1/4. Close-range shotgun and rifle injuries to the face.The treatment of extensive shotgun and rifle injuries to the face is extremely difficult and demands experience in microsurgery and craniofacial surgery. Early aggressive surgery with immediate bone and soft tissue reconstruction is recommended for the management of extensive facial gunshot wounds. Experience has shown that early three-dimensional bone replacement can be achieved with bone grafts in the midfacial area if the bone grafts are covered with well-vascularized tissues. Large midfacial defects can be reconstructed safely and effectively with free-tissue transfers, including bone. In the acute stage, microvascular muscle flaps are preferred because of their good vascularity and good filling capacity. These flaps are able to cover the anterior cranial fossa. When vascularized bone is needed, the authors' first choice is a latissimus dorsi flap with scapular bone. patients treated with an early and aggressive surgical strategy develop fewer problems in form of infection, contraction, scarring, and require fewer secondary corrections. Successful primary treatment allows the surgeon to use multiple modalities, including tissue expansion, free-tissue transfers, and local flaps in a noninfected environment. The treatment is rewarding, and the results are surprisingly good. It is extremely unusual for patients with self-inflicted gunshot injuries to reattempt suicide.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/4. Intracranial insertion of a nasopharyngeal airway in a patient with craniofacial trauma.Intracranial insertion of a nasopharyngeal airway is an unusual and catastrophic complication of airway management in the patient with a severe closed head injury. We present an unfortunate 43-year-old patient with intracranial insertion of a nasopharyngeal airway during trauma resuscitation. The nasopharyngeal airway was removed. Attempts to resuscitate the patient were continued, but were eventually unsuccessful. Blind nasopharyngeal airway insertion may result in iatrogenic injury when used in the head-injured patient. Oropharyngeal airways may be used to assist with ventilation. However, it is preferable to definitively secure the airway through inline endotracheal intubation or with surgical techniques in this patient population. Should violation of the skull base occur, removal is accomplished in the controlled environment of the operating room.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/4. Dog bite of the face in an adult Nigerian--a case report.BACKGROUND: Dog bite of the face is uncommon in adults. This is, in fact very rare in our environment and presentation of this single case to our centre led to our desire to discuss both the presentation and management of the patient in this paper. methods: An adult female Nigerian who had dog bite to her face involving both lips and the commisure is presented. The folder of the patient and the operation note were the sources of the information. RESULTS: She had minimal debridement of the wound with Abbe-Estlander flap cover of the wound. The dog was also placed under surveillance for a period of 2 weeks. The wound healed perfectly with no complication. The involved dog remained healthy 2 weeks after the injury. CONCLUSION: Dog bite of the face, though uncommon, can present in an adult. Sometimes the challenges of reconstruction of such defect could be great. Wound management with minimal debridement and closure gives good results on the face.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/4. Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. Secondary orbital and facial reconstruction used available bone fragments and iliac bone graft in one patient and vascularized free tissue transfer in the other. In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |