1/9. Revival of non-surgical management of neonatal depressed skull fractures.The management of depressed skull fractures in the newborn infant can be controversial. We report on a neonate, born by Caesarean section with difficult head extraction, complicated by a parietal depressed fracture. This 'ping-pong' fracture was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible treatment modalities for neonatal depressed fractures, being conservative or operative, will be discussed.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/9. "Growing fontanelle": a serious complication of difficult vacuum extraction.Growing skull fractures in combination with leptomeningeal cysts are well known in childhood. A rare case of a growing fontanelle due to a leptomeningeal cyst is presented. The cyst occurred due to a traumatic delivery with vacuum extraction. Operative repair of the cyst revealed a dural tear at the border of the fontanelle. The imaging findings are discussed.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
3/9. Management of orbital-sinus foreign bodies.Orbital-sinus foreign bodies traverse the orbit and lay, at least partially, within the paranasal sinuses. Most of these injuries occur as a result of facial trauma. In most cases, history alone is not sufficient to rule out a retained foreign body. Early magnetic resonance imaging is necessary to evaluate the full extent of injury. Since these foreign bodies may cause a severe orbital infection and threaten the patient's vision, surgical removal is recommended. Endoscopic sinus surgery provides a safe and effective approach for extraction of these foreign bodies that can be used alone or in conjunction with other surgical approaches. The case of an orbital-sinus foreign body is presented together with a comprehensive approach for diagnosis and management of this type of injury.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/9. Traumatic neonatal intracranial bleeding and stroke.Ischaemia within the regions supplied by vertebral and posterior cerebral arteries has been described as a complication of birth injury, either by direct trauma or by compression from a herniated temporal uncus. Ischaemia within the territory of the middle cerebral artery has been documented after a stretch injury of the vessel's elastica interna. From a series of seven personal observations on birth trauma and related cerebral stroke, we describe three neonates with the uncal herniation type of occipital stroke and four infants with hypoperfusion of the middle cerebral artery or one of its major branches. In three of the latter a basal convexity subdural haemorrhage probably induced the ischaemia, whereas in the other it was associated with haemorrhagic contusion of the parietal lobe. Experimental work and reports on older children support the idea that vasospasm due to surrounding extravasated blood can be one of the responsible mechanisms. Both forceps delivery and difficult vacuum extraction can be implicated in this supratentorial injury, leading to permanent neurological damage in at least half of the survivors in this series.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/9. Blowout fracture of the orbital floor with entrapment caused by isolated trauma to the orbital rim.There are two main theories on the cause of blowout fractures of the orbit: the "hydraulic" theory and the "buckling force" theory. Although both mechanisms have been shown responsible for experimental blowout fractures, the role of isolated rim trauma in producing clinical blowout fractures with entrapment of orbital soft tissues continues to be questioned. I examined a 69-year-old patient who developed a blowout fracture with clinical evidence of entrapment after isolated trauma to the orbital rim. Five days previously the patient had had a cataract extraction and implantation of an intraocular lens in the ipsilateral eye, which remained undisturbed by the trauma. This case supports the role of a buckling force to the rim in producing orbital blowout fractures. review of the circumstances of injury in large series of blowout fractures suggests that this mechanism may be operative in the majority of cases.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/9. Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication.A case of growing skull fracture following birth trauma and caused by vacuum extraction is reported in order to emphasize the incidence of this peculiar head injury at the beginning of extrauterine life and to point out its relation to possible neuropsychological disturbances that may appear later in childhood. Delivery by vacuum extraction increases the incidence of perinatal injuries and consequently the incidence of neurological deficits in children. Neurosurgical repair is advocated as the appropriate treatment, with the aim not only of cosmetically correcting the lesion's typical subgaleal protuberance with cranioplasty, but also of performing a water-tight closure of the dura, enabling the cerebral cortex to "fill in" the intracerebral lesion. The surgical technique and gross pathology of the lesion are described together with radiological findings before and after surgery. Reports by other authors are reviewed in an attempt to identify the conditioning factors and pathological features of this traumatic injury to skull and brain in neonates and infants. The literature on cranial fractures associated with intracerebral lesions at this age shows a significant difference in recovery and outcome from that after similar lesions in older children.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |
7/9. Skull fracture caused by vacuum extraction.BACKGROUND: The vacuum extractor is being increasingly advocated as the instrument of first choice for assisted vaginal delivery. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. CASE: Rotational delivery of a term infant was effected using a vacuum extractor. A 6-cm Malmstrom metal cup with a paramedian application was in place for 12 minutes. The vacuum pressure developed was 0.8 kg/cm2. Four traction efforts with contractions were required to deliver the fetal head. A neonatal skull x-ray the following day showed a comminuted parietal bone fracture at the vacuum cup application site. Management was conservative, and the infant's neurologic behavior remained normal. CONCLUSION: The vacuum extractor exerts considerable traction force. Fetal skull fracture can result, and its true incidence may be higher than expected, considering that few neonates with normal neurologic behavior undergo skull x-ray.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
8/9. Removal of foreign bodies (two teeth) by fiberoptic bronchoscopy.In special situations the flexible fiberoptic bronchoscope, with its increased visual range and extended capabilities for extraction, may be utilized to augment rigid bronchoscopy. Recently developed tools for extraction (claw, basket, forceps, and balloon catheter) may be inserted through the channel of the fiberoptic bronchoscope to capture small, peripheral foreign objects. We present the case of a 76-year-old man in whom two aspirated teeth were removed from the right lower lobe (RB9a and RB9b) using the fiberoptic bronchoscope, a wire basket, and a Fogarty balloon catheter. Rigid tube bronchoscopy was contraindicated because the patient had just sustained a fractured skull and jaw in an automobile accident.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
9/9. Rapid evolution of a growing skull fracture after vacuum extraction in case of fetal hydrocephalus.vacuum extraction in nonprogressive labor is relatively safe. Only a few major complications have been mentioned. This article describes the rapid development of a growing skull fracture associated with a porencephalic cyst and parenchymal brain damage after a difficult vacuum extraction in a patient with congenital hydrocephalus and a thoracic meningomyelocele. The diagnostic and therapeutic management is discussed.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |