to the face with a crowbar. He was discharged from the department, in the absence of any facial bone fractures and given normal examination findings, except for a puncture wound on the mentum. The patient then re-presented within 24 hours with extensive cervical emphysema extending into the mediastinal cavity.He was referred to ear, nose and throat team for further management. CT scan of the chest and neck showed extensive surgical emphysema and a pneumomediastinum. The patient was managed conservatively and recovered well with no significant sequelae.Even in the absence of facial bone fractures, it is imperative to understand the force of impact which should prompt a consideration of imaging of the chest. Appropriate advice regarding avoidance of Valsalva manoeuvres will help prevent extensive propagation of air through the fascial planes that can result in a pneumomediastinum.

An outcome comparison of superficial versus deep plane dissection of cervicofacial flaps: A systematic review and meta-analysis.

PURPOSE: Cervicofacial flaps represent an excellent option for coverage of cheek defects secondary to oncologic resection, trauma or infection. However, there remains clinical equipoise regarding whether superficial plane or deep plane dissection results in the lowest rates of complications and optimal outcomes. METHODS: A systematic review and meta-analysis of proportions was conducted to assesses outcomes between cheek reconstruction superficial plane or deep plane cervicofacial flaps. Outcome measures included flap necrosis, ectropion, hematoma formation, facial nerve injury, and requirement for further operative or non-operative intervention. RESULTS: Of 881 citations identified for review, 10 met the inclusion criteria. In total, 284 patients received superficial plane flaps while 44 patients received deep plane flaps. Overall, reported rates of complications were low for cervicofacial flaps. The proportion of necrosis, ectropion, and hematoma were 3.05% (95% CI: 0.00-10.71%), 2.03% (95% CI: 0.41-4.42%), and 0.05% (95% CI: 0.00-3.29%), respectively. No cases of permanent facial nerve injury were reported. Sub-group analysis demonstrated comparable rates of complications between superficial and deep plane dissection and no difference was found between groups. Other complications were noted with low incidence. CONCLUSIONS: Currently published literature demonstrates that superficial and deep plane cervicofacial flaps exhibit similar rates of complications, although there is a low level of evidence overall. Overall, the rates of flap necrosis (3.05%), ectropion (2.03%), and hematoma (0.05%) are low. Notably, there were no reported cases of permanent facial nerve injury from either technique.

[A traumatic swollen cheek]. / Een traumatische zwelling van de wang.

A 3-year-old girl was referred to a Department of Oral and Maxillofacial Surgery with a swelling in the mouth she had had for 2 weeks. The swelling followed the hard impact of a football against her face. The swelling appeared to result from an intraoral herniation of the buccal fat pad. The treatment of the herniation of fatty tissue depends on how long it has existed. If it has existed for only a short time, an attempt can be made to relocate the herniated tissue. If the swelling has existed for a longer time, a decision will be made for excision with primary closure of the mucosa.

Craniofacial penetration by a wooden stick.

INTRODUCTION: Penetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity. CASE SUMMARY: We describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain. DISCUSSION: Penetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.

A rare presentation of lobular panniculitis in the oral cavity of a 2-year-old patient.

Pannicultis is a rare disorder which usually affects the organ and tissue which are abundant in fat cells. It causes fatty degeneration of the fat cells and the diagnosis is usually made histologically. Here we present you a rare case of lobular pannicultis which occurred in a 2 year old patient in its oral cavity.

The Enigma of "Traumatic Pseudolipoma" and "Traumatic Herniation of Buccal Fat Pad": A Systematic Review and New Classification System of Post-Traumatic Craniofacial Fatty Masses.

PURPOSE: Intraoral traumatic herniation of the buccal fat pad has been reported using various terms such as traumatic pseudolipoma, traumatic prolapse of buccal fat pad, and traumatic avulsion of buccal fat pad. Because there is no uniformity in nomenclature, this condition needs to be distinguished from other entities such as post-traumatic pseudolipoma and lipoma and pseudoherniation of the buccal fat pad. MATERIALS AND METHODS: A systematic review and thorough search of the literature was planned in online databases such as PubMed, Medline, Scopus, Embase, and Google Scholar. The keywords used were traumatic pseudolipoma, traumatic herniation of buccal fat pad, and traumatic prolapse of buccal fat pad. Of 95 articles initially screened, 45 were included in the study. All pertinent data were extracted by the authors independently. Extracted data were cross-examined for any discrepancy. Summary statistics were not used because the research question did not support pooling of data. RESULTS: Only 24 cases were found to have reported the condition correctly. Terms such as traumatic pseudolipoma were used synonymously and erroneously for this condition. CONCLUSION: Based on the gross inaccuracy in reporting, the authors propose a new comprehensive classification of post-traumatic craniofacial fatty masses.

Reconstruction of full-thickness cheek defect with chimeric facial artery free flap: A case report.

Full-thickness cheek defects represent a difficult challenge for reconstructive surgeons. Multiple techniques have been described, including local, regional, and free flaps. In this report, the reconstruction of a through and through left cheek defect, resulting from a self-inflicted gunshot injury, with a chimeric facial artery free flap is presented. The patient underwent reconstruction with a chimeric full-thickness facial artery free flap, with 9 × 3 cm diameter skin paddle and a 6 × 5 cm myomucosal paddle, was harvested on the contralateral cheek with a 7-cm length of facial pedicle. The flap was transferred via a microsurgical technique and an end-to-end microsurgical anastomosis was performed between the donor and the contralateral facial vessels. The flap was transplanted successfully and there were no donor or recipient site complications with a satisfactory esthetic result 5 years after surgery. This technique may be a good reconstructive option for medium size, full-thickness, cheek defects allowing a "like with like" reconstruction with minimal donor-site morbidity.

Use of sialendoscopy as an aid to identify a large retained foreign body.

We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.

Enfermedad de Rosai-Dorfman cutánea facial / Facial Cutaneous Rosai-Dorfman Disease

No disponible

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review.

PURPOSE: The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures. METHODS: In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed. RESULTS: This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively. CONCLUSIONS: Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

Repeated haemorrhages in peripheral nerve sheath tumours of the salivary glands after minor injury.

Repeated haemorrhages in peripheral nerve sheath tumours of the salivary glands are rare. We report the case of a patient with neurofibromatosis type 1 who had two episodes of massive haemorrhage in his right parotid gland the day after a minor injury. Oral and maxillofacial surgeons should be aware that vasculopathy may occur in patients with these tumours.

Utilidad de colgajos locales para reconstrucción de mejillas en lesiones oncológicas de piel / Usefulness of local flaps for cheek reconstruction in skin cancer lesions

Introducción: el cáncer de piel afecta con frecuencia la región facial por su alta exposición a la radiación ultravioleta. La mejilla es un sitio frecuente y como consecuencia de la exéresis, quedan amplios defectos que requieren de técnicas reconstructivas. Este estudio tuvo como objetivo evaluar la utilidad del uso de colgajos locales para la reconstrucción de mejilla en pacientes intervenidos de lesiones tumorales de piel. Métodos: se realizó un estudio prospectivo en 27 pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología desde julio de 2013 hasta julio de 2015. Resultados: el grupo etario predominante estuvo integrado por mujeres entre 67-77, el tipo histológico que predominó fue el carcinoma basocelular. Predominó la mejilla izquierda. El colgajo que más se realizó fue el de rotación (Mustardé) y la complicación más frecuente fue el ectropión. Conclusiones: todos los casos fueron reconstruidos de forma inmediata, independientemente del tamaño del defecto(AU)

Introduction: Skin cancer frequently affects the facial area, due to high exposure to ultraviolet radiation. The most frequent affected area is the cheek. The wide excisions resulting from excision require reconstructive techniques to repair them. Objective: to evaluate the usefulness of local flaps for the cheek reconstruction in skin cancer lesions. Methods: A prospective study was conducted in 27 patients seen at the National Institute of Oncology and Radiobiology from July 2013 through July 2015. Results: The predominant age group comprised women aged 67-77 years, being the basal cell carcinoma the predominant one. The left cheek was the most affected. The most used flap was the rotation flap(Mustarde) and the most common complication was ectropion.Conclusions: All the cheek defects were immediately reconstructed regardless of their size(AU)

Lesiones de la mucosa bucal en una población infantil de Montevideo, Uruguay / Oral mucosal lesions in a child population of Montevideo, Uruguay

Justificación: Existen escasos estudios que documenten la frecuencia de lesiones de la mucosa bucal en niños y adolescentes, y todos revelan resultados dispares.Materiales y método: Se realizó un estudio observacional, descriptivo, transversal, en niños de 3 a 12 años de edad que participan del Programa de Salud Bucal de la Facultad de Odontología de la Universidad Católica del Uruguay. Se tomaron en cuenta lesiones en la totalidad de la cavidad bucal, describiendo y registrando cada uno de los hallazgos. Se seleccionaron las 7 lesiones más frecuentes enla bibliografía consultada. Se realizó un análisis estadístico según edad, género y tipo de dentición.Resultados: Se estudiaron 191 sujetos; 103 presentaron alguna lesión. La lesión identificada con mayor frecuencia fue Morsicatio buccarum es decir, mordisqueo de mucosa yugal (trauma inflingido). La siguiente lesión más frecuente fue Lengua geográfica.Conclusiones: Las niñas tuvieron mayor probabilidad de presentar algún tipo de lesión que los niños. El rango de edades de 6-9 años tuvo mayor riesgo de presentar alguna lesión que el grupo de 9-12 años. Los sujetos con dentición mixta tuvieron más riesgo de presentarMorsicatio buccarum que el grupo de dentición permanente. Asimismo, los individuos de 6-9 años tuvieron mayores posibilidades de presentar Morsicatio buccarum que el grupo de 9-12 años. No se encontró un estudio epidemiológicamente comparable que describa las mismas lesiones que éste; esto lleva a concluir que es necesario realizar otros estudios con la misma metodología y ampliando los criterios diagnósticos.

Justification: There are few studies that document the frequency of oral mucosal lesions in children and adolescents, and all of them reveal different results.Materials and method: This was an observational, descriptive, transversal survey, in children between the ages of 3 and 12, that participate in the “Programa de Salud Bucal de la Facultad de Odontología de la Universidad Católica del Uruguay”/ Oral Health Program of the Dentistry School of Uruguayan Catholic University. Lesions in the whole oral cavity were taken into account, describing and registering each one of the findings. The 7 lesions more frequent in the bibliography consulted were selected. A descriptive statisticalanalysis was made using the variables age, gender and dentition stages.Results: 191 children were examined; lesions were found in 103 children. Morsicatio buccarum, meaning the bitening of the cheek mucosa (self inflicted trauma), was the most common lesion. The second most frequent lesion was Geographic tongue. Conclusions: Girls had higher probability of presenting a lesion than boys. The age range between 6-9 had more risk of developing a lesion than the group ranging in age from 9-12. The children with mixed dentition had more risk of having Morsicatio buccarumthan the children with permanent dentition; and the children ranging in age from 6-9 had more probabilities of presenting Morsicatio buccarum than the children ranging 9-12. We could not find any other survey epidemiologically comparable that described the samelesions than ours. This leads to the conclussion that it is necessary to perform further studies with the same methodology and a wider range of diagnosis criteria.

Utilidad de colgajos locales para reconstrucción de mejillas en lesiones oncológicas de piel / Usefulness of local flaps for cheek reconstruction in skin cancer lesions

Introducción: el cáncer de piel afecta con frecuencia la región facial por su alta exposición a la radiación ultravioleta. La mejilla es un sitio frecuente y como consecuencia de la exéresis, quedan amplios defectos que requieren de técnicas reconstructivas. Este estudio tuvo como objetivo evaluar la utilidad del uso de colgajos locales para la reconstrucción de mejilla en pacientes intervenidos de lesiones tumorales de piel. Métodos: se realizó un estudio prospectivo en 27 pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología desde julio de 2013 hasta julio de 2015. Resultados: el grupo etario predominante estuvo integrado por mujeres entre 67-77, el tipo histológico que predominó fue el carcinoma basocelular. Predominó la mejilla izquierda. El colgajo que más se realizó fue el de rotación (Mustardé) y la complicación más frecuente fue el ectropión. Conclusiones: todos los casos fueron reconstruidos de forma inmediata, independientemente del tamaño del defecto(AU)

Introduction: Skin cancer frequently affects the facial area, due to high exposure to ultraviolet radiation. The most frequent affected area is the cheek. The wide excisions resulting from excision require reconstructive techniques to repair them. Objective: to evaluate the usefulness of local flaps for the cheek reconstruction in skin cancer lesions. Methods: A prospective study was conducted in 27 patients seen at the National Institute of Oncology and Radiobiology from July 2013 through July 2015. Results: The predominant age group comprised women aged 67-77 years, being the basal cell carcinoma the predominant one. The left cheek was the most affected. The most used flap was the rotation flap(Mustarde) and the most common complication was ectropion. Conclusions: All the cheek defects were immediately reconstructed regardless of their size(AU)

Expanded Cheek-Shaped Flap for Aesthetic Cheek Reconstruction in the Cervicoperiauricular Area.

BACKGROUND: The cervical area is well acknowledged as an ideal donor site for aesthetic reconstruction of the cheek, and tissue expansion may play an important role for maximally achieving such a purpose. However, the conventional design of the expanded cervical flap generally results in unsightly morbidity of the donor site. The aim of this study is to evaluate the results of using an improvised cervical expanded flap in aesthetic reconstruction of the cheek. METHODS: From July 2004 to October 2012, a total of 23 burn sequelae patients (30 cheeks) underwent cheek reconstruction with an expanded flap that originated from the cervicoperiauricular area. The procedures were initially carried out with the insertion of a round tissue expander in the cervicoperiauricular area, followed by serial inflation of the expander, and finally, transplantation of the expanded flap to the cheek in a rotation advancement fashion. The donor site closure was along the auricular sulcus. RESULTS: The average area of the harvested flaps was 9.7 × 8.1 cm. All the flaps completely survived, only one major complication occur-a dome exposure of the tissue expander after the expansion was completed. The flap was salvaged, and the transfer stage was done without intact. Minor complications after flap transfer include: widened scar at the donor site, a "dog-ear" needing additional minor surgery, distal part of the flap transient congestion. The patients achieved very satisfactory results functionally and aesthetically. CONCLUSIONS: Using the expanded cheek-shaped flap technique can provide a safe, thin, and color-matched flap in aesthetic reconstruction of the cheek with minimal donor site morbidity.

Orofacial pain due to rare interosseous hemangioma first diagnosed as secondary to trauma.

Pain is among the most common reasons for patient visits to healthcare providers, especially to dental practitioners. This case illustrates the obligation of the general dentist and specialist to recognize facial pain disorders of nonodontogenic origin, and outlines a paradigm for treatment of this unusual case. A 59-year-old man presented with chronic, progressive right periorbital pain since 2006, of 7 years duration. The initial diagnosis was a fracture of the right outer rim of the orbit secondary to trauma. The patient had undergone a variety of clinical and radiographic evaluations, pharmacologic therapies, and limited surgical procedures with no benefit. The description of his pain varied. Initially complaints were consistent with musculoskeletal pain, ie chronic, localized, aching, and evoked by pressure. It evolved into a neuropathic quality with increasing and spontaneous pain associated with sensory changes. Pain levels, which were initially mild, became moderate to severe. After a detailed review of the patient's history, radiographic records, and a comprehensive clinical evaluation, a CBCT of the maxilla was performed. While not considered a routine radiographic study, CBCT is readily available to the general dentist and specialist. CBCT was indicated in this case and revealed a rare interosseous hemangioma of the maxilla. The portion of the maxilla containing the lesion was surgically removed and a prosthetic replacement was placed. At 12 months after the procedure the patient remains pain free.

Traumatic Herniation of the Buccal Fat Pad Into the Oral Cavity of a 3.5-Year-Old Boy: A Case Report.

The buccal fat pad represents a specialized type of tissue that is distinct from subcutaneous fat. Its primary function is to serve as a cushioning tissue and as a sucking pad. In this case report, we present an interesting lesion and its management, wherein a tiny traumatic perforation of the buccal mucosa caused a large portion of the buccal fat pad to extrude into the oral cavity.

Treatment of Parotid Sialocele after Sustaining a Facial Injury. Case Report and Literature Review.

We are presenting the case of a patient who developed a parotid sialocele after sustaining a facial injury. The patient was treated by creating a controlled intraoral fistula that drained saliva into the oral cavity and led to resolution of the sialocele. Articles were reviewed for discussion of current treatment methods in managing parotid sialocele and fistula. The articles reported successful management of parotid sialocele and fistula using both nonsurgical and surgical methods. Treatment depends upon the location of the injury (ductal injury vs. parenchymal injury) and the time of treatment (delayed vs. immediate).

An unusual site for a snakebite.

Snakebites are an important cause of death in rural and suburban India. Most of these deaths occur due to envenomation. The incidence of snake bite is highest in developing countries with the most common site of such bites in the lower limbs. Here, we present a case where a 12-year-old boy had been bitten on his face which is an unusual site and as a consequence the treating doctor failed to make the correct diagnosis promptly and the boy died.