351/859. Traumatic orbital encephalocele. We describe a 39-year-old man in whom progressive pulsatile proptosis developed 2 days after he suffered a head injury. Computed tomography revealed an isolated blow-in fracture of the orbital roof with herniation of the left frontal lobe into the orbit. Neurosurgical intervention to repair the orbital defect led to full recovery. ( info) |
352/859. Late brain abscess years after severe cerebrocranial trauma with fronto-orbitobasal fracture. An 8-year-old boy suffered severe craniocerebral trauma with left-sided fronto-orbitobasal fracture. The CT scan showed minor subdural air inclusions. The child recovered well and had no clinical signs of aftereffects. Eight years after the accident, symptoms of intracranial pressure developed progressively with nuchal rigidity and elevated temperature. The CT showed an extensive left fronto-orbitobasal abscess. The intraoperative finding was a brain prolapse both into the frontal sinus and into the ethmoidal cavity with a large dura-bone defect at the site of the former fracture line, which was closed with refobacin-bone-meal fibrin sealant plasty and glued periostal patch. The postoperative course was unremarkable. Evidently, the accident had caused a brain prolapse into the bone defect, which prevented liquorrhea. Due to the lack of bone and dura barrier, a late brain abscess developed in the course of sinusitis. In such cases, primary surgical revision seems to be indicated. ( info) |
353/859. The fjord murders. The method used to locate the bodies of victims of a double murder and retrieve them from the bottom of the sea at a depth of 340 m is reviewed. ( info) |
354/859. Reversible visual loss due to impacted lateral orbital wall fractures. Impaction of the sharp medial edge of the orbital plate of the greater sphenoid wing into the orbital apex is a unique type of lateral orbital wall fracture that can produce a potentially reversible optic neuropathy. Two patients in whom the lateral or temporal approach to the orbit was used to reduce this type of fracture will be presented. In both patients, improvement in vision appeared to be related to removal of a bone fragment compressing the optic nerve in the orbital apex. ( info) |
| cholesteatoma can develop as a late complication of fracture of the temporal bone. The otologist must be wary of it since the growth of the cholesteatoma resulting from a temporal bone fracture can be undetected for years allowing for invasive and extensive growth. Three illustrative cases are presented. ( info) |
356/859. Growing skull fractures: progressive evolution of brain damage and effectiveness of surgical treatment. The growing skull fracture of childhood is a well-known but variously interpreted syndrome. Attempts have been made to find different pathogeneses for clinical and pathological patterns that are really successive phases of a single process, arising from the interaction of three basic conditions: (1) head injury with a large gaping fracture; (2) corresponding dural tear; (3) occurrence nearly always in infancy (the first year of life or period of maximum brain growth). This combination of factors alters the normal distribution of the intracranial pressure vectors and the fracture behaves like a "neosuture" with abnormal growth of the skull on the injured side. Simultaneously, the ventricular system tends to deform, dilating and shifting towards the side of the fracture. Three cases, successfully treated at a very late stage, are described. The good surgical results confirm the validity of the surgical method and its underlying theoretical basis. ( info) |
357/859. Growing fractures: an unusual complication of head injuries in pediatric patients. Authors analyze three cases of growing fractures they observed in infants under the age of one year. It is noticeable that in two cases, even if the lesion was already present when babies underwent the first procedure, no specific treatment was adopted, thus resulting in a progressive enlargement of the extracranial mass. Surgical treatment must be performed quickly after the diagnosis of growing fracture is done due to the necessity of an early repair of the bone defect to avoid the eventual onset of neurological deficits since they are not reversible. ( info) |
358/859. The trigeminal (V), an oft-neglected nerve. Corneal denervation is one of the most serious insults that can occur to an eye; disease symptoms can be suppressed, and epithelial breakdown is likely to occur. In the cases presented, failure to test corneal sensation delayed diagnosis and endangered the cornea. Conditions affecting the trigeminal sensory pathway, including those causing a pain-anesthesia paradox, are described. Corneal sensation must be tested in all instances of suspicious head pain or paresthesia, head trauma, cranial nerve defect, cranial autonomic dysfunction, or unexplained corneal epithelial defect. The trigeminal nerve is often neglected, but corneal anesthesia aids in the diagnosis of intracranial disease and dictates the need for corneal observation and protection. ( info) |
359/859. Combined orbito-frontal injuries. Our experiences in 55 patients suffering from orbitofrontal injuries are discussed. The prognosis is determined by the severity of the brain injuries and the cerebral complications. The relation of fronto-basal, orbital, and maxillofacial fractures to lesions of the brain tissue and contents of the orbita is best demonstrated in high-resolution CT scan. Surgery is usually possible in one interdisciplinary operating session. Penetrating injuries with CSF leakage primarily require operative therapy; indirect, open, frontobasal fractures should be covered secondarily within two weeks following trauma. A debridement of the paranasal sinuses is necessary if drainage is obstructed or infection is imminent. We found no improvement of visual function in eight patients following transethmoidal optic nerve decompression; the visus recovered only in one patient after removal of a bone fragment impressing on the eyeball. Typical complications are systematic or central nervous system infections; less frequent are traumatic cavernous-sinus fistulas and pneumato- or encephaloceles. ( info) |
360/859. Fetal skull fracture from an automobile accident. This is a case report of a fetal skull fracture that resulted in fetal death caused by a high-velocity automobile accident. As a 25-year old gravida 3, para 2, was pulling out of a driveway onto a highway, her car was struck in the left front end by a car traveling perpendicular to her vehicle. She died almost instantly from shock caused by massive injuries and internal hemorrhage. She had a fractured rib and multiple fractures of the pelvis as well as bilateral hemothorax and ruptured splenic and renal vessels. The fetus had depressed multiple skull fractures. The probable mechanism of fetal injury, as well as the influence of seat restraints on injury to the mother and fetus, are discussed. ( info) |