1/19. Extensive facial damage caused by a blast injury arising from a 6 volt lead accumulator.Low-voltage electrical injuries are relatively uncommon. Injury caused by flow of heavy current due to short-circuiting a low-voltage battery has not been described in the English literature. A 9-year-old boy connected two thin household electrical wires to the two terminals of a 6 volt (lead accumulator) battery and pressed the other two ends between his teeth. This resulted in a blast causing a compound comminuted fracture of the mandible and extensive tissue damage in the oral cavity. The low internal resistance of a lead accumulator (approximately 0.03 ohms) permits the flow of a heavy current (approximately 200 amps) when short-circuited. This instantaneously vaporises a minuscule portion of wire at approximately 2000 K resulting in a sudden rise of intraoral pressure to 30 kg cm-2 leading to tissue damage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/19. Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway.PURPOSE: Proper care of the trauma patient often includes tracheal intubation to insure adequate ventilation and oxygenation, protect the airway from aspiration, and facilitate surgery. airway management can be particularly complex when there are facial bone fractures, head injury and cervical spine instability. CLINICAL FEATURES: A 29-yr-old intoxicated woman suffered a motor vehicle accident. Injuries consisted of multiple abrasions to her head, forehead, and face, right temporal lobe hemorrhage, and complex mandibular fractures with displacement. mouth opening was <10 mm. blood pressure was 106/71 mm Hg, pulse 109, respirations 18, temperature 37.3 degrees C, SpO2 100%. Chest and pelvic radiographs were normal and the there was increased anterior angulation of C4-C5 on the cervical spine film. Drug screen was positive for cocaine and alcohol. The initial plan was to perform awake tracheostomy with local anesthesia. However, the patient was uncooperative despite sedation and infiltration of local anesthesia. Sevoflurane, 1%, inspired in oxygen 100%, was administered via face mask. The concentration of sevoflurane was gradually increased to 4%, and loss of consciousness occurred within one minute. The patient breathed spontaneously and required gentle chin lift and jaw thrust. A cuffed tracheostomy tube was surgically inserted without complication. Blood gas showed pH 7.40, PCO2 35 mm Hg, PO2 396 mm Hg, hematocrit 33.6%. Diagnostic peritoneal lavage was negative. Pulmonary aspiration did not occur. Oxygenation and ventilation were maintained throughout the procedure. CONCLUSION: Continuous mask ventilation with sevoflurane is an appropriate technique when confronted with an uncooperative trauma patient with a difficult airway.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/19. zinc burns: a rare burn injury.A patient was presented with significant burns resulting from a workplace accident in a zinc production unit. This occurred as a result of the spontaneous combustion of zinc bleed under high pressure. The patient sustained burns to the face, body, and hands and suffered significant injury to the left cornea. Computed imaging revealed solid particles in the ethmoid sinus and also in the right nasal fossa, dissecting the right lacrimal duct. Photographic documentation is presented. This injury was potentially preventable and resulted from poor observance of safety procedures.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/19. Effect of facial pressure garments for burn injury in adult patients after orthodontic treatment.Pressure garments are commonly used to prevent and control hypertrophic scar tissue. Complications are unusual, though in children with facial burns, pressure garments may lead to skeletal and dental deformities. Studies in adolescents and adults are sparse. We describe a 24-year-old woman who sustained facial burns. Prior to injury, the patient had undergone premolar extraction in preparation for orthodontic treatment. Her post-burn care consisted of application of a Jobst pressure garment. After 2 months treatment, severe deformation of the dental-alveolar structure was observed. This reports suggests that adults after dental extraction are at a high risk of dental-alveolar deformities from pressure garments and might benefit from the use of occlusal wafers.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
5/19. Disseminated pneumocephalus secondary to an unusual facial trauma.pneumocephalus can be secondary to a postintrathecal procedure, sinus fracture, basilar skull fracture, congenital skull defect, neoplasm, gas producing organism, barotrauma, neurosurgery, paranasal sinus surgery, mask or nasal continuous positive-airway pressure. Unusual facial traumas can also be rare causes of pneumocephalus. Here, we present such a case in whom an air compressor tip injury to both eyes led to the disseminated pneumocephalus. We report this rare case with the computed tomography findings and try to explain the possible mechanism of the pnemocephalus.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/19. Use of surface scanning for creation of transparent facial orthoses. A report of two cases.OBJECTIVE: To introduce the advantages of surface scanning over conventional burn mask construction to produce better fitting transparent facial orthoses (TFO). DESIGN: Two case reports. SETTING: Regional burn center. PARTICIPANTS: Two burn survivors who sustained 25% and 82% total body surface area second and third degree flame burns, respectively. DESCRIPTION: A 50-year-old male who sustained 4.5% second and third degree facial burns and a 41-year-old female who sustained 6% second and third degree facial burns during the World Trade Center were fitted with a digitally produced TFO approximately 4 months after injury. After the patients were scanned, the images were edited to smooth existing scars and replicated as a mold through which the healing process was observed. RESULTS/DISCUSSION: Facial burns represent many psychological and rehabilitation challenges. We recommend the use of a digitally produced device in patients with severe facial burns who require constant pressure to minimize hypertrophic scarring and to improve cosmesis. Scar management studies have shown that surface scanning results in a better fitting mask than conventional fabrication, without the labor-intensive, time-consuming, and imprecise process, which may delay treatment effects. The conventional process is slow and anxiety-provoking, especially for children, who often require anesthesia. In contrast, the head scanner rotates 360 degrees around the pateint's head, painlessly and accurately capturing the profile and contour of the face in 7s. Since the procurement of this scanner, our two patients, as well as many other burn victims, have greatly benefited from the creation of face masks utilizing this equipment. We believe that all rehabilitation professionals caring for burn patients should be aware of this new technology.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/19. High-pressure grease injury of the face.We describe a rare case of high-pressure grease injury of the face in a 48-year-old man with severe facial edema, soft palate swelling, and bleeding from the nose and mouth. Preoperative computed tomography (CT) revealed multiple low-density areas in nasal cavity, subcutaneous tissue of the cheek, soft palate, right maxillary sinus, and right infratemporal fossa. The patient complained of a dyspnea feeling, and immediate tracheostomy was performed. The grease was removed by the Caldwell-Luc incision approach but was partially left in the infratemporal fossa. After the operation, the patient still complained cheek and temporal pain. CT and magnetic resonance imaging were useful to diagnose the remaining grease, and the remnant of the grease was completely removed by the Weber-Fergusson incision approach.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/19. The use of vacuum-assisted closure therapy for the treatment of a large infected facial wound.Chronic wounds in difficult locations pose constant challenges to health care providers. negative-pressure wound therapy is a relatively new treatment to promote wound healing. Laboratory and clinical studies have shown that the vacuum-assisted closure (VAC) therapy increases wound blood flow, granulation tissue formation, and decreases accumulation of fluid and bacteria. VAC therapy has been shown to hasten wound closure and formation of granulation tissue in a variety of settings. Accepted indications for VAC therapy include the infected sternum, open abdomen, chronic, nonhealing extremity wounds and decubitus ulcers. We report the first case of VAC therapy successfully used on a large infected wound to the face to promote healing.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/19. Principles of treatment and indications for surgery in severe multiple trauma.Despite major advances, pitfalls in diagnosis and emergency treatment influence the survival chances of multitraumatized patients considerably. diagnosis of traumatic shock cannot be made by blood pressure, pulse rate and shock index. Immediate shock therapy is indicated in all cases with severe trauma of two body regions, combined injury of one body cavity and long bone fractures and in all cases with one major thoracic or pelvic injury. In a consecutive series of 418 multitrauma patients, extremity injuries were present in 90%, severe head injuries in 65%, major thoracic trauma in 50% and abdominal or pelvic injuries in 40%. The most frequent pattern of multitrauma was long bone fractures with associated head trauma and one thoracic, abdominal or pelvic injury. Priorities of treatment are based on a 4-stage-schedule: Stage 1 includes intubation and hyperventilation for cerebral trauma, volume replacement by central venous catheter, emergency x-ray of cervical spine, chest, abdomen, pelvis and diagnostic peritoneal lavage. In 25% of admitted cases, diagnosis of abdominal hemorrhage was missed by the referring surgeon despite hemorrhagic shock, falsely attributed to cerebral trauma. At Stage 2, emergency surgery of internal and external bleeding is indicated. Wide open fractures are stabilized by external fixation. Stage 3 is concerned with stabilization of vital systems and further diagnostic evaluation, its duration varying from 2 hours to 2 days. At Stage 4, internal fixation of fractures and other non-emergency-operations are indicated. Operating time can be reduced considerably by 2 surgical teams operating simultaneously or overlapping. Early shock diagnosis, immediate intubation, ventilator treatment and the "4-stages-schedule" are considered the most successful steps in the management of multitrauma, as well as volume replacement with Fox' hypertonic saline solution and blood constituents instead of colloids. This has reduced mortality due to respiratory failure from 31% to 20%.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/19. A semi-rigid transparent face mask in the treatment of postburn hypertrophic scars.Scars, following burns to the face or subsequent skin grafts, can become hypertrophic. The concept of pressure in their treatment is not new. Elastic garments have been popularised and used successfully. However, they have certain limitations. To date, very little reference has been made in the literature to the use of masks. The use of a semi-rigid face mask in the treatment of hypertrophic scars is described. These masks are comfortable to wear, well tolerated and very effective. case reports are presented and the technique of manufacture detailed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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