1/13. Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the united states seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, otolaryngology-head & neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
2/13. Simultaneous reconstruction of the area of the temporo-mandibular joint including the ramus of the mandible in a posttraumatic case. A case report.A new technique for the simultaneous reconstruction of the glenoid fossa and the ramus of the mandible is described. By combining and adapting procedures already described, the missing bone of the zygomatic arch, temporo-mandibular joint and ramus was replaced in one operation in a post-traumatic case. The indication for this operation is discussed. It is rather limited. The technique can be used for reconstruction of skeletal defects after tumour resection and in congenital aplasias of this region.- - - - - - - - - - ranking = 366.22534722222keywords = mandible (Clic here for more details about this article) |
3/13. A surgical treatment of severe late posttraumatic enophthalmos using sliced costal cartilage chip grafts.The efficacy of sliced costal cartilage chip grafts for the treatment of late posttraumatic enophthalmos was investigated. Surgery was conducted based on the method reported by Matsuo et al. in 1989. After making an incision in the lower eyelid, dissecting the subperiosteum of the medial orbital wall, orbital floor and lateral orbital wall was performed to the posterior of the orbit, and then costal cartilage chips were gradually grafted in a step-like configuration to the subperiosteum from a location posterior to the equatorial plane of the eyeball. At this time, as well as to the area of concave depression in the orbital bone caused by the fracture, grafts were made to the subperiosteum of the non-deformed medial and lateral orbital wall, to move all of the orbital tissue, including the eyeball, forward. This was performed for five cases of severe late posttraumatic enophthalmos. Among the five cases, there were four cases of severe orbital fracture and one case for which malignant orbital tumor extirpation and radiation therapy had been performed. Following surgery, although mild enophthalmos remained in three of the five cases, esthetically satisfactory results were obtained for all cases. Costal cartilage chip grafts were shown to be an effective method for the treatment of late posttraumatic enophthalmos.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
4/13. Treatment of 813 zygoma-lateral orbital complex fractures. New aspects.A 10-year experience with surgical treatment of 813 zygomalateral orbital complex fractures is reviewed. Regardless of the type or severity of the fracture pattern, concomitant fractures of the orbital floor and rim were approached exclusively through the transconjunctival approach without a lateral canthotomy. The advantages of this approach compared with the subciliary access are the avoidance of a visible scar and markedly reduced incidence of postoperative lower eyelid complications such as ectropion and edema. Implants of lyophilized dura or cartilage and autogenous bone were used to reconstruct orbital floor defects. Malar asymmetry is a frequent complication of zygoma fractures resulting from inadequate three-dimensional reduction. methods for accurate reduction and stabilization, indications for closed and open reduction, and management of the fractured infraorbital rim are emphasized. The indications for miniplates vs wire ligatures for the infraorbital rim are discussed. Long-term follow up and evaluation of the results with regard to the fracture pattern, complications, maxillary sinus dysfunction, and facial and orbital symmetry are presented.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
5/13. carotid-cavernous sinus fistula accompanying facial trauma. Report of a case with a review of the literature.A case of traumatic carotid-cavernous sinus fistula, an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus, complicating fractures of the zygoma and mandible is described. Typical signs and symptoms appeared immediately after the injury resulting from a traffic accident. angiography revealed a definite CCSF and a balloon embolization was performed with a good result. The importance of a multidisciplinary examination of the ophthalmic function and periorbital condition following trauma is emphasized, and interdepartmental cooperation helped to establish a rational diagnosis and obtain a good result.- - - - - - - - - - ranking = 73.245069444444keywords = mandible (Clic here for more details about this article) |
6/13. Some interesting complications of a malar bone fracture.A case is described of the treatment of a malar bone fracture which was complicated by the development of a lower eyelid abscess, dehiscence and discharge from the temporal wound and prolapse of necrotic temporal fascia.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
7/13. The vertical avulsion flap.Unilateral vertical tangential maxillofacial trauma may result in a combination of a certain number of charcteristic lesions. Although composed of wounds and fractures in the upper, middle and lower third of the face, this form of injury can be considered to be a separate distinct entity. Two patients are described, illustrating this type of injury. Both also sustained trauma of the ipsilateral shoulder.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
8/13. Extra-articular fibrous ankylosis of the mandible after zygomatic fracture.Zygomatico-coronoid fibrous ankylosis of the mandible is a complication which rarely occurs if fractures of the middle third of the facial skeleton have been adequately treated. 379 zygomatic fractures in hospitalized patients were treated at the Department of jaw Surgery of the Surgical Hospital in Helsinki between 1969 and 1975. 36 cases were characterized by convalescence being complicated by significant restriction of jaw opening. 25 patients were successfully treated by physiotherapy and 6 other by a forced opening of the jaws under general anaesthesia. In the remaining 5 cases 91.3% of the fractures) the clinically verified fibrous extra-articular ankylosis was resistant to the above mentioned conservative methods and was treated instead by intraoral coronoidectomy, supplemented in one instance by a partial myotomy of the affected masseter muscle. The importance of prophylactic physiotherapy is stressed and applies to both the post-accident and the post-corrective-operation period.- - - - - - - - - - ranking = 366.22534722222keywords = mandible (Clic here for more details about this article) |
9/13. Complex maxillofacial fractures: management and surgical procedures.Complex maxillofacial fractures may be defined as combined, mixed, or unclassified. Adequate diagnostic technics must be used with the formulation of a plan for general management and sequential maxillofacial surgery. The basic principal of building from the stable mandible to the first superior stable bone must be adhered to. Exploration of all fracture sites with direct reduction and fixation is the most satisfactory technic for best cosmetic and functional results. The maxillary buccal vestibule incision in midfacial fractures provides exploration of the lateral walls of the maxilla, nasal aperture, zygomatic buttress, maxillary tuberosity and pterygoid area, maxillary antrum and roof (or orbital floor), and infraorbital rim. The extent of the injury can be determined and direct reduction and fixation obtained. Additional approaches for reduction and internal stabilization are used according to the findings. When direct wiring technics are inadequate, internal and external skeletal fixation must be used.- - - - - - - - - - ranking = 73.245069444444keywords = mandible (Clic here for more details about this article) |
10/13. Malar/orbital/zygomatic fracture causing fracture of underlying coronoid process.In 1 week two patients with depressed fractures of the malar/orbital/zygomatic complex presented with roentgen evidence of fractures of the underlying coronoid process caused by the transmitted impact of the malar/orbital/zygomatic fragment without direct injury to the mandible. No similar cases had been seen in the previous 12 years, and reports found in the literature stated that this type of fracture occurs in only about 2% of all mandible fractures. Conservative treatment is recommended unless there is obvious displacement.- - - - - - - - - - ranking = 146.49013888889keywords = mandible (Clic here for more details about this article) |
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